Topic: Diphtheria
Description
Diphtheria is an infection of the throat and nose caused by the Corynebacterium diphtheriae bacteria. Diphtheria can cause a membrane to grow around the inside of the throat which can lead to difficulty in swallowing, breathlessness and suffocation. Occasionally these bacteria can cause skin infections, usually in people with poor health or poor hygiene. Diphtheria has been rare in Australia since the introduction of an effective vaccine, but a century ago diphtheria was the commonest infectious cause of death. Outbreaks still occur in countries with low vaccination rates.
Symptoms
Symptoms include sore throat, swollen neck glands, and a discharge from the nose. The diphtheria bacteria can also produce a toxin which may cause serious complications such as paralysis and heart failure. Diphtheria is suspected when a white or grey membrane is seen on the back of the throat.
The time from contact with the bacteria and the development of symptoms is usually about two to five days, but can be longer.
Transmission
The disease is spread directly from person-to-person, by contact with airborne droplets from the nose or throat, or indirectly by contact with sores, or articles soiled with discharges from the nose or throat.
A person is considered non-infectious after receiving appropriate antibiotic therapy. Without antibiotic therapy, a person is usually infectious for approximately two weeks, but can be as long as six months.
Treatment
A person with diphtheria usually needs to be admitted to hospital for appropriate care and treated with antibiotics and the antidote to the toxin.
Control
- People with diphtheria need to be kept in isolation until they are proven to be free of the disease.
- Contacts (those having close physical association) of a person with diphtheria need to be investigated for the disease and are to receive appropriate antibiotics, regardless of their vaccination status.
- Vaccinated contacts should receive a booster dose of diphtheria vaccine if more than five years have elapsed since their last dose. Unvaccinated contacts should commence a primary course of diphtheria vaccination (three doses at 0, 1 and 2 months) plus two booster doses (children 6 months and 10 years, adults at 10 yearly intervals).
- Family or household contacts should be excluded from child care, school or work until cleared to return by an appropriate medical health care authority.
- Contacts whose work involves food handling or caring for unimmunised children are to be excluded from work until they are proven to be free of infection.
Prevention
Widespread vaccination against diphtheria is the only effective method of preventing the disease.
The diphtheria vaccine is available as a combination vaccine either as:
- diphtheria, tetanus, acellular pertussis–inactivated poliomyelitis vaccine (DTPa-IPV) for children less than 8 years of age, or
- lower dose diphtheria, tetanus acellular pertussis (dTpa) for children over 8 years of age, who have previously had a primary course of diphtheria-tetanus vaccine, or
- as a diphtheria, tetanus (dT) for adults.
Diphtheria is part of the National Immunisation Program and is recommended for:
- all children at 2, 4 and 6 months with a booster at 4 years of age
- adolescents between 15-17 years of age
- adults 50 years and over.
People travelling to countries where diphtheria is common should ensure their diphtheria vaccination is up to date.
Help and Assistance
For further information please contact your local doctor, community health centre, nearest population health unit or the 13HEALTH information line (13 432584).
Other Resources
References and related content
Heymann, D., ed. 2004. Control of Communicable Diseases Manual, 18th edition. Washington, DC: American Public Health Association.
National Health and Medical Research Council, 2003. The Australian Immunisation Handbook (9th Ed.) Canberra: National Capital Printing.
Diphtheria and immunisation fact sheet
Last Updated: 12th October, 2009
Date Valid to: 30th June, 2010
