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Diphtheria Is Still a Threat

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The respiratory infection diphtheria has been almost eradicated by vaccines. But not quite. Most of us hear about it only in terms of the diphtheria, tetanus, and pertussis vaccine.

The Centers for Disease Control and Prevention (CDC) website tells us there has not been a confirmed case in the United States since 2003. However, the disease remains endemic in other parts of the world. International travel has the potential to put anyone at risk.

Diphtheria cases for 2011 include the following from Europe and Indonesia:

1. Dr. Anja Berger reported in the November 1, 2011 issue of Annals of Internal Medicine that a 62-year-old diabetic woman from Dinkelsbuhl, Germany, contracted diphtheria from a stray cat bite.

2. Elly Burhaini Faizal reported in The Jakarta Post on October 12, 2011 that an outbreak in East Java, Indonesia, produced 48 cases, prompting the government to allocate $896,000 for vaccines and treatment.

3. Cyril Rousseau and colleagues reported 2 cases in France in the May 12, 2011 issue of Euro Surveillance. One was a 40 year-old unvaccinated French man who went to his doctor with a sore throat. He was treated with antibiotics. His partner, who had been vaccinated, was identified as a carrier with no symptoms, and also treated with antibiotics.

The CDC website provides a description of diphtheria illness. It is caused by the bacterium Corynebacterium diphtheriae. There are two types, respiratory and cutaneous.

The respiratory infection begins with a sore throat and fever. It may produce airway obstruction along with heart and nerve damage. Death occurs in 5 to 10 percent of respiratory diphtheria. The cutaneous version produces skin lesions which are less likely to be fatal. Transmission occurs by person-to-person contact with respiratory secretions or skin lesions.

American adults who travel to countries with high diphtheria rates are at risk. Vaccination rates are high in children, but immunity wanes with time. Booster shots are recommended every ten years. The CDC provides a comprehensive list of countries where diphtheria poses a risk for travelers.


1. Berger A et al, “Human Diphtheria From a Cat Bite”, Annals of Internal Medicine 2011 Nov. 1; 155(9): 646-8. Web. November 7, 2011.

2. The Jakarta Post. Elly Burhaini Faizal. October 12, 2011. E. Java ravaged by diphtheria epidemic, govt sends vaccines. Web. November 7, 2011.

3. Rousseau C et al, “Diphtheria in the south of France, March 2011”, Euro Surveill 2011 May 12; 16(19). pii: 19867.

4. Centers for Disease Control and Prevention. Diphtheria. Web. November 7, 2011.

5. Centers for Disease Control and Prevention. Traveler's Health. Infectious Diseases Related to Travel. Web. November 7, 2011.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

Reviewed November 29, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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