Diphtheria is a respiratory disease where symptoms are caused by powerful toxin produced by strains of Corynebacterim diphtheria, and occasionally C. ulcernas. A skin form of disease can also occur and toxin is known to affect a number of tissues including heart, peripheral nerves and kidneys. It used to be a leading cause of mortality from an infectious disease until development of vaccine in 1940’s.  Diphtheria is an endemic disease, and outbreaks can still occur when immunity within population declines, such as in the elderly. In an epidemic in the Eastern Europe during mid 1990’s, it was reported over 150,000 cases with >4,000 deaths. In UK it is a rare disease with only few reported cases per year.

 

Vaccination is known to provide protection by production of antibodies to the diphtheria toxin. The vaccine is produced from chemically inactivated toxin, known as toxoid, using a traditional method developed in the 1940’s.  It is presented singly or in combination with other bacterial and/or viral antigens to form part of the primary immunization of children (e.g. DTaP or DTwP in combinations with IPV, Hib and/or HepB). Diphtheria toxoid is also included in vaccines for reinforcement of immunity of adults, where it is presented in reduced antigen form usually presented together with tetanus and IPV.

 

As part of therapeutic intervention diphtheria antitoxin can be given within 48 hours of diagnosis.