Diphtheria: What Exactly Is It ... And Why Is It Back?

npr ^ | December 8, 20173:33 PM ET | Rae Ellen Bichell

[BenLurkin]

In the first century, a doctor called Aretaeus of Cappadocia described the rotting smell of "Egyptian ulcers." Ancient Chinese medical literature mentions a disease called "children-killing carbuncle." In 17th century Spain there were references to an illness known as "the strangler."

They were talking about diphtheria, a highly infectious respiratory disease that colonizes a person's nose and throat, creating a thick layer of dead cells that can block the airway. It has always had a reputation for sickening children.

With the introduction of a highly effective vaccine in the 1920s and early '30s, diphtheria faded away in much of the world. Today it's largely considered a disease of the past. But now it's back in the headlines, spreading quickly in places like Bangladesh and Yemen. The World Health Organization says it is sending a shipment of antitoxins to Bangladesh this weekend, after six deaths in a Rohingya refugee settlement. The organization did the same last week for Yemen, where at least 30 have died of the bacterial infection, many of them children.

The disease is named for the bacterium that causes it: Corynebacterium diphtheriae. Diphthera is Greek for "skin" or "hide," a reference to the thick membrane that forms in air passages. It can be pronounced two ways: "diff-THEE-ree-uh" or "dip-THEE-ree-uh." How does it spread?

The bacterium that causes diphtheria can live in some people without causing them to show symptoms, which can occasionally lead to a Typhoid Mary-type situation where a person spreads it around without even realizing he has it.

It spreads between people in infected coughs and sneezes. Kids can also pick it up from playing with contaminated toys. Symptoms include sore throat, a low fever and lack of appetite, followed by a visible grayish coating in the nose or throat, and a swollen throat sometimes called a "bullneck."

What does it do to people?

The bacteria attach to the lining of the respiratory system and produce a poison that starts killing healthy tissue. It does so by preventing cells from creating proteins, which essentially shuts them down. After a few days, it can kill so many cells that dead tissue forms a grayish layer in the nose and throat that can make it hard to breathe or swallow. Essentially, it can choke a person on his own dead cells. If the poison also gets into the bloodstream, it can damage vital organs like the heart and kidneys. Interestingly, there are actually two layers of infection going on here, because it's a virus inside the bacterium that causes it to create the toxin in the first place. Eventually, the illness can cause nerve damage, paralysis and respiratory failure.

How do you treat it?

A vaccine was invented in 1921 but wasn't used widely until the 1930s. It is a modified form of the toxin that is not poisonous but still teaches the immune system to recognize the toxin in the future. These days, people usually get a three-in-one vaccine for tetanus, whooping cough and diphtheria.

Vaccines keep people from getting the illness in the first place. Typically, people are supposed to get a four-dose vaccine administered in the first 18 months of life, then a booster once before age 7 and again at age 11 or 12. Adults are supposed to get boosters once every 10 years, though some research has suggested that a booster every 30 years might be enough.

Once a person is sick, he has to take antitoxins and antibiotics to get rid of the infection. Antitoxins keep the poison from further harming the body. A 14-day course of antibiotics kills the bacteria. It takes about two days after starting antibiotics before a person is no longer contagious.

Without treatment, diphtheria can be a real problem. For example, in 1921, before the vaccine was available, the disease killed more than 15,000 people in the U.S. According to the Centers for Disease Control and Prevention, the U.S. has seen fewer than five reported cases in the past 10 years.

According to the CDC, even when people receive treatment, as many as 1 in 10 dies (and that ratio can be as high as 1 in 5 for children under the age of 5). For those who don't receive treatment, as many as 1 in 2 dies.

Why is it a problem in places like Yemen and Bangladesh? Infections can pop up under the wrong conditions, which include vaccination coverage below about 80 percent, malnutrition and lots of people living in close contact, and poor access to medical care, all of which are currently present in outbreak areas in Bangladesh and Yemen.

This year, more than half a million members of the Rohingya ethnic group have fled to Bangladesh from Myanmar, where violence against them, including execution, arson and rape, has been denounced by the United Nations and the U.S. State Department as ethnic cleansing. In a border city called Cox's Bazar, refugee camps reportedly house up to 30 people per tent.

In Yemen, WHO researchers reported that vaccination rates among children had dropped below 70 percent after a civil war started in 2015, meaning the population was no longer protected by herd immunity, the concept that if enough people are immune to a disease, any individual who hasn't been vaccinated won't encounter the disease. The vaccination rate remained low in 2016, at 71 percent. In the past few days, blockades have prevented organizations like Doctors Without Borders from shipping medical supplies. The country has also suffered from a shortage of health professionals since its central bank stopped paying them.

Could it make a comeback in other countries as well?

Yes. For example, in 1989 the Soviet Union had 839 cases of diphtheria. But when the Soviet Union fell — and with it, vaccination rates — cases of diphtheria shot up. Between 1994 and 1995, about 100,000 people came down with the illness in former Soviet states. By the end of the outbreak, about 5,000 had died.

