Diphtheria

What is diphtheria?

Diphtheria is a highly infectious bacterial infection which can be fatal. It is caused by Corynebacterium diphtheria bacteria.

Diphtheria causes nose and throat infections. Lymph glands can also become swollen.

Diphtheria is still a high for unvaccinated travellers to countries where diphtheria vaccinations are not readily available.1

The following is a summary about the disease. For further details speak to your local pharmacist or GP.

Related: Polio | Tetanus

How is diphtheria spread?

Diphtheria is spread by:

  • Coughing
  • Sneezing
  • Close contact with infected people or contaminated clothes and bedding2

Some types of diphtheria bacteria can also spread from animals to humans1

Which countries is diphtheria found in?

Diphtheria is found in many areas, including:

  • Asia
  • The South Pacific
  • The Middle East
  • Eastern Europe
  • The Caribbean2

A world map showing risk areas for diphtheria can be found here.3

What are the signs and symptoms of diphtheria?

The incubation period for diphtheria is between 2-5 days. Symptoms may include:

  • A thick grey-white coating at the back of the throat
  • Fever
  • Feeling sick
  • Sore throat
  • Headache
  • Swollen glands in your neck
  • Difficulty breathing and swallowing

If the bacteria affects the skin (cutaneous diphtheria), it can cause:

  • Pus-filled blisters on the legs, feet and hands
  • Large ulcers surrounded by red, sore-looking skin2

What are the complications of diphtheria?

Effects of toxin produced by the bacteria may include:

  • Heart complications (such as cardiomyopathy and myocarditis)
  • Arrhythmias of the heart during early or late in the illness
  • Neuritis (inflammation of nerves) causing paralysis of muscles and nerves.
  • Difficulty swallowing and nasal speech
  • Airway obstruction
  • Low platelet levels in the blood (thrombocytopenia)4

How is diphtheria treated?

Diphtheria needs to be treated quickly in hospital to help prevent serious complications, such as breathing difficulties or heart problems.

The main treatments are:

  • Antibiotics (erythromycin, azithromycin, clarithromycin or penicillins)
  • Anti-toxin to counter the effects of the toxins produced by the bacteria
  • Thoroughly cleaning infected wounds  affecting the skin2
  • Completely immunised individuals should receive a single reinforcing dose of a diphtheria-containing vaccine according to their age.4

Treatment usually lasts between 2-3 weeks. Any skin ulcers heal within 2-3 months but may leave scars.

Anyone who has been in close contact with someone who has diphtheria may also need to take antibiotics or may be given a dose of the diphtheria vaccination.2

What advice is there for those travelling to high risk countries?

Get urgent medical help if diphtheria is suspected, especially if:

  • You are in an area of the world where the infection is widespread
  • You have recently returned from somewhere where the infection is widespread
  • You have been in close contact with someone who has diphtheria2

Travellers should be advised not to consume raw dairy products, to avoid close contact with cattle/farm animals and to follow good personal hygiene rules to minimise risk of infection.1

When to consider vaccination

An effective vaccination against diphtheria is available. In addition to vaccination, travellers should:

  • Ensure good personal hygiene (including regular hand washing)
  • Minimising hand contact with eyes, nose and mouth
  • Follow advice on prevention of food and water-borne diseases

Vaccination

The diphtheria vaccine is now only given as part of combined products:

  • Diphtheria/tetanus/acellular pertussis/inactivated polio/Haemophilus influenzae type b vaccines (DTaP/IPV/ Hib).
  • Diphtheria/tetanus/acellular pertussis/inactivated polio vaccines (DTaP/IPV or dTaP/IPV).
  • Tetanus/diphtheria/inactivated polio (Td/IPV)

These vaccines are inactivated, do not contain live organisms and cannot cause the diseases against which they protect. It can therefore be given safely to people with immunosuppression (including those with HIV) and to pregnant and breast-feeding women.5

Childhood vaccination programme:

The diphtheria vaccination is offered as part of the NHS routine childhood vaccination programme. It’s given by injection in 5 separate doses. These are normally given at:

References

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

References:

  1. Travel Health Pro: Diphtheria – Diseases in brief
  2. NHS: Diphtheria
  3. WHO: Risk areas for Diphtheria (adapted from WHO, 2017)
  4. patient.info: Diphtheria and diphtheria vaccination
  5. The Green Book: Chapter 5 – Diphtheria
  6. NHS: 6-in-1 vaccine
  7. NHS: 4-in-1 pre-school booster
  8. NHS: 3-in-1 teenage booster

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