Who is at risk for diphtheria?

Diphtheria is mainly transmitted through the respiratory tract, caused by diphtheria bacilli (Corynebacterium diphtheriae).

Who is at risk for diphtheria?

The disease can occur at any age, but 70% of cases occur in children under 15 years old who have not been vaccinated. Even with treatment, the mortality rate is up to 5-10%. Diphtheria is classified as a group B infectious disease (dangerous infectious diseases that can spread rapidly and cause death) in the Law on Prevention and Control of Infectious Diseases.

In Vietnam, thanks to the diphtheria-pertussis-tetanus (DPT) vaccination strategy in the expanded immunization program since 1981, the diphtheria infection rate has decreased sharply in the 2010s. However, since 2013, sporadic outbreaks have occurred, mainly in the Central Highlands provinces, and recently in the northern provinces such as Ha Giang, Dien Bien, and Thai Nguyen.

How dangerous is diphtheria?

Diphtheria can cause many dangerous complications, called malignant diphtheria, if not treated promptly. The most common complications are cardiac complications (usually myocarditis and cardiac conduction disorders) and neurological complications (causing paralysis). In addition, complications may occur in the kidneys, liver, and adrenal glands.

Transmission route

The source of diphtheria is infected patients or healthy people who carry the bacteria but do not show symptoms of the disease.

The disease is mainly transmitted through the respiratory tract when coming into contact with droplets from an infected person when coughing or sneezing. In addition, the disease can be transmitted indirectly when coming into contact with objects contaminated with nasal secretions from an infected person. The disease can also be transmitted through contact with skin lesions caused by diphtheria.

Symptoms

The most common form of diphtheria is in the respiratory tract (nose, throat, larynx, tracheobronchial), of which 70% is pharyngeal diphtheria. In addition, other locations can be infected such as cutaneous diphtheria, ocular diphtheria.

With pharyngeal diphtheria, after an incubation period of 2-5 days, the patient begins to show symptoms such as mild fever of 37.5-38 degrees Celsius, sore throat, discomfort, runny nose that may be mixed with blood; examination of the throat may reveal a slightly red throat, with faint white spots on the tonsils; palpable small, mobile, painless neck lymph nodes.

After about 3 days, the disease enters the full-blown stage with the most typical symptoms: Fever increases to 38-38.5 degrees Celsius, painful swallowing, pale skin, fatigue, runny nose, white nasal discharge or pus; examination of the throat shows pseudomembranes spreading on one or both sides of the tonsils, possibly covering the uvula and palate; painful, swollen lymph nodes in the neck, when there are signs of a bull neck, it is a serious sign.

Extensive pseudomembranes can cause wheezing, airway obstruction and respiratory failure, even death if not treated promptly. If diagnosed and treated early, pseudomembranes disappear quickly (1-3 days), the patient's fever subsides and he or she gradually recovers after 2-3 weeks.

How to treat diphtheria?

Diphtheria needs to be detected and treated early to avoid complications and possible death. The main treatment for diphtheria is diphtheria antitoxin (SAD), which should be used as soon as possible to neutralize the diphtheria toxin still circulating in the blood (most effective within the first 48 hours). In addition, antibiotics (usually Penicillin and Erythromycin) are also used to prevent the growth and production of toxins by bacteria and reduce the spread of the disease.

Other combination treatments are also used such as corticosteroids, airway management, cardiovascular management, and nutrition.

How to prevent diphtheria?

All patients with suspected diphtheria must be hospitalized for isolation, monitoring, diagnosis and treatment. The patient's house, equipment in the room, belongings and clothing must be disinfected and sterilized. Hand washing must be performed properly with soap or antiseptic solution. People in contact with diphtheria patients must be given prophylactic antibiotics.

Diphtheria vaccine plays an important role in protecting the body from infection and reducing the incidence of the disease in the general population. Therefore, children need to be fully vaccinated (Diphtheria - Pertussis - Tetanus, DPT) according to the vaccination program. Adults should be re-vaccinated with diphtheria vaccine every 10 years to strengthen the body's immunity.