Introduction

Diphtheria is a potentially fatal contagious bacterial infection that mainly affects the nose and throat, and sometimes the skin.

Diphtheria is highly contagious. Its spread by coughs and sneezes, or by contact with someone with diphtheria or items belonging to them, such as bedding or clothing.

The infection is usually caught after being in close or prolonged contact with someone who has the condition or is carrying the infection. For example, you may catch diphtheria from someone you live with.

However, diphtheria is very rare in England because most people have been vaccinated against it.Ittends to be a problem in parts of the world where fewer people are vaccinated, such as Africa, South Asia and the former Soviet Union.

What are the symptoms?

The symptoms of diphtheria include:

• a thick grey-white coating at the back of the throat
• a high temperature (fever) of 38C (100.4F) or above
• Strep throat
• breathing difficulties

Older people and people with a weakened immune system are more at risk of the effects of diphtheria. The most serious cases can be fatal.

An estimated 5-10% of people who get the infection will die from complications of diphtheria , such as breathing difficulties, inflammation of the heart (myocarditis) or problems with the nervous system.

Diagnosing diphtheria

A diagnosis of diphtheria can be confirmed by taking a sample of cells from the throat, nose or wound on the skin.

This will be examined to see whether the bacteria that cause diphtheria are present.

Treating diphtheria

Diphtheria must be treated quickly to prevent serious complications developing. If diphtheria is suspected, treatment will begin before any test results are confirmed.

Treatment for diphtheria comprises antibiotics and antitoxin medicine. Anyone suspected of having the condition will be put in isolation when theyre admitted to hospital. Those who develop heart and nervous system complications will need specialist treatment, and may need to be admitted to the intensive care ward.

Vaccination

All children should be vaccinated against diphtheria as part of the routine childhood vaccination schedule .

Adults should consider having a booster vaccine when travelling to parts of the world where diphtheria is widespread.

The vaccination programme has been very successful. Since 2010, there have been only 20 recorded cases of diphtheria in England and Wales, and one death. Diphtheria is a notifiable disease, which means that if a doctor diagnoses the condition, they must tell the local authority.

Even though the numbers of diphtheria cases in England is low, there's a risk that an outbreak could occur if the number of people who are vaccinated falls below a certain level.

This risk was demonstrated by the diphtheria epidemic that struck the countries of the former Soviet Union between 1990 and 1998. It resulted in 157,000 cases and 5,000 deaths. The epidemic was caused by an increase in the number of children who were not vaccinated against the disease.

All children should be vaccinated against diphtheria at two months of age as part of the routine childhood vaccination schedule.