DTwP (Whole-Cell Pertussis) Has the Highest Incidence of Fever
Among the components listed in Quadravac vaccine, the DTwP (whole-cell pertussis) booster has significantly higher fever incidence compared to all other components, including DtaP, OPV, IPV, and Hib.
Evidence-Based Comparison of Fever Rates
DTwP vs. DtaP Fever Incidence
The whole-cell pertussis component is the primary driver of fever in combination vaccines:
- DTwP causes fever in 52-90% of recipients, while DtaP causes fever in only 9.6-52% of recipients, representing a substantial reduction 1, 2
- The ACIP explicitly states that "mild systemic reactions such as fever, drowsiness, fretfulness, and anorexia occur frequently" after whole-cell DTP vaccination and are "substantially more common following the administration of DTP than of DT" 3
- Fever occurs approximately 2-3 times more frequently with DTwP compared to DtaP across multiple studies 2, 4, 5
Specific Temperature Thresholds
The difference becomes even more pronounced at higher temperatures:
- High fever ≥40.5°C (≥105°F) occurs more frequently with DTwP than with DtaP 3
- In one comparative study, 29.4% of DTwP recipients developed fever >38°C versus only 9.6% of 3-component DTaP recipients (p<0.02) 2
- Another study showed 90% fever incidence in DTwP recipients compared to 52% in DTaP recipients (p<0.001) 1
Other Components Have Minimal Fever Risk
The non-pertussis components contribute negligibly to fever:
- OPV and IPV are not associated with significant fever as standalone vaccines 3
- Hib conjugate vaccine can be administered simultaneously without substantially increasing fever rates beyond what the pertussis component causes 3
- Diphtheria and tetanus toxoids alone (DT) cause substantially less fever than when combined with whole-cell pertussis 3
Clinical Implications
Timing and Management
- Fever typically begins 6-12 hours after DTwP vaccination and peaks within the first 24 hours 6, 7
- Fever persisting >24 hours or beginning ≥24 hours post-vaccination should NOT be attributed to the vaccine and requires evaluation for other causes such as otitis media or meningitis 3, 6
- Acetaminophen 10-15 mg/kg every 4-6 hours can be used for symptomatic management, with prophylactic use reserved only for children with seizure history 6, 8
Important Caveats
- The frequency of fever increases with successive doses of DTwP, with the fourth and fifth doses causing more fever than earlier doses 3
- Temperature ≥40.5°C (≥105°F) within 48 hours is a precaution for future pertussis vaccination but not an absolute contraindication 3, 8
- Because DTaP causes fever less frequently than DTwP, febrile seizures are anticipated to be less common after DTaP 3