What are the contraindications to the Diphtheria, Pertussis, and Tetanus (DPT) vaccine?

Contraindications to the Diphtheria, Pertussis, and Tetanus (DPT) Vaccine

The absolute contraindications to DPT vaccine are severe allergic reaction (anaphylaxis) to a previous dose or vaccine component, encephalopathy within 7 days of a previous pertussis-containing vaccine, and progressive neurologic disorders. 1

Absolute Contraindications

• Severe allergic reaction (anaphylaxis) after a previous dose of any diphtheria toxoid-, tetanus toxoid-, or pertussis-containing vaccine, or to any component of the vaccine 1

  • Patients with history of anaphylaxis should be referred to an allergist to determine if they have a specific allergy to tetanus toxoid and can be desensitized to tetanus toxoid 2

• Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) within 7 days of administration of a previous dose of a pertussis-containing vaccine that is not attributable to another identifiable cause 1

  • In such cases, DT vaccine should be administered for the remaining doses in the vaccination schedule to ensure protection against diphtheria and tetanus 2

• Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, or progressive encephalopathy 1

  • Pertussis vaccine should not be administered to individuals with these conditions until a treatment regimen has been established and the condition has stabilized 1

Precautions (Not Absolute Contraindications)

These conditions require careful risk-benefit assessment before administering DPT:

• Guillain-Barré syndrome within 6 weeks after a previous dose of tetanus toxoid-containing vaccine 2

  • If decision is made to continue tetanus toxoid immunization, Tdap is preferred if otherwise indicated 2

• Temperature of ≥40.5°C (105°F) within 48 hours after a previous dose of DTP/DTaP not due to another identifiable cause 2

• Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP 2

• Persistent, inconsolable crying lasting ≥3 hours within 48 hours after receiving a previous dose of DTP/DTaP 2

• Seizures with or without fever occurring within 3 days after receiving a previous dose of DTP/DTaP 2

• History of Arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria toxoid-containing vaccines; defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccine 2

• Moderate or severe acute illness with or without fever 2

Special Considerations

For children at higher risk for seizures than the general population:

• An appropriate antipyretic (acetaminophen 15 mg/kg) may be administered at the time of vaccination and every 4 hours for 24 hours to reduce the possibility of post-vaccination fever 3, 1

Conditions That Are NOT Contraindications

The following are commonly misperceived as contraindications but are NOT reasons to avoid DPT vaccination:

• Mild acute illness with or without fever 2
• Mild-to-moderate local reaction or low-grade fever after previous dose 2
• Current antimicrobial therapy 2
• Convalescent phase of illness 2
• Preterm birth 2
• Recent exposure to an infectious disease 2
• History of allergies other than anaphylaxis to vaccine components (including penicillin allergy) 2
• Family history of seizures, sudden infant death syndrome, or adverse events after DTP/DTaP 2
• Stable neurologic conditions (e.g., cerebral palsy, well-controlled seizures, developmental delay) 2

Clinical Decision Algorithm

1. Assess for absolute contraindications:

   • If present → Do not administer pertussis-containing vaccine; use DT instead for children or Td for older individuals
   • If absent → Proceed to next step

2. Assess for precautions:

   • If present → Evaluate risk-benefit ratio
   • If benefits outweigh risks → Administer vaccine
   • If risks outweigh benefits → Use alternative vaccine (DT/Td)

3. For patients with history of seizures or at high risk:

   • Consider prophylactic acetaminophen (15 mg/kg) at time of vaccination and every 4 hours for 24 hours 3

Remember that proper assessment of contraindications is essential to balance the benefits of protection against these serious diseases with the risks of adverse reactions in individual patients.