Period of communicability About weeks

Occurrence and distribution Commonly a disease of children, diphtheria can occur in non-immunized adults with serious results. Outbreaks of the disease are seen, but it is probably a much more frequent disease than realised, as sub-clinical transmission through skin and possibly nasal lesions, maintains immunity. This was probably the situation in many tropical countries, but now universal childhood vaccination programmes are protecting young children. A breakdown of these programmes, or remaining pockets of unvaccinated adults, leads to serious disease.

Control and prevention Diphtheria is prevented by vaccination of all children with three doses of diphtheria toxoid. This is normally combined with pertussis and tetanus as triple vaccine commencing in the first or second month of life. Ideally, a booster dose should be given at 18 months to 4 years of age. As with polio and rubella vaccination, diphtheria immunization shifts the likelihood of disease to an older and more dangerous age so complete coverage of all children is imperative. Adults visiting an endemic country from one in which the vaccination status is good, should have an adult-type booster (adult Td) in which the concentration of the toxoid is reduced. Ideally, adults, particularly travellers, should have booster doses of adult Td every 10 years.

In the event of an outbreak, previously vaccinated contacts should be given tetanus and diphtheria toxoids and those not vaccinated the toxoid and an antibiotic (ery-thromycin or penicillin).

Treatment If diphtheria antitoxin is available, it should be given to cases following a test dose for hypersensitivity. Erythromycin or procaine penicillin G should be used for specific treatment.

Surveillance Diphtheria is a notifiable disease in most countries.

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