Diphtheria Vaccine

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Diphtheria Vaccine Infection Control
???
??.(?????)??????????? ?????????????? ????????????
?????? 11, ????????????????????????????????? ?????
?????? ????????????????
2
???????????????????????????????????????

1. ??????????????????????? (passive immunization)
   ???? ??????????????? Diphtheria
   antitoxin(DAT),Tetanus antitoxin (TAT),Hepatitis
   B immunoglobulin(HBIG),etc.
2. ????????????????????????????????? (active
   immunization) ???? ??????????????????

3
???????????????

1. ??????????????? (Toxoid) ?????????????????????????
   ???? ?????????????????????????????????????????
   ???? ????? ????????
2. ?????????????? (Killed vaccine)
   ??????????????????????????????????????????????????
   ???? ????? ????????????? ???
3. ???????????????????????? (live attenuated
   vaccine) ?????????????????????????????? ?????????
   ?????????????? ???? ???-??????????-??????

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???????????????? DTP Vaccine

• ???? Diphtheria toxoid Tetanus toxoid
  inactivate whole all pertussis vaccine
  ????????????? ??.1920
• ??????????????? ??.1930, ???????????? 70-90
• ???.?.1991 ???????????????????????????????????????
  ?????????????? DTaP
• ???.?.2005 ???????????????????????????????????-
  Tdap

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Components of Toxoid in Various Vaccines
Vaccines D (Lf.) T (Lf.) P (whole)
DTP 7-30 10 20,000 mil. DT 7-30 10 - dT
2 10 - Tetanus toxoid - 10 -
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?????????? (D,T,P)???????????????
?????????? ?????????? ????????????
DTP 2?.- 6 ?? ???????(????????????????)
? DTaP 2?.- 6 ?? ???????(???????????????)
? DT 2?.- 6 ?? ???????(??????? wP ??????)
? Td 7???????? ??????? (booster) ??? 10 ??
? Tdap 7???????? ??????? (booster)??????????
???????? - ??????????????/ ????????? ?????? Td 0,1-2,6-12 ?????(3 ????) - ???????????? ??????????? 64 ???????? Tdap ??? Td (1 ?????) ???????? - ??????????????/ ????????? ?????? Td 0,1-2,6-12 ?????(3 ????) - ???????????? ??????????? 64 ???????? Tdap ??? Td (1 ?????) ???????? - ??????????????/ ????????? ?????? Td 0,1-2,6-12 ?????(3 ????) - ???????????? ??????????? 64 ???????? Tdap ??? Td (1 ?????)
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?????????????? Td
DPT ??????? ??????? 4-6 ?? Td ???????????????
11-12 ?? (????????????? 16 ??) Td ???????? 10
?? ?????????????????? 10 ?? ?????????????????????
??? ???????????? ( Arthus-liked reaction)
( Red Book 2003 P 616 )
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??????????????????? DTaP or Td/Tdap

• ??????????? 5 ???? (2, 4, 6, 15-18 ?, 4-6 ??)
• ?????????????? - Diphtheria antitoxin
  95
• - Tetanus antitoxin 100
• - ??? booster Td ??? 10 ?? ????? waning ab.
• - Pertussis Vaccine efficacy 80-85
• ( ???????????? whole all Pertussis Vaccine ?? )

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DAT Level for Protection

• DAT lt0.01 IU/ml no protection
• DAT 0.01-0.1 IU/ml partial protection
• DAT gt0.1 IU/ml full protection
• DAT gt1.0 IU/ml long term protection
• (several years)

( N Emgl J Med 1954 251 459-66. )
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???????????? Td ??????????????????????????
?????? Diphtheria

• ??????????? ?????????????????????????????????????
  1
• ??????????????????? ??? booster Td ??? 10 ??
  ??????????????????????????????????????????????????
  ???????????? ????????????????????????????????2
• ??????????????????? ?????? Td vaccine ????? 1
  ?????????????, ?????? 2 ??????????????

1 Eur J Epidimiol 1995 11 107-17. 2 Eur J
Epidimiol 1995 11 95-105.
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Immunogenicity of Tetanus-Diphtheria Toxoids (Td)
among Ukrainian Adults Implications for
Diphtheria Control
(Sutter RW.JID2000181(Suppl1)S197-202.)
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?????????????? Td. vaccine

• ???????? ??? ???????????? ?????? ????????????
  ?????????????????????????
• ?????????????????? (Arthus-like reaction)
  ???????????? ??????????????????????????????????
  2-8 ??.??????? ???????????????????????????????????
  ??? Tetanus ??? Diphtheria ?????? ??????????????
  ?????? booster ???????? 10 ??

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????????????????????????????????
??????????????????????????????????? ?.?. 2555 (3)

• DTwP ???? DTaP
• DTaP ?????????????????????? 3 ?????????? 2, 4, 6
  ????? (??????????? ?????????)
• DTaP ??????????? ??????? 18 ?????
• DTwP, DTaP, Tdap ?????????????????? 4-6 ??
• dT ??? 10 ?? ???????????????????
• (????????? Tdap ??? dT ??? 1 ?????)

