R.No.

77198/Immn/S3/18 Directorate of Public Health &

Preventive Medicine, Chennai-6.
Dated: 28.09.2018.

Sub: Public Health and Preventive Medicine – Immunisation –

Prevention and control of Diphtheria certain instructions - issued–
regarding.
Ref: 1. D.O. LrNo.T-22011/01/2017-Imm dt.14.8.2018 of Joint Secretary,
MoH&FW, New Delhi

2. Minutes of the Immunisation Advisory Committee meeting

held on 23.8.2018.
3. The Indian Express dated: 23.09.2018.

*******
In the reference first cited, Government of India have informed to
replace TT vaccine with Td vaccine under routine immunisation schedule by
December’ 2018 depending on the vaccine supply and as per GoI guidelines.
In this regard Immunisation Advisory Committee meeting was conducted on
23.08.2018 and the issues related to Diphtheria prevention, control and
management were discussed.
Diphtheria cases started declining after the introduction of Universal
Immunization Programme. In Kerala, Diphtheria and Whooping Cough
outbreaks were reported during 2017. In Tamilnadu, sporadic cases of
Diphtheria do occur and containment vaccination is carried out in the
affected areas with DPT and Td Vaccine.
In Tetanus and Diphtheria natural infection do not confer any
immunity and also immunity in Diphtheria wanes slowly after few years. If
the child does not get 1st booster dose, Diphtheria may appear at the age of
7, 8 or 9 and if the 2nd booster is not given Diphtheria may appear at the age
of 12 years and above. Frequent travel to other States/Countries increases
the risk of getting Diphtheria among children as well as adults. Labour
migration also increases vulnerability to Diphtheria infection.

Instead of TT vaccine Td vaccine can be given for 5 th & 10th Standard

children, Antenatal TT for Pregnant Mothers under Routine Immunization
programme as and when replaced with Td vaccine by Government of India.
DPT Vaccine can be given only up to 7 years of age.
….2
 -2-
The dates of replacement /Change over to Td vaccine will be informed
in due course of time as per GoI guidelines and on receipt of Td vaccine by
Government of India. Td vaccine supplied now by Director of Public Health
and Preventive Medicine, procured by TNMSC should be used only for
containment Immunisation.

Moreover, 14 Diphtheria deaths have been reported in New Delhi as

per the report in the reference 3rd cited. In this connection, the following
instructions are issued to all Deputy Director of Health Services`.
1.DPT Booster dose coverage
100% coverage of DPT first booster and second booster, including
migrant children should be ensured.
2. Guidelines for Containment immunization against Diphtheria:
1. Children upto 10th Standard are to be given either DPT/Td as per
age.
2. Whole PHC area and 5 km radius of the case where the child
usually resides, and also the school contacts upto 10 th Standard
even if the school is located outside the PHC area as per situation.
3. If necessary the whole block may be covered.
1st booster DPT: (16-24 months: If not immunized upto 5 years)
 Any child not received 1st booster should be given one dose of
DPT.
 Children who do not have proper records should also be
given one dose of DPT as first booster.
2nd booster DPT:
 Children in 1st Std. and 2nd Std (5 to 7 years age group) who
have not received 2nd booster are to be given one dose of 2nd
booster DPT.
Note: DPT can be given upto 7 years of age only.
Children in 3rd Standard to 10th Standard (Td vaccine):
 One dose Td vaccine for all children irrespective of previous
vaccination status.
Note: Children 7 years and above are to be given Td vaccine.
….3
 -3-

3. Preparatory arrangements for switching over to Td Vaccine:

 By December, 2018 Routine Immunisation schedule will be
switching over to Td Vaccine from TT Vaccine, depending on
the vaccine supply and GoI guidelines. Hence all DDHS are
requested to initiate preparatory activities from now
onwards.
 IMA, IAP, FOGSI may be informed to change over to Td
vaccine for 10 years and 16 years children and ANCs from
now onwards.

4. Availabilty of Diphtheria Anti Toxin (DAT) and antibiotics:

 Atleast 20 vials of Diphtheria Anti Toxin (DAT) should be
available in each HUD.
 Adequate antibiotics namely Tab.Erythromycin,
Inj.Crystalline Pencillin, Inj.Benzathine Pencillin should be
made available.
 List of manufacturers for the Diphtheria Anti Toxin (DAT) as
per GoI is given below.
S.No Manufacturers
1. CRI, Kasauli
2. Haffkine Bio Pharmaceutical Corporation (India), Mumbai
3. BS & V Ltd, Thane
4. Vins Bioproducts Limited (India), Hyderabad

5. Training:
 All Medical Officers and female field functionaries should be
trained well in Diphtheria prevention and control measures.

High level of alert and early detection can save lives.

Director of Public Health and

Preventive Medicine, Chennai-6.
To:
All Deputy Director of Health Services
Copy to
1.All Programme Officers.
2.All Public Health Training Centres including ANM Schools.

//True copy – Forwarded//

 For Director of Public Health and
Preve

ntive Medicine, Chennai-6.

 N.F.No.77198/Imm/S3/2018

ON Submitted

Sir/Madam,

Sub: Public Health and Preventive Medicine – Immunisation –

Prevention and control of Diphtheria certain instructions - issued–
regarding .
Ref: 1. D.O. LrNo.T-22011/01/2017-Imm dt.14.8.2018 of Joint Secretary,
MoH&FW, New Delhi

2. Minutes of the Immunisation Advisory Committee meeting

held on 23.8.2018.
3. The Indian Express dated: 23.09.2018.

*******

Consequent on the decision taken in the Immunisation Advisory

Committee meeting held on 23.08.2018 under the Chairmanship of the
Director of Public Health and Preventive Medicine, a draft addressed to all
the Deputy Director of Health Services regarding Prevention and control of
Diphtheria is kept below for approval.
 Annexure

List of manufacturers of Anti-Diphtheria Serum in India

S.No Manufacturers

1. CRI,Kasauli

2. Haffkine Bio Pharmaceutical Corporation(India), Mumbai

3. BS & V Ltd. Thane

4. Vins Bioproducts Limited (India), Hyderabad

 -3-

3. Preparatory arrangements for switching over to Td Vaccine:

 By December, 2018 Routine Immunisation schedule will be
switching over to Td Vaccine from TT Vaccine, depending on
the vaccine supply and GoI guidelines. Hence all DDHS are
requested to initiate preparatory activities from now
onwards.
 IMA, IAP, FOGSI may be informed to change over to Td
vaccine for 10 years and 16 years children and ANCs from
now onwards.

4. Availabilty of Diphtheria Anti Toxin (DAT) and antibiotics:

 Atleast 20 vials of Diphtheria Anti Toxin (DAT) should be
available in each HUD .
 Adequate antibiotics namely Tab.Erythromycin,
Inj.Benzathine Pencillin should be made available .
 List of manufacturers for the Diphtheria Anti Toxin (DAT) as
per GoI is enclosed as detailed below.
S.No Manufacturers

1. CRI,Kasauli

2. Haffkine Bio Pharmaceutical Corporation(India),

Mumbai

3. BS & V Ltd. Thane

4. Vins Bioproducts Limited (India), Hyderabad

5. Training :
 All Medical Officers and female field functionaries should be
trained .

High level of alert and early detection can save lives.

K.Kolandaswamy
Director of Public Health and
Preventive Medicine, Chennai-6.
To:
All Deputy Director of Health Services
Copy to
1.All Programme Officers.
2.All Public Health Training Centres including ANM Schools.
//True copy – Forwarded//

For Director of Public Health and

Preventive Medicine, Chennai-6.