To pick a much smaller example, in 1996 researchers found 11 people with diphtheria in South Dakota, where the infection was thought to have disappeared.

In Bangladesh, WHO and partner organizations are now training people to give vaccines against diphtheria and other diseases to all children under the age of 6.

[ProtectOurFreedom]

Good stuff. When I worked in China in 1976-1977, I had to get a huge battery of inoculations. The only place on the entire West Coast where I could get the shots was the VA hospital in SF. The battery included diphtheria, typhus, typhoid, yellow fever, and tetanus (I’m probably forgetting a couple others). I never knew what diphtheria did to you until reading this article. There was no Hepatitis A or Dengue Fever shot in those days, either. I wound up getting Hep A in Mexico.

I also thought it was pronounced “dip-ther-ia.” I never noticed the “h”after the “p” before!

[South Dakota]

You dont suppose it was reintroduced into our society by foreigners...noooooo

[jonascord]

"You dont suppose it was reintroduced into our society by foreigners...noooooo"

Let's not forget that there are leftist stupids who think that all vaccinations are some kind of Big Pharma corporate plot.

Never underestimate the power of a low IQ.

[jmacusa]

Pfffft! How could letting in millions of unvetted, uninoculated Third World garbage do something like that?, I mean, wtf, right?

[JudgemAll]

A J Liebling, a liberal, said the press communicated instead of informed, Diphteria, that is

[Bigg Red]

Mark

[LadyDoc]

You now need hep A AND hep B...but don't get dengue vaccine. It cuts the number of cases, but if you do come down with it, you have a higher chance to get the more severe version of the disease.
There is a huge scandal about this right now in the Philippines.
I never saw a case of diphtheria, but when I started medical school in the 1960s, the city still had an infectious disease hospital. Our teachers pointed out the bell at the entrance that they rang for help for children coming in with diptheria chocking on the membrane, so the doctor could do an emergency tracheostomy, that is cut open the windpipe so the kid could breathe.
Scarey. I had to do this surgery twice when I worked in Africa, but both cases turned out to be severe viral croup..

[cba123]

Very early. 1976-1977.

Interesting time then. Before Tian an Men. I think I have never met someone who went to China, so early before.

Nice to meet you.

[ProtectOurFreedom]

Thanks. Nice to meet you, too. Arrived in China two weeks after Mao had died and the country was in mourning. Huge amount of political upheaval at the time with lots of people jockeying tip for the top spot. There was no clear legal or electoral system to determine succession as is the case in all countries ruled by strongmen and charismatics. Spent seven months there at three remote fertilizer factory sites.

[GailA]

I’m neither, well informed, Conservative, who has witnessness the damage some cause; but want to know ALL the POSSIBLE SIDE EFFECTS OF ANY VACCINE. Some contain Mercury. I vaccinated my boys, had issues with the DPT shots, DR had to use the 1 minus the Pertusis.

I’ve seen the damage Gardasil did first hand to my 16 yr old non-sexually active grand daughter because her dumb mom believed the Pediatrician’s lies about the need for it. Covers 8 of 30 strains, it’s actually a STD DRUG, which is why the FDA & WHO, ETC are pushing it on our sons too. She is on the lawsuit list, she now has Rheumatoid Arthritis and Fibromyalgia and lives in constant pain and will end up in a wheel chair. $6 Million in death suits already. India, Spain, Japan have Banned it, India calls it Bill Gates Genocide drug.

[NativeSon]

"children-killing carbuncle" -Margaret Sanger?

[cba123]

I was there in 1979.

Also about 7 months, worked at a hotel there. It was just starting to open to the outside world way back then. Fascinating. I have not actually been back there since.

It is nice to meet you.

[cba123]

Or thinking back now, maybe 1981. Anyway it was back around the same time, but it was after you were there. Have a good one. 再见

[ProtectOurFreedom]

I have not been back since, either.

My main job site was in Shuifu, Yunnan Province. It was a village with a few mud houses, thatched roofs, no glass in the windows, and a bare single electric bulb hanging from the ceiling. The Chinese were very proud of this electrification. Villagers sold meat sitting in the dirt on the streets covered in flies. Water sanitation was boiling the water. Sewage flowed directly into the Yangtze River. There were no paved streets. There was one vehicle in the village, the bus used to transport the foreign workers from the guest house to the job site. The 40 year transformation is incredible:

That may be the fertilizer plant I worked to the right in the photo. When I was there, barge traffic on the river was hauled by gangs of men pulling tow ropes, not gasoline engines and not even draft animals. Kids about four years old helped unload bricks from the barges in bamboo backpacks.

[Exit148]

My first time was 1983. It was starting to get established then. But still had horse drawn wagons on city streets, and lots of Mao jackets. Now I see the traffic jams with cars all over. Times change!