South Africa will be making a switch of one of its EPI vaccines on the 1st February 2008. The vaccine affected is the DT (diphtheria-tetanus) which is currently given at 5 years of age, and will be replaced by the Td (tetanus-diphtheria) vaccine, which will be given at 6 years of age and again at 12 years of age.   The rationale behind the change is to replace the current 5-dose EPI schedule of tetanus vaccination, which is given as part of DTP at 6, 10 and 14 weeks followed by booster doses (DT) at 18 months and 5 years of age, with a recommended 6-dose schedule from the World Health Organisation (WHO).  The current EPI 5-dose schedule is not considered effective enough to induce long-term protection due to short time interval between doses, hence the need to provide booster vaccination to pregnant women.  However, WHO recommends an effective 6-dose schedule, with a long time interval between doses, to allow for a maximum duration of protection of up to 20 years.  The long-term goal is to cease tetanus vaccination for pregnant women but this will only be done when the uptake of the new schedule is very good at both 6 and 12 years of age.

Tetanus vaccines are based on tetanus toxoid, a modified neurotoxin that induces protective antitoxin.  Tetanus vaccines are available in different formulations and presentations: single toxoid (TT), combined with diphtheria toxoid (DT) or low-dose diphtheria toxoid (dT), combined with diphtheria and pertussis vaccines (DTwP, DTaP, dTwP or dTaP), combined with diphtheria and pertussis vaccines as well as one or more of the following vaccines; hepatitis B, Haemophilus influenzae type B and Polio.

Tetanus vaccination prevents infection with the bacterium Clostridium tetani which causes neonatal tetanus (NNT), the 4th leading cause of death from vaccine-preventable diseases among children worldwide. Since the agent of NNT cannot be eradicated as it stays in ground soil, the WHO advocated that countries should aim for elimination of the disease, and South Africa adopted the NNT elimination goal and achieved elimination status in 2003. Part of the elimination goal is to maintain very high NNT surveillance.

To prepare for the switch there will be a wash out period of two months from 31st December 2007 to 31st January 2008 during which no DT will be administered by any health facility, public or private. This period will be used to remove all stocks of DT that are still available and replace these with Td stocks, which will only be administered as from the 1st February 2008.

This change will also result in a change in the EPI schedule, which is effective from 1st February 2008, and later on this will be followed by the issuing of new road to health cards.

 

NEW EPI IMMUNISATION SCHEDULE EFFECTIVE 1st FEBRUARY 2008

AGE	VACCINE	ROUTE OF ADMINISTRATION
At birth	BCG Polio	Intradermal injection to right upper arm Oral drops
6 weeks	Polio DPT-Hib Hepatitis B	Oral drops Intramuscular injection to left thigh intramusculart injection to right thigh
10 weeks	Polio DPT-Hib Hepatitis B	Oral drops Intramuscular injection to left thigh Intramusculart injection to right thigh
14 weeks	Polio DPT-Hib Hepatitis B	Oral drops Intramuscular injection to left thigh Intramuscular injection to right thigh
9 months	Measles	Intramuscular injection to right thigh
18 months	Polio DPT Measles	Oral drops Intramuscular injection to left arm Intramuscular injection to right arm
6 years	Polio Td	Oral drops Intramuscular injection to left arm
12 years	Td	Intramuscular injection to left arms

 

Source: Department of Health