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  » Immunization Schedules  »  Diphtheria, tetanus and whooping coughn

Diphtheria, tetanus and whooping cough

Diphtheria, tetanus and whooping cough are serious diseases that occur in children and adults. Combination vaccines that include DTPa (diphtheria-tetanus-acellular pertussis) give effective protection against these diseases.


Diphtheria is caused by bacteria which are found in the mouth, throat and nose of an infected person. Diphtheria can cause a membrane to grow around the inside of the throat which can lead to difficulty in swallowing, breathlessness and suffocation. A powerful poison (toxin) is produced by the diphtheria bacteria and may spread throughout the body. The toxin may cause serious complications such as paralysis and heart failure. About 7% of people who contract diphtheria die from it.


Tetanus is an often fatal disease caused by a toxin made by bacteria present in soil and manure. You don’t catch tetanus from other people. Rather, the bacteria enter the body through a wound which may be as small and insignificant as a pinprick. Tetanus attacks the nervous system, causing severe muscle spasms, first felt in the neck and jaw muscles (lockjaw). The effects spread, causing breathing difficulties, painful convulsions and abnormal heart rhythms. Because of immunisation, tetanus is now rare in children in Australia but it still occurs in adults who have never been immunised against it or who have not had their boosters.

Whooping cough

Whooping cough, which is also known as pertussis, is a highly contagious disease caused by bacteria and is spread by coughing or sneezing. Whooping cough affects the air passages and can cause difficulty in breathing. Severe coughing spasms occur and between these spasms, the child gasps for breath causing the characteristic ‘whoop’ sound. Not all children get the ‘whoop’ and vomiting often follows a coughing spasm. The cough may last for months. Whooping cough is most serious in babies under 12 months of age, often requiring admission to hospital. Complications include convulsions, pneumonia, coma, inflammation of the brain, permanent brain damage and long-term lung damage. Around one in every 200 children under six months of age who catches whooping cough will die.

DTPa immunisation

Immunisation with DTPa vaccine is the best way to prevent diphtheria, tetanus and whooping cough. DTPa vaccine is a combination vaccine in which three vaccines are combined in one injection to prevent diphtheria, tetanus and whooping cough. Alternatively, these three vaccines are combined with hepatitis B vaccine. DTPa-containing vaccines contain a small amount of diphtheria and tetanus toxins which are modified to make them harmless, small parts of the pertussis bacteria, aluminium hydroxide (to increase the effectiveness of the vaccine) and a preservative (phenoxyethanol).

Possible side effects of DTPa immunisation

The recommended DTPa immunisation has few side effects, although some children may have mild fever and redness, soreness and swelling in the area where the injection was given. Mostly these side effects will settle without treatment but paracetamol may help to reduce fever and soreness at the injection site. In the past, concerns have been expressed about the possibility of whooping cough vaccine causing encephalitis (inflammation of the brain) and brain damage. The most careful studies show that there is not a proven link between DTPa vaccine and brain damage, and the risk is thought to be less than one in a million, if any at all. The very real risk of severe complications from the whooping cough disease is much greater than the risk of an extremely rare reaction following a DTPa immunisation.

If none of the children in a child care centre of 150 children were immunised, and a whooping cough outbreak occurred, about 135 children would come down with the disease. On average, one child would get encephalitis (inflammation of the brain) as a result of the disease. If every child in the centre was immunised correctly with four doses of DTPa, possibly one child at the centre every 170 years could get encephalitis associated with the immunisation.