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DPT (also DTP and DTwP) is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and killed whole cells of the bacterium that causes pertussis (wP).
Also available are the DT and Td vaccines, which lack the pertussis component.
In the United Kingdom, the Netherlands and France, the abbreviation DTP refers to a combination vaccine against diphtheria, tetanus, and poliomyelitis. In the Netherlands, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, kinkhoest, tetanus, and polio.
The usual course of childhood immunization in the USA is five doses between 2 months and 15 years. For adults, Td boosters are recommended every 10 years.
In the latter 20th century, vaccinations helped to reduce the incidence of childhood pertussis in the United States. Despite this, reported instances of the disease increased twenty-fold in the early 21st century, resulting in numerous fatalities. Over this time, many parents declined to vaccinate their children against pertussis for fear of side effects. In 2009, the journal Pediatrics concluded the largest risk among unvaccinated children was not the contraction of side effects, but rather the disease that the vaccination aims to protect against.
DTP was licensed in 1949.
Combination vaccines with acellular pertussis
DTaP and Tdap are both combined vaccines against diphtheria, tetanus, and pertussis. The difference is in the dosage, with the upper case letters meaning higher quantity. The names are easy to confuse, and the Institute for Safe Medication Practices reports hundreds of cases of accidental mix-ups.
DTaP (also DTPa and TDaP) is a combined vaccine against diphtheria, tetanus, and pertussis, in which the pertussis component is acellular. This is in contrast to whole-cell, inactivated DTP (aka DTwP). The acellular vaccine uses selected antigens of the pertussis pathogen to induce immunity. Because it uses fewer antigens than the whole cell vaccines, it is considered safer, but it is also more expensive. Recent research suggests that the DTP vaccine is more effective than DTaP in conferring immunity; this is because DTaP's narrower antigen base is less effective against current pathogen strains.
Also dTpa, is a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) was licensed in the United States for use in adults and adolescents on June 10, 2005. The lower case "d" and "p" indicated smaller concentrations of diphtheria toxoids and pertussis antigens, and "a" in "ap" indicates that the pertussis toxoids are acellular. Two Tdap vaccines are available in the U.S. Adacel, manufactured by Sanofi Pasteur, is licensed for use in adults ages 11 to 64. Boostrix, manufactured by GlaxoSmithKline, is licensed for use in adolescents and adults ages 10 to 64. In January 2011, the U.S.'s Advisory Committee on Immunization Practices (ACIP) recommended Tdap's use in adults of all ages, including those age 65 and above.  In October 2011, in an effort to reduce the burden of pertussis in infants, the ACIP recommended that unvaccinated pregnant women receive a dose of Tdap. On October 24, 2012, the ACIP voted to recommend use of Tdap during every pregnancy.
The U.S.'s Advisory Committee on Immunization Practices (ACIP) and Canada's National Advisory Committee on Immunization (NACI) recommended that both adolescents and adults receive Tdap in place of their next Td booster (recommended to be given every 10 years). Tdap and Td can be used as prophylaxis for tetanus in wound management. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than 5 years since Td or TT to reduce the risk of infants being exposed to pertussis. The ACIP statement on Tdap use in adolescents encourages 5 years between Td and Tdap to reduce the risk of side effects; however, both suggest that shorter intervals may be appropriate in some circumstances, such as for protection in pertussis outbreaks. NACI suggests intervals shorter than 5 years can be used for catch-up programs and other instances where programmatic concerns make 5-year intervals difficult.
There were several mix-ups between Daptacel and Adacel. Daptacel is for active immunization in infants and children 6 weeks to 6 years old. Adacel is indicated for active booster immunization as a single dose in persons 11 to 64 years old and is the first vaccine approved as a pertussis booster for adults. The component antigens in Adacel and Daptacel are the same, but the relative amounts are much greater with the infant vaccination.
In one clinic, 13 adults were vaccinated with Daptacel in error. At another clinic, seven adults received Daptacel instead of Adacel. None of the patients appeared to have experienced any unusual vaccine reactions despite the fact that the pediatric formulation contains greater amounts of the detoxified pertussis toxin and diphtheria toxoid. The similarities of the brand names, generic designations, and vaccine abbreviations (Tdap and DTaP) were felt to have contributed to the confusion.
The World Health Organization recommends a pentavalent vaccine, combining the DTP vaccine with vaccines against Haemophilus influenzae type B and hepatitis B. There is not yet sufficient evidence on how effective this pentavalent vaccine is compared to the individual vaccines.
Guidelines on prenatal care in the United States state that, if an urgent need for tetanus protection occurs during pregnancy, Td vaccine should be administered. If no urgent need arises and the woman has previously received tetanus vaccine, Td vaccination should be delayed until the postpartum period. All postpartum women who have not received Td or Tdap vaccine in the last two years are recommended to receive Tdap prior to discharge after delivery. It is recommended for pregnant women who have never received tetanus vaccine (i.e., have never received DTP, DTaP or DT as child or Td or TT as adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus. In such cases, administration of Tdap is recommended after 20 weeks' gestation, and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td. The United States Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend that health-care personnel should administer a dose of Tdap during each pregnancy at 27 through 36 weeks gestation irrespective of the patient's prior history of receiving Tdap.
Purported non-specific effects
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A systematic review was recently completed on this topic so as to compile and rate all of the available evidence. This review showed that receipt of DTP had no significant non-specific effect on all-cause mortality (relative risk 1.38, 0.92 to 2.08). In addition, it showed that many of the studies reporting on this topic were at a high risk of bias. The WHO has recommended that further studies, which are well designed and reflect current vaccine schedules, be carried out on this topic.
DTP vaccine seem to have negative non-specific effects on survival rate of children in high-mortality countries in Africa and Asia The negative effects are seen as long as DTP vaccine is the most recent vaccine. BCG or measles vaccine given after DTP reverses the negative effects of DTP. The negative effects are seen mostly in females.
The negative effects are found in several observational studies. However, six WHO-commissioned studies concluded that there were strong beneficial effects of DTP on overall mortality. However, controversy ensued as to the design of these studies that had important methodological shortcomings. Among others, the WHO-commissioned studies had counted “no information about vaccination” as “unvaccinated”, and they had retrospectively updated vaccine information from surviving children, while no similar update could be made for dead children, creating a so-called “survival bias” which will always produce highly beneficial effect estimates for the most recent vaccine.
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