Vaccine Preventable Diseases – Diphtheria

This disease of colder months in temporary areas is practically non-existent in the US due to an aggressive vaccine program for the past several decades. We currently see less than 5 cases of respiratory diphtheria annually.

This dangerous respiratory disease is caused by a potent toxin produced by certain strains of the bacterium Corynebacterium diphtheria e.

Unlike tetanus, diphtheria is extremely contagious through coughing or sneezing. Risk factors include crowding, poor hygiene, and lack of immunization.

Symptoms usually appear within a week of infection. This infection is characterized by a sore throat, coughing and fever very similar to many common diseases like strep throat. Additional symptoms may be bloody, watery discharge from the nose and rapid breathing. However, a presumptive diagnosis can be made by observing a characteristic thick grayish patch (membrane) found in the throat. In more severe cases, neck swelling (see picture below) and airway obstruction may be observed. In the tropics, cutaneous and wound diphtheria is much more common and can be a source of transmission.

The real serious danger is when the toxin that is produced by the bacterium gets into the bloodstream and spreads to organs like the heart and nervous system. Myocarditis, congestive heart failure and neurological illnesses of paralysis that mimic Guillain-Barre syndrome are most severe. Even with treatment, fatalities are still seen in up to 10% of cases.

Diphtheria can be treated and cured successfully with antitoxin and antibiotics if started early enough.

Although rarely seen in this country, it is still seen frequently in many parts of the world; including the Caribbean, Latin America and it is considered a re-emerging problem in parts of Russia. So ensuring your diphtheria vaccination is up to date is of importance prior to foreign travel.

The prevention of diphtheria is through infection. The vaccination schedule is the same as for tetanus (see previous article). Immunity does wane after a period of time and re-vaccination should be done at least every 10 years.

Although now a rare disease in the United States, foreign travel is still a risk factor for Americans and up to date vaccination is critical in preventing this disease.