diphtheria, tetanus and poliomyelitis: clinical use

Prescribing considerations

• Confirm prior primary immunisation because Revaxis is licensed as a booster.
• Defer during acute severe febrile illness; a minor infection alone is not a contraindication.
• Consider reduced immunogenicity during immunosuppression and seek specialist advice where timing is clinically important.
• Assess bleeding risk in thrombocytopenia or bleeding disorders.
• If Guillain–Barré syndrome or brachial neuritis followed a previous tetanus-toxoid vaccine, make an individual benefit–risk assessment.
• Anticipate vasovagal syncope and prevent injury.

Contraindications and cautions

• Hypersensitivity to diphtheria, tetanus or poliomyelitis vaccines, an excipient, or residual neomycin, streptomycin or polymyxin B.
• Acute severe febrile illness.
• Neurological complications following earlier diphtheria and/or tetanus immunisation.

Monitoring

• Ensure immediate access to treatment for anaphylaxis.
• Record the vaccine name and batch number.
• Monitor and manage syncope or immediate allergic reactions clinically; routine laboratory monitoring is not required.

Clinical pharmacology

Adsorbed diphtheria and tetanus toxoids and inactivated poliovirus types 1, 2 and 3 induce active antibody responses and reinforce immunological memory. Pharmacokinetic evaluation is not applicable to vaccines.

Formulation and product differences

• Revaxis is a cloudy white adsorbed suspension in a pre-filled syringe. Sediment may form during storage, so it requires thorough shaking.
• It contains phenylalanine and small amounts of ethanol and may contain trace neomycin, streptomycin and polymyxin B.
• It must be refrigerated, protected from freezing and discarded if frozen.
• Needle presentations may differ; not all pack formats may be marketed.