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Diphtheria: Causes, Symptoms, Treatment and Prevention
Diphtheria is an acute bacterial disease that usually affects the tonsils, throat, nose and/or skin. It is passed from person to person by droplet transmission, usually by breathing in diphtheria bacteria after an infected person has coughed, sneezed or even laughed. It can also be spread by handling used tissues or by drinking from a glass used by an infected person. Diphtheria can lead to breathing problems, heart failure, paralysis and sometimes death.
Mortality/Morbidity
- The overall fatality rate for diphtheria is 5-10%, with higher death rates (20%) in persons younger than 5 years or older than 40 years. This rate has changed very little over the last 50 years.
- The mortality rate in the untreated patient is as much as 50% in some epidemics.
- In recent decades, the mortality rate has been nearly 10% in the United States.
- In a recent Swedish outbreak, the mortality rate was 18%. The mortality rate of the epidemic in the newly independent states of the former Soviet Union ranged from 3-23%.
- Native Americans generally have much higher rates of diphtheria infection than whites; however, this is likely owing to socioeconomic status and living conditions.
- Some studies suggest that women are at higher risk than men because of lower immunization rates.
- Before immunization programs developed, diphtheria was an illness of childhood. Most young infants were immune because of transplacental transfer of maternal immunoglobulin G (IgG) antitoxin; however, children became susceptible when aged 6-12 months. Since 1980, routine immunization has resulted in a progressive decline of cases among this population. As the incidence decreased, a higher proportion of cases were found among older persons (secondary to either never being immunized or a waning immunity) and individuals with immunocompromise.
Symptoms
In its early stages, diphtheria may be mistaken for a severe sore throat. Other symptoms include a low-grade fever and enlarged lymph nodes (swollen glands) located in the neck. Another presentation of diphtheria can be skin lesions that may be painful, red and swollen. Symptoms usually appear 2 to 4 days after infection, with a range of 1 to 6 days. People carrying diphtheria germs are contagious for up to 4 weeks without antibiotic therapy, even if they themselves do not develop symptoms.
Who should get Td vaccine?
- All persons who did not receive a primary series of immunization against tetanus and diphtheria during childhood.
- Persons who have not received a booster dose within the past 10 years.
- All adolescents and adults who deferred their regular booster during 2001-2002 because of shortages of the vaccine -- the supply problems have been resolved.
Vaccine Safety
The tetanus-diphtheria (Td) vaccine is very safe. When side effects do occur, they are usually soreness, redness or swelling at the injection site, and a slight fever. As with any medicine, there are very small risks that serious problems, such as an allergic reaction or neurologic condition, could occur after getting a vaccine. However, the potential risks associated with diphtheria are much greater than the potential risks associated with the diphtheria vaccine. You cannot get diphtheria from the vaccine.
Facts:
- Diphtheria can be prevented with a safe and effective vaccine.
- You cannot get diphtheria from the vaccine.
- Diphtheria is transmitted to others through close contact with discharges from an infected person's nose, throat, eyes and/or skin lesions.
- Nearly one out of every 10 people who get diphtheria will die from it.
- Diphtheria can lead to breathing problems, heart failure, paralysis and sometimes death.
- Most cases of diphtheria occur among unvaccinated or inadequately vaccinated people.
- Recovery from diphtheria is not always followed by lasting immunity, so even those persons who have survived the disease need to be immunized.
- A tetanus-diphtheria (Td) shot every 10 years gives protection against these two diseases.
- Although no longer a very common disease in the United States, diphtheria remains a large problem in other countries and can pose a serious threat to United States citizens who may not be fully immunized and who travel to other countries or have contact with immigrants or international travelers coming to the U.S.
- A recent epidemic of diphtheria in Eastern Europe and the New Independent States of the former Soviet Union resulted in over 5,000 deaths between 1990 and 1995.
Prevention
There is a vaccine for diphtheria. Most people receive their first dose as children in the form of a combined vaccine called DTP (diphtheria-tetanus-pertussis).
For adults, a combination shot, called a Td booster, protects against both tetanus and diphtheria. It should be administered once every 10 years after age 7 to maintain immunity.
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