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Diphtheria
What is diphtheria?
Diphtheria is a serious disease caused by a toxin (poison) made by bacteria. It causes a thick coating in the back of the nose or throat that makes it hard to breathe or swallow. It can be deadly.
How common is diphtheria?
Respiratory diphtheria has not been reported in the United States (U.S.) since 2003. Prior to the introduction of a vaccine in the 1920s, as many as 10 percent of American children developed clinical diphtheria, and a significant number died from its complications (case-fatality rate of 5 to 10 percent). Diphtheria remains a serious issue in developing countries with low vaccination coverage.
What are the symptoms of diphtheria?
Diphtheria starts like a cold, with sore throat, mild fever (101 degrees Fahrenheit or less), and chills. Next, the diphtheria toxin makes a thick coating on the back of the nose or throat. It may be blue or grayish green. The coating makes it hard to breathe or swallow.
A milder form of diphtheria can cause skin wounds, but this form usually does not spread to the other parts of the body.
How serious is diphtheria?
The coating on the throat can get so thick that it blocks the airway, so the person cannot breathe.
The diphtheria toxin can attack the heart, causing abnormal heart rhythms and even heart failure. It also can attack the nerves, which leads to paralysis (unable to move parts of the body). Rarely, it can also damage the kidneys.
About one out of 10 people who get diphtheria dies. In children younger than 5 years, as many as one out of five children who get diphtheria dies.
5-10% of those with diphtheria could die from it. Prior to any treatments being available, about half of those with diphtheria would die from it.
How does diphtheria spread and how can I prevent it from spreading?
Diphtheria spreads when an infected person coughs or sneezes. A person can spread the disease for up to two weeks after infection.
Patients with diphtheria who are at home should be wearing masks and stay away from others. Isolation should be continued until treatment has been completed and no live bacteria grow out from two consecutive samples taken at least 24 hours apart.
Close contacts of those with diphtheria should be assessed for active infection and given antibiotics to PREVENT developing active infection. They should also receive the vaccine if they haven’t already been adequately vaccinated.
What is the treatment for diphtheria?
Diphtheria can be treated with both an antitoxin and antibiotics. The antitoxin only works if it is given early in the course of the illness and must be obtained from CDC as it is not commercially available in the US. Antibiotics to treat diphtheria are commonly available and usually given for a 14-day period.
Can diphtheria be prevented?
The best prevention against diphtheria is immunization. There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults.
Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also contains protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap also should be given to 7-to-10-year-olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received.
(Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.)
Reporting to Public Health
Diphtheria is reportable in Illinois immediately, within three hours, to the local health department and/or Illinois Department of Public Health.
A positive result on any laboratory test indicative of and specific for detecting Corynebacterium diphtheriae infection should be reported to public health. Laboratories must forward clinical materials positive for Corynebacterium diphtheriae to the state laboratory for toxicity testing at CDC. Any request for suspected diphtheria testing should be reported to public health, as soon as possible, within three hours.
