Introduction

Diphtheria is an acute infection affecting the upper respiratory system. Diphtheria outbreaks occurred in Russia, Ukraine, Mongolia and Ecuador in the 90’s It is not common in industrialized countries because of long standing routine use of DPT vaccine.

A disease of colder months in temperate zones, involving primarily non-immunized children under 15 years of age.

Often found among adults in population groups whose immunization were neglected.

Causative agent: Caused by Corynebacterium diphtheriae. Toxin production results when the bacteria are infected by corynebacteriophage containing the diphtheria toxin gene tox.

Involving primarily tonsils, pharynx, larynx, nose, occasionally under mucous membranes or skin and sometimes the conjunctiva or genitalia.

Transmission: From person-to-person, through droplets and close physical contact.

Incubation period: Usually 2-5 days, occasionally longer

Potentially life threatening illness and severe, lifelong complications are possible in incompletely immunized individuals. The risk is increased in overcrowded and poor socioeconomic conditions.

Sign & Symptoms

The characteristic lesion caused by liberation of a specific cytotoxin, is marked by a patch or patches of an adherent grayish membrane with a surrounding inflammation.

The throat is moderately sore in faucial or pharyngotonsillar diphtheria with cervical lymph nodes enlarged and tender.

In severe cases, there is marked swelling and edema of the neck.

Complication

Cranial and peripheral motor and sensory nerve palsies and myocarditis.

Treatment

Specific treatment:

Antitoxin should be given immediately after bacteriologic specimens are taken without waiting for results.

Antibiotics are not a substitute for antitoxin. Erythromycin and Penicillin are recommended. Administered after cultures have been obtained

Prevention & Precautions

All travelers should be up to date with the vaccine.

Type of vaccine: Diphtheria as toxoid

Number of doses: At least three, given i.m

Schedule: 2, 3 and 5 months of age according to the Malaysian National Immunization Program.

Booster: 18 months of age. Td booster at 7 years old.

Contraindications: Adverse reaction to a previous dose.

Adverse reactions: Mild local or systemic reaction is common.

Before departure: As long as possible. Some protection after second dose.

References organisation/ support

International Travel & Health, WHO 2006

Control of Communicable Diseases Manual, 18th Edition by David L.Heymann, MD, Editor, 2004

National Immunization Program, Ministry of Health Malaysia.

www.dph.gov.my/cdc/childhoodimmunisation