The National Health and Medical Research Council recommends diphtheria vaccination as part of the standard childhood vaccination schedule.1 Primary vaccination is achieved with three doses of a diphtheria toxoid-containing vaccine at one to two monthly intervals, with boosters at 18 months and four to five years.
Prior to the eighth birthday DTP (diphtheria, tetanus, pertussis vaccine) should be given. If there is a genuine contraindication to pertussis vaccine, CDT (adsorbed diphtheria, tetanus vaccine, paediatric formulation) should be used. After the eighth birthday, the low dose diphtheria adult formulation (ADT) should be given. The change to ADT after the eighth birthday is required because of the reduced tolerance of older children and adults to diphtheria toxoid.
Older children who have not received diphtheria vaccination are also likely to have missed tetanus vaccination. Those who have not reached their eighth birthday should receive three injections of DTP (or CDT) at intervals of one to two months, and those individuals who have passed their eighth birthday should receive three doses of ADT at intervals of two months.
The need for booster injections in adult life is unclear. However, as protective antibody levels wane with age, it is considered prudent for adults to have booster injections, which may be given as ADT vaccine, at 10 year intervals. Diphtheria can be a significant risk for travellers to some countries, so all international travellers should ensure that their vaccination is current.
Reference1. National Health and Medical Research Council. The Australian Immunisation Handbook. Sixth edition. Canberra: Australian Government Publishing Service, 1997.
This article was published in Communicable Diseases Intelligence Volume 22, No 9, 3 September 1998.