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Td / Tdap Vaccination, 2011 (USA)

• ?????? Tdap ??????????????? (booster) ??????????
  4-6 ??(???) ???? 10-12 ??
• ??????????? 19 - lt 65 ?? (???????????? Tdap
  ??????)
• - ???????????????????????
• - ??????????????????????????? lt12 ????? ( ????
  ??? ??? ?? ??? ???
• ???????????- ?????????)
• - ????????????????????????????????
• ??????????? gt 65 ?? ???????????????????????? lt12
  ????? ???????? ? ????????????)

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Composition of Tdap in Adacel and Boostrix
Component Adacel Boostrix
Tetanus toxoid 5 Lf 5 Lf
Diphtheria toxoid 2 Lf 2.5 Lf
Pertussis components - PT - FHA - Pertactin (PRN) - Fimbrial agglutinogen 2, 3 2.5 µg 5 µg 3 µg 5 µg 8 µg 8 µg 2.5 µg -
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Infection Control for Diphtheria
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??????? Infection Control

• Standard precautions
• Transmission-based precautions droplet, contact,
  airborne
• Respiratory hygiene/cough etiquette

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??????? Standard Precautions

• ????????? HCW ?????
• ????????????? ?????????????????????????????????
• ?????????????????? ??????????????????????????????
  ?????????????????

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????????????? Standard Precautions

• ??????????
• ?????? Personal protective equipments (PPE)
• ???????????????????????????????? ??????????
  ???????? ??????????
• ??????????????????? ???? ??????????
• ?????????????????????????????
• ????????????

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???????????????????????? ?? Standard Precautions

• Normal hand washing - ????????????????? 10 ??????
• Hygienic hand washing - ???? antiseptic soap
  ??? 30 ??????
• Surgical hand washing ???? antiseptic soap
  ??? 3-5 ????

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?????????????? Alcohol gel ?? Standard Precautions

• ????????? alcohol gel ??? 10 ??????
• ???????? - ?????
• - ???????
• ???????????????????? ???????????
  ????????????????????????? alcohol gel

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Infection Control Recommendations

• Standard precautions
• Transmission-based precautions droplet, contact,
  airborne
• Respiratory hygiene/cough etiquette

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Transmission-BasedMode of Transmission

• Droplet transmission
• Contact transmission
• Airborne transmission

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?????????? Droplet Transmission

• ?????????????????????????????? RT infection
• ???????????? gt 5 microns
• ?????????????? ??? ??? ???
• ????????????????? ???????????????? 3 ???
• ???????????????-????????? ???????????????

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????????????? Droplet Precautions

• Standard and droplet precautions
  ???????????????????? HCW ?????
• ?????????????? ???? cohorting
• ??? Surgical mask
• ??? Eye protection
• ???????????????????????????? ??? surgical mask

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Droplet Precautions apply to

• SARS
• Influenza, Avian Influenza
• Mumps
• Neisseria meningitidis (invasive)
• Pertussis
• Diphtheria
• Plague (pneumonic)
• Parvovirus B19

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Transmission-BasedMode of Transmission

• Droplet transmission
• Contact transmission
• Airborne transmission

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?????????? Contact Transmission

• ??????????????????????
• ????????????? ?????????????????? ??????????
  ?????????????? ?????? ???
• ??????????????? ???? ??? ?????????

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????????????? Contact Precautions

• ???????????? ??????????
• Gown
• ???????????????????????????????????????
• ????????????????????
• ???????????????????????????
• ??????????????????? ???? cohorting

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• Contact Transmission
• Multidrug-resistant bacteria MRSA, VRSA, VRE
• Ebola, Lassa, Marburg
• SARS
• Cutaneous Anthrax
• Enteroviruses, EV71
• RSV
• Human Herpesvirus 8, Human Herpesvirus 6
• E. coli O 157H7 and other shiga toxin-producing
• Shigella
• Clostridium difficile

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Transmission-Based Mode of Transmission

• Droplet transmission
• Contact transmission
• Airborne transmission

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?????????? Airborne Transmission

• ???????? lt 5 ? ??????????????????
  ???????????????????????
• ??????????????????????
• ??????????????????????????????????????????????????
  ???????????????????????????????

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Airborne Precautions apply to

• Anthrax (aerozolized spore containing powder)
• Avian influenza , other Influenza (some
  occasion)
• Disseminated Herpes zoster
• Varicella
• Monkeypox (until Smallpox is exclude)
• Measles
• Smallpox
• SARS
• M.tuberculosis pulmonary, laryngeal,
  extrapulmonary with draining
• Viral hemorrhagic fevers Ebola, Lassa, Marburg
  ,Crimean-Congo fever
• CDC, HICPAC. Guidelines for
• Isolation Precautions 2007

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Infection Control Recommendations

• Standard precautions
• Transmission-based precautions droplet, contact,
  airborne
• Respiratory hygiene/cough etiquette

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?????????????????? ????????????????????
??????????

1. ??????? ??????? ???????
2. ????????????? ???

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???????????????????????????? C. diphtheriae
???????????

• 1. Respiratory diphtheria
• - ?????????? droplet precaution
• - ????????????? mask, glove, gown, (goggle)
• 2. Cutaneous diphtheria
• - ?????????? contact precaution
• - ????????????? glove, gown
• 3. Admit ???????????????, cohort ward