Diphtheria is a disease that primarily affects the upper respiratory area. Children under the age of five and adults over the age of 60 are at highest risk of infection.

Diphtheria has almost been eliminated in the U.S., though occasionally cases still occur. There were only 52 cases diagnosed between 1980-2000, while only five cases were found between 2000-2007.

However, diphtheria is still a common ailment in those countries that do not immunize against the disease. With the number of people traveling to and from the U.S. every day, the risk of infection exists.

Diphtheria can be prevented by vaccination but because some parents may choose to not immunize their child, it is possible that a case of this infectious disease can occur in your childcare setting.

What Causes Diphtheria?

Diphtheria is caused by a bacterium called Corynebacterium diphtheriae. These bacteria live in or on the mucous membranes of the back of the throat and nose of an infected person. Inflammation of these membranes occurs, causing swelling and pain.
The bacterium releases a toxin (poison) into the bloodstream. As this toxin spreads throughout the body, it can cause damage to the heart, brain and nervous system.

How Is Diphtheria Transmitted?

Diphtheria is a highly contagious disease. It is usually passed from person-to-person by droplet spray. As the person with diphtheria coughs, sneezes, talks, or laughs, droplets loaded with the diphtheria bacteria spray through the air.

In the early care and education setting, diphtheria can be spread if an infected child sneezes and droplets land on toys, books or playground equipment. Another child may come in contact with these droplets, touch their mouth, and the infectious cycle begins. This child has now been exposed to the disease and may become infected.

Children who have been exposed to the diphtheria germ can infect others for up to four weeks, even if they do not exhibit any symptoms. The incubation period, or the time it takes for a person to become infected after being exposed, for diphtheria is two-four days, although it can range from one-six days.

Factors that influence the chance of catching diphtheria include living in crowded or unsanitary conditions, being malnourished, or interacting with those not immunized against the disease.

Diphtheria Symptoms

Following an incubation period of two-five days after exposure, a child may start experiencing sore throat, fever, malaise, hoarseness, and difficulty swallowing. As the disease progresses, a gray membrane forms on the back of the throat.

Other symptoms, such as swelling of the lymph nodes of the neck, may develop. As the membrane grows, it may extend into the upper airway (trachea) and this can lead to obstruction, suffocation, and death.

Diphtheria can have serious complications. The toxin generated by the bacterium can spread throughout the body and cause problems with other organs in the body, such as myocarditis (an inflammation of the heart).

Nerve inflammation can lead to paralysis of any body part; for example, paralysis of the soft palate on the roof of the mouth can lead to swallowing problems, while paralysis of the diaphragm can lead to pneumonia, respiratory failure and death.
The membrane that forms at the back of the throat can lead to suffocation. The fatality rate of those who get the disease and do not get treated can be 40-50 percent.

Treating Diphtheria

If a diagnosis of diphtheria is suspected, a diphtheria antitoxin is administered before laboratory results of the culture confirm the diagnosis. This antitoxin helps to prevent damage caused by the bacterial toxin to vital organs. Antibiotics are also given to treat the infection.

When a child is diagnosed with diphtheria, the local health department will be notified by health care professionals. Everyone in the household who may have been exposed to the bacteria will need to receive medical care including an assessment of immune status, throat cultures, and booster doses of the diphtheria vaccine, if required. Family members also will receive antibiotics as a precaution.

If a child in your childcare setting is diagnosed or suspected to have diphtheria, contact your local health department to see if preventive treatment might be necessary for childcare staff and children who may have been exposed to this disease.

How Is Diphtheria Prevented?

Prior to adoption of immunizations against it, diphtheria was a dreaded common childhood illness. Unlike measles and chicken pox, having the disease of diphtheria did not give immunity. A child could survive the disease and then become infected again.

In the 1940s, a vaccine for diphtheria was developed and because of immunization, infection with diphtheria is almost unheard of in the U.S. today. Diphtheria vaccine is now combined with the tetanus and pertussis (whooping cough) vaccines to form the immunization called DTaP. Children should get five doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months, and 4-6 years.

Adolescents and adults should have booster vaccines every 10 years or after an injury with possible exposure to tetanus. A new booster was developed in 2005; this vaccine, called Tdap, protects against tetanus, diphtheria, and pertussis.

Although most children tolerate the vaccine with no difficulty, some children may experience mild side effects such a low-grade fever, redness or tenderness at the injection site, or a general fussiness or crankiness. Severe complications, such as an allergic reaction, are rare with this vaccine.

Immunization Policy

All early childhood education programs should follow a written policy requiring documentation of up-to-date immunization for all children. Immunization records should be included in the current health records for each child.

Caring for our Children: National Health & Safety Performance Standards states that infants, toddlers, older children, and adolescents should be immunized as specified in the Recommended Childhood Immunization Schedule. Because of frequent changes, an updated schedule is published every January; this schedule is posted at www.cdc/gov/vaccines.

Diphtheria and other preventable diseases can be serious and even life-threatening. It is essential that all children under your care be properly immunized.

Joe Knight
Medical Writer and Physician Assistant, Chowchilla, California

Internet Resources

Caring for Our Children; National Health and Safety Performance Standards, nrc.uchsc.edu

Centers for Disease Control & Prevention (CDC), www.cdc.gov/vaccines/vpd-vac/diphtheria/default.htm

Diphtheria Facts, www.dhpe.org/infect/dip.html

Mayo Clinic, www.mayoclinic.com/health/diphtheria/DS00495/DSECTION=prevention