Angels, Bulls & Diphtheria?

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Diphtheria is a disease so distant, so lost in the past that many parents do not believe there is a need to vaccinate their children against it. However, diphtheria has neither changed nor disappeared. It remains prevalent in certain parts of the world where it is still a life-threatening disease in children. According to the WHO, there were 30,000 cases and 3,000 deaths of diphtheria reported worldwide in 2000.

In Malaysia, the number of reported diphtheria cases has declined dramatically since the late 1980s, due to improved living conditions and the use of the diphtheria vaccine. To ensure this trend continues we should continue to immunise our children against this disease.

In this article, we will share with you essential information about diphtheria. We will also share the plight of generations of children in the past, who grew up in a time when there was no vaccine against this disease. Hopefully, this would allow you to understand the importance of immunising your children.

How Diphtheria Got Its Name

Diphtheria was given the name ‘Strangling Angel’ for the wing-shaped patches of the grey-white membrane that often forms on a child’s tonsils. Eventually, these patches fill up and block the throat, voice box and lungs, causing the child to suffocate. It was a major cause of illness and death among children in the world. It was common for parents to lose their child to diphtheria within a matter of days.

It was said that children died so quickly and in such great numbers that there wasn’t enough time to hold funeral services or processions. In 1921, there were 206,000 recorded cases of diphtheria and 15,520 deaths in the USA alone. Many families voluntarily locked themselves in their homes in an attempt to keep their children safe.

At its peak, diphtheria was such a devastating disease that healthcare professionals like doctors and nurses of the day viewed it as one of the most difficult childhood disease to treat and control. Often, they could offer little more than sympathy and advice to the parents on how to make their children’s final days as comfortable as possible.

Diphtheria is caused by the contagious bacteria, Corynebacterium diphtheria, which primarily affects the mucous membranes of the upper respiratory tract. The diphtheria bacteria releases toxins which can cause paralysis in muscles. These toxins remain in the body for months, and when they reach the heart, they can cause abnormal rhythms and heart failure.

How It Spreads

Diphtheria is a contagious disease. It can be easily transmitted from person to person, usually via respiratory droplets when the infected person coughs sneezes or talks.

It can also spread through close contact, which is why diphtheria are often found in urban areas especially in poorer towns and cities where overcrowding is commonplace.

Infected individuals can remain infectious for two to three weeks following the initial exposure to the bacteria. Furthermore, some infected individuals may not show symptoms of infection, and therefore unknowingly transmitting the disease to other people.

Signs And Symptoms

Diphtheria often affects children of very young age, who are unfortunately weaker and therefore harder to treat. The initial symptoms of diphtheria are generally non-specific and usually appear after 2-5 days after initial infection.

They typically include:
• Sore throat;
• Coughing;
• Headaches;
• High fever;
• Tiredness;
• Difficulty swallowing;
• Foul-smelling, bloodstained nasal discharge;
• Swollen glands in the neck;
• Difficulty breathing.

As the disease progresses, a grey-white membrane would often develop inside the throat and cause the neck to swell, giving infected individuals a “bull-neck” appearance. Over time, this grey-white membrane would increase in size and become large enough to block the airways, leading to possible life-threatening complications.

Complications Of Diphtheria

Once the grey-white membrane in diphtheria begins to obstruct the airways, the infected person would find it near-impossible to swallow, speak, and later, breathe. This could lead to suffocation and death.

Other complications associated with diphtheria may include:
• Damage to the heart muscle (myocarditis),
• Inflammation of nerves (neuritis),
• Nerve damage;
• Paralysis;
• Respiratory failure;
• Pneumonia;
• Ear infection.

Protection Against The Strangling Angel

The first diphtheria vaccine was introduced in the 1920s and led to significant reductions in the number of cases in the following years. The diphtheria vaccine contains an inactive diphtheria toxoid that will stimulate antibody production against the toxin and confer immunity.

Then in 1948, the diphtheria vaccine became part of the triple antigen vaccine DTP (diphtheria-tetanus-pertussis). In Malaysia, infants are given three shots against diphtheria in the first year of life at 2, 3, and 5 months. Protection is topped up with a booster dose before starting school at 18 months of age and again at 7 years in the form of a DT booster vaccine (DTaP in some private facilities).

However, in adolescents and adults, immunisation needs to be repeated every ten years to ensure an appropriate level of antibodies is maintained to protect against diphtheria. There is a booster vaccine called Tdap that will do this, and as such it is recommended for individuals from the age of 15 get their Tdap boosters every 10 years.

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