Diphtheria

7 March 2012

Background

  • Diphtheria is an infectious disease that spreads from person to person by respiratory droplets from the throat through coughing and sneezing.
  • The disease normally breaks out 2 to 5 days after infection.
  • Diphtheria usually affects the tonsils, pharynx, larynx and occasionally the skin.
  • Symptoms range from a moderately sore throat to toxic life-threatening diphtheria of the larynx or of the lower and upper respiratory tracts.
  • Diphtheria is often complicated by diphtheric myocarditis (toxic damage to heart muscles) and neuritis (toxic damage to peripheral nerves).
  • The disease can be fatal. Between 5% and 10% of diphtheria patients die, even if properly treated. Untreated, the disease claims even more lives.
  • Untreated patients are infectious for 2 to 3 weeks.

Prevention

  • Diphtheria vaccines are based on diphtheria toxoid, a modified bacterial toxin that induces protective antitoxin.
  • Three doses are delivered during infancy, starting as early as 6 weeks of age, and are given at least 4 weeks apart.
  • Diphtheria toxoid combined with tetanus and pertussis vaccines (DTP) has been part of the WHO Expanded Programme on Immunization (EPI) since its inception in 1974.
  • Following the primary immunization series, the average duration of protection is about 10 years.
  • Protective immunity may be boosted through exposure to circulating strains of toxigenic C. diphtheriae.
  • Where natural boosting does not occur, booster doses of diphtheria toxoid beyond infancy and early school age are required to maintain protective immunity.

Treatment

  • Treatment consists of immediate administration of diphtheria antitoxin and antibiotics.
  • Antibiotic treatment usually renders patients non-infectious within 24 hours.
  • Unless immunized, children and adults may repeatedly be infected with the disease.

How can an epidemic be controlled?

  • The most effective method is mass immunization of the entire population.
  • Those individuals who are in close contact with a sick person should be identified and treated immediately with antibiotics.
  • The disease should be diagnosed early and proper case management procedures (i.e.immediate treatment and hospitalization) should be followed in order to prevent complications and death.

Global situation

  • Diphtheria is still a significant child health problem in countries with poor EPI coverage.
  • In 2010, a total of 4,187 cases were reported. 5,000 deaths had been estimated in 2004.
  • The occurrence of diphtheria reflects inadequate coverage of the national childhood immunization programme. Therefore, obstacles to optimal vaccine delivery must be identified and forceful measures taken to improve immunization coverage.
  • Where EPI coverage is high and natural boosting low, as in most industrialized countries, a large proportion of the adult population is gradually rendered susceptible to diphtheria as a result of waning immunity.
  • Diphtheria remains endemic in developing countries with low vaccination coverage.
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Last update:

25 July 2013 09:38 CEST