A life-threatening disease mainly affecting preschool & school-aged children 1

- Toxin-mediated, potentially systemic disease; transmitted via respiratory droplets or skin lesions1

- Development of pseudo-membrane is a medical emergency1

- 5-10% CFR with highest mortality in young children 2

- 1st epidemiologic stage in countries relying on 3-dose PS only: highest proportion of cases in children 5-14 years (preschool & school-aged children) 1,3

- School attendance = high risk of transmission 3

- Preschool children less able to control respiratory secretions 4

- 2nd epidemiologic stage: shift to adolescents/adults due to recognized waning of immunity after PS1,3

- Regular boosters needed to compensate absence of natural boosting (2nd year, school-entry & school-leaving prior to adolescence)3

    1. WHO. WER, 2017;92(31)
    2. WHO. Online
    3. Clarke. SAGE Meeting, April 2017
    4. Bertilone. Commun Dis Intell Q Rep, 2014;38(3)

Waning Anti-Diphtheria Immunity

A School-entry booster is needed to maintain immunity 1

Immune responses after a DTaP-IPV/Hib toddler booster (n=69) and before/2 months after DTaP-IPV school-entry booster (n=232) at 5-6 years in children primed w/ DTaP-IPV/Hib at 2-3-4/2-4-6 months (3+1 schedule, France, 2000-01)1


NA: not available; mo: months; yr: years

    1. Mallet. Vaccine, 2004;22(11-12)

Importance of DTaP-IPV School-Entry Booster


Diphtheria is a life-threatening disease that still kills young children around the world 1,2

  • Vaccine-induced immunity is known to wane after primary vaccination 3
  • Introduction of primary vaccination is known to result in 2 epidemiologic stages1,3
    1. In countries relying on 3-dose primary series only, the highest proportion of cases occurs in children aged 5-14 years (preschool & school-aged children)
    2. A shift to adolescents/adults as a result of waning immunity after primary vaccination
    Regular boosters are needed to compensate for waning immunity and the absence of natural boosting3
    1. WHO. WER, 2017;92(31)
    2. WHO. Online
    3. Clarke. SAGE Meeting, April 2017

Vaccination Recommendations - WHO

School-entry boosters are recommended for long-lived protection 1-5

    1. WHO. WER, 2017;92(31)
    2. WHO. WER, 2017;92(6)
    3. WHO. WER, 2015;90(351
    4. WHO. WER, 2016;91(12)
    5. Martinon-Torres. Expert Rev Vaccines, 2018;17(4)