Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



    Diphtheria most often occurs as membranous nasopharyngitis and/or laryngotracheitis which may lead to airway obstruction. Less commonly the disease manifest as cutaneous or chronic ear infections. Life threatening complications include heart failure from myocarditis and paralysis from the effects of diphtheria toxin. The case fatality rate is approximately 10%.

    Diphtheria toxoid prevents disease in most completely immunized individuals and results in milder illness in the few who get the disease. Immunization does not prevent carriage of toxigenic strains so that it is important to continue routine boosters throughout childhood and adult life in order to prevent disease.


    Slight fever, local pain, redness, and/or swelling at the injection site occasionally occur. Sterile abscesses rarely occur after use of absorbed vaccines containing diphtheria toxoid, most often because of inadvertent subcutaneous rather than intramuscular injection. In children over 7 years of age and in adults, a reduced dose of diphtheria toxoid must be used in order to minimized adverse reactions.


    Convulsions compatible with simple febrile seizures may rarely occur after diphtheria toxoid in association with high fever. Such convulsions are not associated with brain damage or an increased risk of subsequent epilepsy.

    Systemic allergic reactions (anaphylaxis, urticaria, bronchospasm, laryngospasm, angioneurotic edema) are rare. In children over 7 years of age, a reduced dose of diphtheria toxoid must be used in order to minimize adverse reactions.


    Fever greater than 40.5oC; convulsions; or systemic allergic reactions occurring within 72 hours of vaccination. Other neurologic events occurring within 15 days of vaccination.

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