Strategies for Preventing Diphtheria: Vaccination and Beyond

Introduction:

Diphtheria is a bacterial infection that mainly affects the mucosal membrane of the nose and the throat and is caused by a toxin produced by the strain Corynebacterium diphtheria (a bacteria). It can be fatal if one does not receive treatment immediately. The disease is more common in developing countries (India, Ethiopia, Indonesia), where the vaccination of children is not routinely done.

What Causes Diphtheria?

A toxin called exotoxin, produced by the bacterial strain, causes cell damage and tissue death. This causes a build-up of grayish-black-colored, thick coating on the mucous membrane of the nose, mouth, and throat, making it difficult for the individual to breathe or swallow. The toxin may also spread through the bloodstream and affect the other organs (heart, liver, kidney), which can be fatal. A milder form of the toxin can also affect the skin (rarely) but never becomes fatal.

Is Diphtheria Contagious?

Yes, diphtheria is highly contagious through an infected individual's sneeze, cough, saliva, sputum, and blood. It can also spread on contact with open skin diphtheritic ulcers. In addition, surfaces contaminated (bedding, clothing, vessels) by the infected individuals can also be a source of infection.

Some individuals may not have any symptoms and are carriers of the infection. As a result, they can spread the infection even with no signs or symptoms of the disease. An individual is usually not contagious after 48 hours of treatment; however, the full course of treatment must be completed.

Who Is at Risk for Diphtheria?

Unvaccinated individuals:

• Living in crowded and unsanitary (unclean) conditions.

• With poor personal hygiene practices.

• Under the age of five years.

• Who are malnourished children are prone to the disease.

• Over 60 years may be prone to the disease due to decreased immune response of the body.

• Traveling to countries (where cases of diphtheria are still common) can expose one to the disease.

How to Prevent Diphtheria?

• First and foremost, get vaccinated according to the protocol to be effectively immune to diphtheria.

• Isolate from the individual infected with diphtheria.

• Isolate from primary or secondary contacts of infected individuals.

• Maintain a clean environment and follow proper personal hygiene measures (regular bath and clean clothes).

• Do not share clothing, bedding, or other common household items or space with the infected individual.

• Attend the infected individual with protective measures such as a mask, gloves, and face shield.

• Disinfect the items and surroundings of an infected individual thoroughly.

• Get vaccinated before traveling to countries where diphtheria is still prevalent.

• The burial of an individual deceased from diphtheria must be done immediately with precautionary measures, and attending the funeral is not advised.

What Is the Vaccination Protocol for Diphtheria?

Prevention is better than cure; hence the vaccine is recommended throughout one's life at divided doses. Diphtheria is preventable with the timely administration of the vaccine. Vaccines against diphtheria are a combination of diphtheria (D), tetanus (T), and pertussis (P), where the appropriate combination is given according to age and previous history of vaccinations.

The Tetanus Vaccine- Prevents a serious infection that affects the nervous system caused by a bacteria called Clostridium tetani.

The Pertussis Vaccine- Prevents whooping cough, a respiratory disease caused by Bordetella pertussis bacteria.

The combination available is as follows:

• DTaP helps protect against diphtheria, tetanus, and pertussis (whooping cough). It is given to infants and younger children.

• DT helps protect against diphtheria and tetanus and not pertussis. Contains diphtheria and tetanus vaccines in the same quantities.

• Tdap helps protect against tetanus, diphtheria, and pertussis. It is given only to older children and adults.

• Td helps protect against tetanus and diphtheria. Contains more of the tetanus vaccine than the diphtheria vaccine.

The vaccination schedule is as follows:

1. DTaP for Babies:

• First dose at 2 months of age.

• Second dose at 4 months of age.

• Third dose at 6 months of age.

• First booster dose at 15 to 18 months of age.

• Second booster dose at 4 to 6 years of age.

2. DT (for Babies Who Cannot Receive Acellular Pertussis Vaccine):

• First dose at 2 months of age.

• Second dose at 4 months of age.

• Third dose at 6 months of age.

• First booster dose at 15 to 18 months of age.

• Second booster dose at 4 to 6 years of age.

3. Tdap Vaccine for Adolescents:

• First dose 11 to 12 years.

4. Tdap Vaccine for Pregnant Women:

• Single dose at 27 to 36 weeks of pregnancy.

5. Tdap Vaccine for Women Postpartum Who Never Received Any Dose of Tdap:

• Single dose immediately after delivery.

6. Tdap Vaccine for Adults:

• Single dose at any age (19 years and above).

• Repeat (Tdap or Td every ten years.

In case of missed doses for babies of a particular age, the vaccine is given at the earliest, and the next dose is repeated only after four weeks.

An individual with diphtheria may get infected again if exposed to the bacteria. Therefore, to prevent the recurrence of diphtheria or to be immune to the disease, one must follow the vaccination protocol as per the WHO (World Health Organization).

After recovering from diphtheria, one must take age-appropriate vaccinations without fail.

After getting vaccinated, mild fever or soreness at the injection site is a common side effect and usually is nothing to worry about.

The vaccine is contraindicated for individuals who have had an allergic reaction to the vaccine or any component of it.

What Are the Signs and Symptoms of Diphtheria?

Suppose one fails to get vaccinated or follow the preventive measures and gets exposed to the bacteria. In that case, it may take two to five days (incubation period) for signs and symptoms of infection to appear. The signs and symptoms are as follows:

• Weakness.

• Sore throat and nasal discharge.

• Mild fever, which progresses to severe fever over the days.

• Greyish black or grayish-white coating in the nose, mouth, and back of the throat.

• Difficulty in breathing and swallowing.

• Swollen neck (caused by swelling of lymph nodes).

• Unclear speech (caused due to coating and swelling).

• If the skin is involved- swelling, skin redness with pus-filled blisters, open ulcers, and red sores.

• Severe cases- affect heart, kidney, and nerve function, which can be fatal.

How to Treat Diphtheria?

• Treatment focuses on preventing the toxin from causing further harm and clearing the airway and nasal obstructions. The treatment usually lasts two to three weeks, depending on the severity of the individual.

• Anti-diphtheritic serum- an antitoxin for diphtheria is the first line of treatment to prevent the spread to the bloodstream and to neutralize the exotoxin.

• Antibiotics (Erythromycin or Penicillin) to treat throat, nose, and skin bacterial infections.

• An individual may need hospital admission for severe cases of diphtheria to maintain a good airway, assess the spread to other organs and manage the individual as required with ventilator support and IV fluid support.

• Skin lesions are treated with topical antibiotics and analgesics (painkillers). They may take two to three months to heal completely and often leave scars.

• Recovery is slow for an infected individual and may require prolonged rest.

Conclusion

Certain diseases, unfortunately, are difficult for the body to recover from even after appropriate treatment measures. Following the preventive measures and vaccination protocol can protect one from the disease and its consequences.