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Diphtheria – why and how to vaccinate?

Diphtheria (respiratory or cutaneous diphtheria) is a worldwide infectious disease caused by the bacterium Corynebacterium (C.) diphtheriae.

Humans are the only reservoir for C. diphtheriae, and acquire the disease via direct contact with other people as a droplet infection. Those who transmit it are either ill with diphtheria themselves, or else the pathogen has colonized the mucous membranes in their respiratory tract. The latter have no disease symptoms but can still transmit the diphtheria pathogens and trigger the disease in others. The incubation period is usually 2-5 days.

Classical respiratory diphtheria manifests as pharyngo-tonsillar diphtheria with a sore throat, fever, and difficulty swallowing. During its course it causes hoarseness, stridor, paralyses of the soft palate and painfully swollen neck lymph nodes.

In laryngeal diphtheria, hoarseness, stridor, croupous cough and respiratory distress occur. The diphtheria pathogen creates toxins that can damage the heart and peripheral nerves, which ends in 5-10% of cases in death. The main risk factor for a fatal course is pharyngeal or laryngeal diphtheria that is established and treated with antibiotics too late. If complications have occurred in the heart and nerves, antibiotics no longer help. It is also too late for antitoxins, because they are useful only so long as toxins have not invaded the cells of the myocardium or nervous system.

The most important and effective preventive measure is vaccination against diphtheria. This is an active vaccination with a dead vaccine. Primary immunization requires 3 vaccinations at intervals of 1 and 6 months. Afterward, there is complete protection for 10 years. The first vaccination can and should be given from the age of 8 weeks. Every 10 years booster vaccinations must be given. In countries with vaccination rates of over 85% of the population, diphtheria is no longer endemic.

Initial diphtheria immunization is carried out in childhood as a multiple vaccination in addition to tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae. Even the booster inoculations should not be against diphtheria alone, but always combined with tetanus (called DT or diphtheria-tetanus vaccination) because this must also be refreshed every 10 years. In special cases the DT vaccine can and should be combined with pertussis or poliomyelitis.

Tolerance of the diphtheria vaccine is excellent. We will be happy to advise and vaccinate you and your family in Freiburg.

Prof. Dr. Markus Hufnagel,
senior physician at the department of General Pediatrics,
Medical Center - University of Freiburg