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Diphtheria
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Diphtheria is a highly contagious disease that is contracted by inhaling bacteria from an infected person. The disease is still common in 87 countries, with some strains continuing to circulate in parts of the U.S. Travel destinations where diphtheria is found include certain parts of Africa, Europe, Central America, the Caribbean, the former Soviet Republics, and Asia. Symptoms begin very much like a common cold, usually two to five days after transmission, but can progress quickly. In some cases, a membrane grows and covers the throat, which can block the airway. The infection can lead to heart failure and paralysis, and, if enough toxin from the membrane is absorbed into the bloodstream, coma or even death in as little as a week.
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Diphtheria was a common disease during the late 19th century. For example, from 1891 to 1895, Massachusetts recorded an average of 2,700 cases per year. New York averaged 7,200 cases per year.(3,4) The case-fatality rate was about five percent.(5,6) In the United States during the 1940's, the number of diphtheria cases fluctuated between 15,000 and 30,000 annually.(7) However, in 1980 a new pattern emerged, with only a few cases occurring each year. In fact, from 1980 to 1989, there were just 24 cases in the entire country. Eighteen of these (75 percent) were in persons 20 years of age or older. Two of the cases were fatal.(8) From 1990 to 2000 (an 11-year period), 25 cases of diphtheria were recorded.
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Diphtheria continues to occur in other parts of the world. A major epidemic of diphtheria occurred in countries of the former Soviet Union beginning in 1990. By 1994, the epidemic had affected all 15 Newly Independent States (NIS). More than 157,000 cases and more than 5,000 deaths were reported. In the six years from 1990 through 1995, the NIS accounted for more than 90 percent of all diphtheria cases reported to the World Health Organization from the entire world. In some NIS countries, up to 80% of the epidemic diphtheria cases have been among adults.
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Diphtheria is endemic in all European and American countries, and is apparently increasing, but the incidence varies greatly. It is far more prevalent on the continent than in England, and still more so in the United States and Canada. The following table, compiled from figures collected by Dr Newsholme, shows how London compares with some foreign cities. The figures give the mean death-rate from diphtheria and croup for the term of years during which records have been kept. The period varies in different cases, and therefore the comparison is only a rough one.
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Diphtheria is an acute, toxin-mediated disease caused by Corynebacterium diphtheriae. The name of the disease is derived from the Greek diphthera, meaning leather hide. The disease was described in the 5th Century B.C. by Hippocrates, and epidemics were described in the 6th Century A.D. by Aetius. The bacterium was first observed in diphtheritic membranes by Klebs in 1883 and cultivated by Löffler in 1884. Antitoxin was invented in the late 19th century, and toxoid was developed in the 1920s.
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Diphtheria can be prevented with a safe and effective vaccine. Most people receive their first vaccine as children in the form of a combined diphtheria-tetanus-pertussis vaccine (DTP). This vaccine is given at 2, 4, 6 and 15 months of age. A combination shot, called a Td booster, should be given once every 10 years to maintain immunity.
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Diphtheria