Immunization : Pertussis, Diphtheria, Tetanus, Polio and Infant Haemophilus type B (cPDT Polio + Hib) Vaccine

Vaccines (or needles or baby shots) are the best way to protect against some very serious infections. The Canadian Paediatric Society and the National Advisory Committee on Immunization strongly recommend routine immunization.

cPDT Polio + Hib is a five in one needle. "cP" stands for "component pertussis" which is also known as "acellular pertussis" or "aP". Therefore, sometimes this combination vaccine is referred to as "DTaP Polio + Hib". It protects children against pertussis, diphtheria, tetanus, polio and serious diseases like meningitis caused by the Hib (Haemophilus influenzae type b) germ. cPDT Polio and Hib are also available as separate needles. Vaccination against diphtheria, tetanus and polio is required by law for all children attending school in Ontario (unless exempted).

Pertussis or whooping cough is a serious disease especially in children. Children who get this disease have spells of violent coughing. This cough can cause them to vomit or stop breathing for a short period of time. The cough can last for weeks and make it hard for a child to eat, drink or even breathe. Pertussis can cause serious complications. Pneumonia can occur in more than two out of 10 children with pertussis. Pertussis can also cause brain damage, seizures and death. These problems happen most often in babies. Pertussis spreads very easily from an infected person to others through coughing or sneezing.

Diphtheria is a serious disease of the nose, throat and skin. It causes sore throat, fever and chills. It can be complicated by breathing problems, heart failure and nerve damage. Diphtheria kills about one out of every 10 people who get the disease. It is most often passed to others through coughing and sneezing.

Tetanus or lockjaw is a serious disease that can happen if dirt with the tetanus germ gets into a cut in the skin. Tetanus germs are found everywhere, usually in soil, dust, and manure. It does not spread from person to person. Tetanus causes cramping of the muscles in the neck, arms, leg and stomach and painful convulsions which can be severe enough to break bones. Even with early treatment, tetanus kills two out of every 10 people who get it.

Polio is a serious disease that people can get from drinking water or eating food with the polio germ in it. It can also be spread from person to person. This disease can cause nerve damage and paralyze a person for life. It can paralyze muscles used for breathing, talking, eating and walking. It can also cause death.

Even though "influenzae" is a part of its name, the Hib germ does not cause influenza. Hib infections are much more serious.

Before the Hib vaccine was used, the Hib germ was a common cause of serious infections in children. Hib was the most common cause of bacterial meningitis in children two months to five years of age. Meningitis is a serious infection of the fluid and lining that covers the spinal cord. Meningitis can cause brain damage, learning and developmental problems, deafness, blindness. One out of 20 children with meningitis can die and serious disability (nerve damage, deafness) occurs in about 15 per cent.

The Hib germ also causes a serious infection of the throat near the voice box. This infection is called epiglottitis. This can make it difficult for the child to breathe. The Hib germ can also cause infection of the lungs (pneumonia) and bone and joint infections.

Children under five years are more likely to get Hib disease. Children who attend childcare centres are even more likely to catch it. The Hib germ spreads to others through coughing and sneezing.

When cPDT Polio + Hib vaccine is given in the recommended number of shots, it protects 85 per cent of children against pertussis, over 95 per cent of children against diphtheria, virtually 100 per cent of children against tetanus, 99 per cent of children against polio and around 95 per cent of children against serious Hib infections. It will not prevent meningitis caused by other germs. Vaccination also makes these diseases milder for those who may catch them.

Your child should have the first needle at two months of age. Three more needles are needed - at four months, six months and 18 months of age.

cPDT Polio vaccine (without the Hib vaccine) is also given before starting kindergarten or school. A booster needle against tetanus, diphtheria and polio is then given around the 15th birthday. After this needle, booster doses against tetanus and diphtheria are required every 10 years for continued protection.

Your child should get the next needle as soon as possible. Your doctor will tell you when to come back for the other needles. If your child did not get the first needle at two months of age, your doctor will recommend a special "catch-up" schedule.

Children between 15 months and five years of age who have never been vaccinated will need one needle of the combined cPDT Polio + Hib vaccine and then additional doses of cPDT Polio vaccine.

Children five years of age and over do not require Hib vaccine so only cPDT Polio will be used for primary immunization of this age group. Your doctor will advise you about the required needles.

Yes. Serious side effects are rare. Mild pain, swelling and redness for a few days are common at the spot where the needle was given. Some children get a fever, rash, lose their appetite or are fussy or drowsy for a day or two after the needle.

Your doctor may suggest that you give your child a medicine called acetaminophen to prevent pain and fever.

An extremely rare side effect, which occurred in about one out of every million children who received the pertussis vaccine used before July 1997, (called "whole cell" pertussis vaccine) was encephalopathy. Encephalopathy, (irritation of the brain or the covering of the brain), results in a range of symptoms which may include headaches, stiff neck, changes in behaviour, confusion or irritability, or speech disturbances. Those who had this side effect recovered completely, in a short period of time, with no permanent damage.

This newer vaccine (component pertussis vaccine-cP) causes even fewer of the minor reactions and chances of brain irritation following this vaccine remain extremely rare. The benefits of this vaccine are much greater than the risks.

There is no risk of a pregnant woman or anyone else catching any disease from a child who has been vaccinated recently. You should always discuss the benefits and risks of any vaccine with your doctor.

Call your doctor if your child has any of the following within three days of getting the needle :

• high fever (over 40 C or 104 F);
• crying for more than three hours;
• convulsions or seizures;
• very pale colour and serious drowsiness;
• hives;
• swelling of the face or mouth;
• trouble breathing;
• other serious problems.

The doctor may decide not to give your child's needle or may give a different vaccine if your child has :

• a high fever or serious infection worse than a cold;
• a severe allergy to an antibiotic called neomycin or polymyxin B;
• a serious allergic reaction (anaphylaxis) to cPDT Polio + Hib vaccine;
• a severe allergy to any component of the vaccine.

Talk to your doctor or call your local public health unit for more information.

After your child receives any immunization, make sure the doctor updates the yellow personal Immunization Record card. You will need to provide this information to your local health unit when your child enters school. Keep it in a safe place !

March 2002