Diphtheria

What is diphtheria

Diphtheria is a very contagious and life-threatening infection caused by the bacterium Corynebacterium diphtheriae. Diphtheria can affect the nose, throat and tonsils, and sometimes the skin. Diphtheria causes a thick covering in the back of the throat. It can lead to difficulty breathing, heart failure, paralysis, and even death. Vaccines are recommended for infants, children, teens and adults to prevent diphtheria. Due to diphtheria vaccinations in United States it has virtually disappeared.

Diphtheria once was a major cause of illness and death among children. The United States recorded 206,000 cases of diphtheria in 1921 and 15,520 deaths. Before there was treatment for diphtheria, up to half of the people who got the disease died from it.

Starting in the 1920s, diphtheria rates dropped quickly in the United States and other countries with the widespread use of vaccines. In the past decade, there were less than five cases of diphtheria in the United States reported to Centers for Disease Control and Prevention ¹. However, diphtheria infection continues to cause illness globally. In 2014, 7,321 cases of diphtheria were reported to the World Health Organization, but there are likely many more cases.

Diphtheria is spread when a person breathes in droplets from an infected person’s cough or sneeze.
Diphtheria can also be spread by direct contact with an infected person’s wounds or any materials they have soiled.

Diphtheria symptoms usually appear 2 to 5 days after infection.

It can give you a sore throat, breathing difficulties, weakness and fever. it can also gives you ulcers on the skin, or make wounds slow to heal.

Diphtheria can also cause nerve paralysis and heart failure.

Diphtheria is treated with antibiotics, and in severe cases with diphtheria antitoxin. Good hygiene stops it spreading.

Figure 1. Pharyngeal diphtheria (pseudomembrane)

Diphtheria causes

What causes diphtheria

Diphtheria is an infection caused by the Corynebacterium diphtheriae bacterium.

Diphtheria is spread (transmitted) from person to person, usually through respiratory droplets, like from coughing or sneezing. Rarely, people can get sick from touching open sores (skin lesions) or clothes that touched open sores of someone sick with diphtheria. A person also can get diphtheria by coming in contact with an object, like a toy, that has the bacteria that cause diphtheria on it.

Diphtheria prevention

The person with diphtheria is excluded from school until they have recovered and had two negative throat swabs
Contacts of the person with diphtheria are given antibiotics and may also need to have a booster vaccination with a diphtheria-toxoid containing vaccine
Contacts who are children are excluded from early childhood education, daycare, school and community activities until throat swabs shown they do not have the disease
Adults who work with food or children are excluded from their work until throat swabs shown they do not have the disease

The best way to prevent diphtheria is to get vaccinated. In the United States, there are four vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of these vaccines prevents diphtheria and tetanus; DTaP and Tdap also help prevent pertussis (whooping cough). DTaP and DT are given to children younger than seven years old, while Tdap and Td are given to older children, teens, and adults.

Babies and Children

The current childhood immunization schedule for diphtheria includes five doses of DTaP for children younger than seven years old.

Figure 2. Diphtheria immunization schedule for babies and children under 2 years

Preteens and Teens

The adolescent immunization schedule recommends that preteens get a booster dose of Tdap at 11 or 12 years old. Teens who did not get Tdap when they were 11 or 12 years old should get a dose the next time they see their doctor.

Figure 3. Diphtheria immunization schedule for preteens and teens

Adults

Adults should get a dose of Td every 10 years according to the adult immunization schedule. For added protection against whooping cough, any adult who never received a dose of Tdap should get one as soon as possible. The dose of Tdap takes the place of one of the Td shots.

Figure 4. Diphtheria immunization schedule for adults

Diphtheria vaccine

Vaccines are available that can help prevent diphtheria, an infection caused by Corynebacterium diphtheriae bacteria. There are four kinds of vaccines used today to protect against diphtheria, all of which are combined with vaccines for other diseases:

Diphtheria and tetanus (DT) vaccines. DT (generic) provide protection against diphtheria and tetanus.
Diphtheria, tetanus, and pertussis (DTaP) vaccines. DTaP (Daptacel®, Infanrix®, Kinrix®, Pediarix®, Pentacel®, and Quadracel®) provides protection against diphtheria, tetanus, and whooping cough.
Tetanus and diphtheria (Td) vaccines. Td (Tenivac® and generic) provide protection against diphtheria and tetanus.
Tetanus, diphtheria, and pertussis (Tdap) vaccines. Tdap (Adacel®and Boostrix®) provides protection against tetanus, diphtheria, and whooping cough.

Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and whooping cough (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and whooping cough used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the whooping cough component contains only parts of the bacteria instead of the whole cell.

Diphtheria vaccination is recommended for all babies, children, teens, and adults. DTaP and DT are given to children younger than 7 years old, while Tdap and Td are given to older children and adults.

Talk with your or your child’s healthcare professional if you have questions about diphtheria vaccines.

How Well Do These Vaccines Work?

Vaccines that help protect against diphtheria, tetanus, and whooping cough (DT, DTaP, Td, and Tdap) differ in how well they work against each disease.

The diphtheria and tetanus toxoid components of these vaccines are estimated to work well for people who receive the primary series (which is three doses for people 7 years old or older and four doses for children younger than 7):

Nearly everyone (95 out of 100) is protected against diphtheria for approximately 10 years.
Nearly everyone is protected against tetanus for approximately 10 years.

In studies showing how well the whooping cough component of DTaP works:

Nearly all children (98 out of 100) who get all five doses of DTaP on schedule are fully protected against whooping cough within the year following the last dose.
About 7 out of every 10 of children who get all five doses of DTaP on schedule are fully protected against whooping cough five years after getting the last dose of DTaP.

In studies showing how well the whooping cough component of Tdap works:

About 7 out of every 10 people are fully protected against whooping cough in the first year after getting it.
About 3 or 4 out of every 10 people are fully protected against whooping cough four years after getting it.

Who Should Get Diphtheria, Tetanus, and Whooping Cough Vaccines?

CDC recommends diphtheria, tetanus, and whooping cough (pertussis) vaccination for everyone. Vaccines used today against diphtheria and tetanus (i.e., DT and Td) sometimes also include protection against whooping cough (i.e., DTaP and Tdap). Two of these (DTaP and DT) are given to children younger than 7 years old, while two (Tdap and Td) are given to older children and adults.

Talk to your or your child’s healthcare professional about what is best for your specific situation.