Tetanus, Diphtheria and Pertussis: A Pediatrician Explains the Risks and Prevention

A Q&A with Le Bonheur Pediatrics Physician Dr. Margo Saharovici

What do tetanus, diphtheria and whooping cough have in common, and why should parents still be thinking about diseases that many assume are “a thing of the past”? In a recent Q&A, Dr. Margo Saharovici of Le Bonheur Pediatrics breaks down these serious, sometimes life-threatening illnesses and the critical role immunizations play in protecting children.

Tetanus

What is tetanus?

Tetanus is a life-threatening neuromuscular syndrome caused by the toxin producing bacteria Clostridium tetani, which is a spore-forming bacteria found in soil and dust. It can also be present on the teeth and paws, as well as in the feces of animals.

How can a child get tetanus?

Tetanus is not spread from person to person. Instead, the bacteria enter the body through breaks in the skin, such as puncture or animal bite wounds, cuts or lacerations. In newborns, infection can occur through the umbilical stump after cutting.

How does it affect a child’s body?

Tetanus is due to a toxin that causes painful muscle spasms all over the body. This can lead to lockjaw, difficulty swallowing, and difficulty breathing.

Is it more severe in children?

Tetanus is most severe in newborns, and the risk of death is especially high among infants and young children.

Can you prevent tetanus?

Yes, with a five-dose DTaP immunization series in infancy and childhood and a Tdap booster at 11-12 years of age and every 10 years thereafter. If you have a cut or an animal bite, your doctor will check your immunization status and may recommend a booster at that time if it has been more than 5 years since your last Tdap vaccine.

Diphtheria

What is diphtheria?

Diphtheria is caused by a toxin producing bacteria called Corynebacterium diphtheriae. It affects the nose and throat, skin or other mucous membranes.

How can a child get diphtheria?

Diphtheria is primarily spread through droplets when an infected person coughs or sneezes. A child can also become infected through close contact with someone who has the disease or by touching contaminated surfaces and then touching their mouth or nose.

How does it affect a child’s body?

Diphtheria causes sore throat, low-grade fever, a gray-white coating (membrane) of the back of the throat, significant swelling of the neck caused by enlarged lymph nodes and soft tissue inflammation and airway blockage. Toxins from the bacteria can also cause inflammation of the heart, kidney failure and neuropathy.

How severe is the disease?

It is most severe in young children and can lead to death due to blockage of the breathing tube by the thick membrane.

How can you prevent diphtheria?

A five-dose DTaP immunization series in infancy and childhood and a Tdap booster at 11-12 years of age and every 10 years thereafter can prevent diphtheria. If your child has come into contact with someone who has a known diphtheria diagnosis, your pediatrician will most likely prescribe a preventative dose of antibiotics.

Pertussis (Whooping Cough)

What is whooping cough?

Whooping cough is a very contagious respiratory infection caused by the bacteria Bordetella pertussis. It is distinguishable from other coughs by its severe, uncontrollable coughing fits followed by a "whooping" sound when gasping for air.

How can a child get whooping cough?

Whooping cough is spread via respiratory droplets from infected persons, and older children and adults with declining immunity are a major transmission source to babies. It is one of the most contagious diseases that can be prevented by immunization.

Is this disease severe for children?

Whooping cough is very serious for all children, especially young children and newborns. Infants younger than 2 months old may present with apnea, a pause in breathing, without the classic cough. It can be a life-threatening infection.

How can you prevent whooping cough?

Whooping cough is prevented with a five-dose DTaP immunization series in infancy and childhood and a Tdap booster at 11-12 years of age and every 10 years thereafter. Initially, the immunization against whooping cough is highly effective, but protection can diminish over time, which is why boosters are recommended.

DTaP/Tdap Immunizations

How many doses are required for this immunization, and at what ages?

The American Academy of Pediatrics (AAP) recommends the DTaP immunization for children younger than 7 years old, while the Tdap immunization is an adolescent and adult booster.

The schedule is as follows:

• DTaP:
  • Primary Series (three doses): Given at 2 months, 4 months and 6 months
  • Toddler Booster (one dose): Given between 15 and 18 months
  • Kindergarten Booster (one dose): Given between 4 and 6 years old.
• Tdap:
  • A single dose is recommended at age 11 to 12 years, but it can be given anytime between ages 11 and 18 if missed.
  • Anyone 19 or older should get a Tdap booster every 10 years.
  • Pregnant women should receive a Tdap booster ideally in their third trimester so they can pass on pertussis antibodies to their newborn child.
  • Other family members and individuals who will be around the baby should also receive Tdap before the baby is born to provide a “cocoon” of protection.

Does immunization prevent these diseases?

This immunization series provides excellent protection against tetanus, diphtheria, and pertussis when the series is completed and boosters are maintained. Protection may decrease against pertussis more rapidly than that for tetanus and diphtheria, before a booster is due, which is why it is recommended for pregnant women and families to make sure vulnerable newborns are protected.

How safe is the immunization? Any side effects?

DTaP/Tdap immunizations are considered very safe, with the majority of side effects being mild and resolved within a few days. These include injection site redness/swelling, fussiness and fever.