Regardless of the fact that diphtheria is regarded by a substantial number of people as an obscure contagious disease from prior years, it currently remains a global illness that attracts the particular attention of scientists, clinicians, and policy-makers. According to the World Health Organization, diphtheria is severe infectious disease caused by the bacterium Corynebacterium diphtheria (WHO 2018). It primarily infects upper airways and the throat and produces a toxin that affects other organs. This toxin kills tissue in the respiratory system and causes the dead tissue’s membrane to build up over the patient’s tonsils and throat, making swallowing and breathing difficult (CDC 2020). In general, diphtheria has an acute onset with the major symptoms that include sore throat, weakness, swollen glands in the neck, and mild fever (CDC 2020). In certain circumstances, the diphtheria toxin may cause peripheral neuropathy, airway blockage, kidney failure, myocarditis, paralysis, and death (WHO 2018). In addition, Corynebacterium diphtheria may infect the skin as well, causing ulcers or open sores (CDC 2020). At the same time, diphtheria skin infections do not lead to severe complications in the future.
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Diphtheria is traditionally spread from person to person in the result of breathing in the aerosolized secretions from the infected individuals’ coughs or sneezes (WHO 2018). In the case of diphtheria skin infections, individuals may get the disease from touching other people’s infected ulcers or open sores. Before the introduction of vaccination against diphtheria that has significantly reduced the morbidity and mortality rates, this disease was the major cause of childhood death in the United States and all over the world (Truelove et al. 2020). Due to the successful immunization program for the control over diphtheria of the American public health system, there are almost no outbreaks of this disease across the country. However, in 2018, the World Health Organization recorded more than 16,000 cases of this infection disease worldwide (WHO 2018). Diphtheria remains a severe child health problem, fatal in 5-10% of cases, in developing countries with the poor coverage of the Expanded Program on Immunization (Clarke et al. 2019).
Diphtheria treatment involves the administration of antibiotics and diphtheria antitoxin for the neutralization of the toxin’s effect. Diphtheria vaccine implies a bacterial toxoid whose toxicity is inactivated, and it is traditionally given in combination with a pentavalent vaccine or DTwP/DTaP vaccine (WHO 2018). For adults and adolescents, the diphtheria vaccine may be combined with the lower concentration of tetanus toxoid (WHO 2018). Diphtheria toxoid vaccine is essential for the control over the disease as it reduces the transmission of diphtheria by 60% (Truelove et al. 2020). In addition, its use is determined by the absence of severe adverse effects – common insignificant adverse effects of this vaccine traditionally include swelling, redness, and pain at the injection site (Liang et al. 2018). However, for the total prevention of subsequent outbreak, isolation of vaccinated individuals, the identification of their contacts, and the use of antibiotics are required (Truelove et al. 2020).
The World Health Organization recommends a three-dose primary vaccination series in children with diphtheria toxoid vaccine and three booster doses that follow it for the control over the disease (WHO 2018). The primary series begins at six-week of age, and subsequent doses should be given with a four-week minimum interval between doses (WHO 2018). Consequently, three booster doses should be given at 12-23 months, 4-7 years, and 9-15 years of age, respectively, and the four-year interval between booster doses is preferable (WHO 2018). It is highly essential for parents to follow their children’s immunization plan as the series of doses that provide high vaccination coverage protects against this life-threatening disease.
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Clarke K E N, MacNeil A, Hadler S, Scott C, Tiwari T S P, Cherian T. 2019. Global epidemiology of diphtheria, 2000–2017. Emerg Infect Dis. 25(10): 1834-1842. Web.
Liang J L, Tiwari T, Moro P, Messonier N E, Reingold A, Sawyer M, Clark T A. 2018. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 67(2): 1–44. Web.
Truelove S A, Keegan L T, Moss W J, Chaisson L H, Macher E, Azman A S, Lessler J. 2020. Clinical and epidemiological aspects of diphtheria: A systematic review and pooled analysis. Clin Infect Dis. 71(1): 89-97. Web.
[WHO] World Health Organization [Internet]. 2018. Geneva (CH): World Health Organization. Web.