Diphtheria is a sudden onset bacterial infection that usually affects the tonsils, throat and nose, and may affect the skin. Diphtheria remains a serious disease throughout much of the world. In particular, large outbreaks of diphtheria occurred in the 1990s throughout Russia and the independent countries of the former Soviet Union. Most cases occurred in unimmunized or inadequately immunized people. Control measures have been implemented, but a risk of diphtheria remains in all these areas.
The disease is passed from person to person by droplet transmission, usually by breathing in diphtheria bacteria after an infected person has laughed, coughed, or sneezed the bacterium onto the victim. It can also be spread by handling used tissues or by drinking from a glass used by an infected person. In its worst extreme, diphtheria can lead to breathing problems, heart failure, paralysis and occasionally death.
The incubation period is quite short: 2-5 days, with a range of 1-10 days
Early symptoms of diphtheria may mimic a cold: sore throat, mild fever, and chills. Usually, the disease causes a thick coating at the back of the throat, and this can make it difficult for patients to breathe or swallow. Other body sites besides throat can also be affected, including the nose, larynx, eye, vagina, and skin
Diphtheria is a serious disease: from 5%-10% of all persons with the disease die. Up to 20% of cases lead to death in certain age groups of individuals (e.g. in groups older than 40 years or younger than 5 years). U p to 8 out of 10 adults 60 years of age and older lack adequate protection from diphtheria. During the 1990s, epidemic diphtheria broke out in several states of the former Soviet Union, causing more than 150,000 cases and 5,000 deaths.
Diphtheria antitoxin is given as an intramuscular or an intravenous injection as soon as the diagnosis is suspected. The infection is then treated with antibiotics, such as penicillin or erythromycin. Antitoxin does not get rid of toxin that is already attached to the body’s tissues, but will neutralize any circulating poison and will prevent the disease from getting worse. The patient should be tested for sensitivity to this antitoxin before it is given.
People with diphtheria may require hospitalisation for supportive treatment and during the administration of antitoxin. Insertion of an endotracheal tube and/or removal of the obstructing membrane may be required if airway obstruction is present. Intravenous fluids, oxygen, bed rest, and cardiac monitoring (due to the possibility of inflammation of the heart muscle ) are usually indicated.
The disease usually becomes non-contagious 48 hours after antibiotics are started. Nevertheless, some individuals continue to carry the diphtheria bacterium even after antibiotic therapy, and treatment should be continued until patients have three consecutive negative throat swab cultures.
Routine childhood immunisations and adult boosters prevent the disease.
Diphtheria is not available as a single vaccine. It is included in the DTaP vaccine.
The diphtheria vaccine is an inactivated toxin called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. The diphtheria vaccine is given as a shot in the muscle.
All infants and children should receive five DTaP vaccine doses as part of their routine immunisation schedule (unless they have a medical reason not to).
Most people have no serious reactions from this combined vaccine. The most common reactions are local reactions at the injection site, such as soreness, redness, and swelling. Other possible reactions may include fussiness, mild fever, loss of appetite, tiredness, and vomiting. The use of the more purified DTaP instead of DTP has decreased even these mild reactions.
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