Title: Pentavalent vaccine
Course: Level 3 - Immunization > Section: Antibacterial vaccines

Pentavalent Vaccine:

A vaccine which contains five different antigens in one vial is called pentavalent ("penta" comes from Greek work which means five). The pentavalent vaccine in Ethiopia contains four antibacterial called DPT-Hib ( diphtheria, pertussis, tetanus and Haemophilus influenza type b bacteria) these four components are described below and one antiviral vaccine (hepatitis b virus) which will be discussed in study session three.

Diphtheria vaccine

Diphtheria is caused by bacteria called Corynebacterium diphtheria. The bacteria produce a toxin that can harm or destroy human body tissues and organs. One type of the disease affects the pharynx and other parts of the throat. Diphtheria affects mostly non-immunized children under 15 years of age, but it can affect people of all age's groups. When diphtheria affects the throat and tonsils, the early sign and symptoms are a sore throat, loss of appetite and fever. The most effective way of preventing diphtheria is to maintain a high level of immunisation in the community. A mother can pass protective antibodies to her baby, but this protection lasts for only about six months after birth. Diphtheria toxoid vaccine is given together with pertussis, hepatitis, Haemophilus influenza type b and tetanus toxoid as DPT-HepB-Hib vaccine.

Pertussis

Pertussis, or whooping cough, is a disease of the respiratory tract caused by inactivated (killed) bacteria called Bordetella pertussis. The germ lives in the mouth, nose and throat. The disease is common in non-immunized children all over the world. Severe epidemics can occur where immunisation coverage is low. The disease is most dangerous for children less than 12 months old.

Tetanus toxoid for neonatal tetanus (TT)

Tetanus or lockjaw is caused be a bacteria Clostridium tetani. Tetanus toxoid is a subunit antibacterial vaccine. Tetanus affects person's muscles all contract, making the body stiff. The disease is particularly common and serious in newborn babies when it is called neonatal tetanus (NNT). TT vaccine is also given on its own as a "booster" to women of childbearing age,

Hemophilus Influenza type b (Hib)

Haemophilus Influenzae type b(Hib) is one of the six serotypes of Haemophilus bacteria that causes about 95% of morbidity and mortality among under-five children where Hib vaccine is not routinely given to all infants. This bacteria causes a majority of the serious childhood illnesses like pneumonia, bacterial meningitis, parotitis, and septicaemia. Hib vaccine is a conjugate antibacterial vaccine, which protects against pneumonia and meningitis caused by the bacteria Haemophilus influenza type b. Pneumonia is a severe infection of the lungs, which causes the air sacs to fill with fluid and pus; this makes breathing painful and difficult and reduces the oxygen getting into the body. Note that Hib vaccine only protects against diseases caused by type b Haemophilus Influenzae bacteria (there are other types), and it does not prevent pneumonia or meningitis caused by other infectious agents.

Summary of Pentavalent Vaccine (DPT-HepB-Hib)

Characteristics | Disruptions
Vaccine type | Five different antigens combined, including one inactivated whole-cell Vaccine, two sub-unit vaccines (toxoids), one conjugate vaccine and one recombinant vaccine
Amount(dose) given | 0.5 ml
Route of administration | Intramuscular (IM)
Site of administration | Upper outer left thigh
Number of doses | Three (Penta1, Penta2 and Penta3)
Schedule | At 6, 10 and 14 weeks of age
Booster (additional) dose | None in males; boosters of tetanus toxoid vaccine are given to women of childbearing age groups (15-49 years)
Storage | Store between +2°C and +8°C. Never freeze. Vaccine storage is described in Study Session 4
Contra-indications | Severe allergic reaction or encephalopathy to a previous pentavalent immunisation
Adverse effect | Mild local reactions are common, rarely, injection-site abscess
Management of AEFIs
- For mild cases Keep dry and clean (do not put any ointment or medicine on it)
- For severe reaction Refer or try antibiotic if bacterial infection is suspected
Special requisitions | Usually not given after six years of age because of the increased risk of serious adverse reactions

Figure 2.5. Needle position for pentavalent vaccine injection.

Tetanus vaccine for the mother

Tetanus toxoid (TT) is given to women of childbearing age and pregnant women to prevent maternal and neonatal tetanus. It is the same tetanus toxoid as that given to children in DPT-HepB-Hib vaccine. When given to a woman, who is or becomes pregnant, the antibodies that formed in her body cross the placenta into the fetus. These antibodies protect the baby against tetanus during birth and for a few months after that. It also protects the woman against tetanus. See characteristics of TT vaccine in the table below.

Summary Tetanus Toxoid Vaccine Components (TT) Vaccine Women

Characteristics | Descriptions
Number of doses | At least two doses to be (PAB) - ideally five
Schedule | First dose at first contact during childbearing years, or as early as possible in pregnancy
Booster | Every 10 years during childbearing years
Injection site | Upper outer arm
Duration of protection in women following 1-5 doses of TT vaccine.
Dose (0.5ml) | When given | Duration of protection
TT1 | At first contact with women of childbearing age, or as early as possible in the pregnancy | No protection
TT2 | At least four weeks after TT1 | 3 years
TT3 | At least six months after TT2 | 5 years
TT4 | At least one year after TT3 | 10 years
TT5 | At least one year after TT4 | Lifelong