One way pediatricians know that vaccines work is that diseases that were once very common are seldom seen in communities and countries with high immunization rates. I am old enough to have seen first-hand the suffering caused by the “14 Diseases You Almost Forgot About (Thanks to Vaccines)”, enumerated by the Centers for Disease Control and Prevention. Every one of them, that is, except this one:
Most of us only know diphtheria as an obscure disease from long ago, thanks to the diphtheria vaccine babies get. This vaccine, called DTaP, provides protection against diphtheria, tetanus, and pertussis (whooping cough). While preventable, diphtheria does still exist and causes a thick covering in the back of the nose or throat. It can lead to difficulty breathing, heart failure, paralysis, and even death. Make sure to vaccinate to help keep this dangerous infection from your kids.
Pediatric infectious disease specialist H. Cody Meissner, M.D. tells us that diphtheria used to be one of the most feared infectious diseases around — a major cause of childhood mortality with very high case fatality rates. The introduction of a vaccine to prevent diphtheria in the 1920s changed everything:
Recent estimates suggest that more than 85% of children globally receive the recommended three-dose infant schedule, and 14% receive no or partial vaccination. The Centers for Disease Control and Prevention estimates that 94% of U.S. children enrolled in kindergarten during the 2016-’17 school year received five doses of diphtheria, tetanus and acellular pertussis vaccine.
Despite high vaccination rates in the U.S., other countries have experienced outbreaks of diphtheria in recent years, including in Eastern Europe in the 1990s (more than 157,000 cases and 5,000 deaths), India from 2011-2015 (more than 18,000 cases), and Yemen just last fall (300 cases, 30 deaths).
Diphtheria is caused by Corynebacterium diphtheriae, which is quite contagious from person-to-person through respiratory droplets and direct contact. After becoming infected with a virus (called a bacteriophage), C. diphtheriae produces a toxin which causes severe, painful, and often deadly symptoms. The throat is most often affected, sometimes leading to obstruction of the airway. However, it is the bacterial toxin’s effect on the heart causing inflammation that leads to most deaths:
Diphtheria starts with a sore throat, mild fever (101 degrees or less), and chills. Next, the diphtheria toxin makes a thick coating in the back of the nose or throat. It may be white or grayish. The coating makes it hard to breathe or swallow.
The coating in the back of the nose or throat can get so thick that it blocks the airway, so the person can’t breathe.
The diphtheria toxin can affect the heart, causing abnormal heart rhythms and even heart failure. It can also affect the nerves and lead to paralysis (unable to move parts of the body).
About 1 out of 10 people who get diphtheria dies. In children younger than 5 years old, as many as 1 out of 5 children who get diphtheria dies.
Diphtheria toxoid is part of the DTaP vaccine given at 2-, 4-, and 6-months (so early in life because infection in young infants leads to higher death rates), 18-months and 4-6 years of age. A booster dose is given at 11 years old as the Tdap vaccine, followed by a booster dose of Tdap or Td vaccines every 10 years.
If you don’t remember the last time you got your tetanus booster (which contains diphtheria vaccine), it might be a good idea to call your doctor and get one. Vaccine-preventable bacteria and viruses are hiding in plain sight, waiting for immunity to decline just low enough to wreak havoc. Bolster your child’s immune defenses by making sure they are completely immunized and keep them safe with their scheduled periodic boosters.