Diphtheria: Sweetwater-Nolan County Health Department monthly focus on diseases

August 16, 2014

Diphtheria once was a major cause of illness and death among children. The U.S. recorded 206,000 cases of diphtheria in 1921, resulting in 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 U.S. and other countries that began widely vaccinating. In the past decade, there were less than five cases of diphtheria in the U.S. reported to CDC. However, the disease continues to play a role globally. In 2011, 4,887 cases of diphtheria were reported to the World Health Organization (WHO), but there are likely many more cases.
Diphtheria is an infection caused by Corynebacterium diphtheriae bacteria. Diphtheria is spread (transmitted) from person to person, usually through respiratory droplets, from coughing or sneezing. Rarely, spreading may occur from skin lesions (like an abnormal sore) or clothes that are contaminated with discharges from lesions (like a sore) of an infected person. A person also can get infected with diphtheria by coming in contact with an object, like a toy, that has been contaminated with the bacteria that cause diphtheria.
When the bacteria that cause diphtheria invade the respiratory system, they produce a poison (toxin) that can cause weakness, sore throat, fever, and swollen neck glands. Within two to three days, a thick coating can build up in the throat or nose, making it very hard to breathe and swallow. This thick gray coating is called a "pseudomembrane" and it can build up over the nasal tissues, tonsils, voice box, and throat. The pseudomembrane is formed from dead tissue caused by the toxin that is produced by the bacteria. The pseudomembrane sticks to the tissue below and may get in the way of breathing. The toxin may be absorbed into the blood stream and may cause damage to the heart, kidneys and nerves.
Complications from diphtheria may include: blocking of airway, damage to the heart muscle (myocarditis), inflammation of nerves, which may cause nerve damage (polyneuropathy), paralysis, and lung infection (respiratory failure or pneumonia). For some people, diphtheria can lead to death. Even with treatment about 1 out of 10 diphtheria patients die. Without treatment, as many as one out of two patients can die from the disease. 
Getting treatment for diphtheria quickly is important. Diagnosis of diphtheria is usually made based on signs and symptoms. A swab specimen is taken from the throat to test for the bacteria. A doctor can also take a sample from a skin lesion (like a sore) and try and grow the bacteria to confirm the diagnosis of diphtheria. It is important to start treatment right away if diphtheria is suspected and not to wait for laboratory confirmation. In the U.S, before there was treatment for diphtheria, up to half of the people who got the disease died from it.
Diphtheria treatment today involves using diphtheria antitoxin to neutralize (counteract) the toxin produced by the bacteria, and using antibiotics to kill and eliminate diphtheria bacteria.
Diphtheria patients are usually kept in isolation, until they are no longer able to infect others — usually about 48 hours after antibiotic treatment begins. The disease is usually not able to be spread after the patient has been on antibiotics for 48 hours. After the course of antibiotic treatment is finished, the doctor will run tests to make sure the bacteria are not in the patient’s body anymore. 
The best way to prevent diphtheria is to get vaccinated. In the U.S., there are four combination vaccines used to prevent diphtheria: DTaP, Tdap, DT and Td. Each of these vaccines prevents diphtheria and tetanus; DTaP and Tdap vaccines also prevent pertussis (whooping cough). DTaP and DT vaccines are given to children younger than seven years of age, and Tdap and Td vaccines are given to older children, teens and adults.
The current childhood immunization schedule for diphtheria includes five doses of diphtheria vaccines (DTaP) for children younger than six years of age,  the adolescent immunization schedule recommends that preteens get a booster dose of a diphtheria vaccine (Tdap) at 11 or 12 years of age. Teens who did not get Tdap at 11 or 12 years of age should get a dose at their next medical visit. Adults should receive a dose of Td every 10 years according to the adult immunization schedule.
For more information contact the Sweetwater-Nolan County Health Department or got to http://www.cdc.gov and search for diphtheria.

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