DIPHTHERIA

Overview:

Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Diphtheria causes a thick covering in the back of the throat. It can lead to difficulty breathing, heart failure, paralysis, and even death. Diphtheria once was a major cause of illness and death among children. Before there was treatment for diphtheria, up to half of the people who got the disease died from it. Starting in the 1920s, diphtheria rates dropped quickly in the United States and other countries with the widespread use of vaccines. In the past decade, there were less than five cases of diphtheria in the United States reported to CDC. However, the disease continues to cause illness globally. 

Mode of Transmission:

Aerosolized droplet

 

Examples of Transmission: 

Diphtheria is spread (transmitted) from person to person, usually through respiratory droplets, like from coughing or sneezing. Rarely, people can get sick from touching open sores (skin lesions) or clothes that touched open sores of someone sick with diphtheria. A person also can get diphtheria by coming in contact with an object, like a toy, that has the bacteria that causes diphtheria on it. Risk factors for transmission include lack of immunization and crowded environments.

 

Prevention:

The best way to prevent diphtheria is to get vaccinated. There are four vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of these vaccines prevents diphtheria and tetanus; DTaP and Tdap also help prevent pertussis (whooping cough). DTaP and DT are given to children younger than seven years of age, while Tdap and Td are given to older children, teens, and adults. Adults should continue to receive the tetanus and diphtheria booster every ten years.

 

Precautions: 

Droplet and Universal precautions

 

The diphtheria bacteria creates toxins that destroy healthy tissues in the respiratory system. Within two to three days, the dead tissue forms a thick, gray coating that can build up in the throat or nose. This thick gray coating is called a “pseudo membrane.” It can cover tissues in the nose, tonsils, voice box, and throat, making it very hard to breathe and swallow. These toxins may even spread into the bloodstream and lead to life threatening complications. Symptoms start between 2 and 5 days after exposure.

 

Signs and symptoms of diphtheria may include:

  • Sore throat (mild to severe) •    Drainage from the nose (watery or bloody)

  • Breathing difficulties •    Barking cough (similar to that seen with Croup)

        • Fever •     Skin ulcers are rare but can occur

        • Painful swallowing •     Swollen glands in the neck

Complications:

Recovery is typically a slow process with diphtheria. The illness may be mild in some or life threatening in others. Complications that are more serious include: myocarditis, nerve damage (polyneuropathy), paralysis, respiratory failure or pneumonia. For some people, diphtheria can lead to death. Even with treatment, about 1 out of 10 diphtheria patients die. Without treatment, as many as 1 out of 2 patients can die from the disease.

 

Exposure Determination:

A significant airborne exposure is a combination of a subject (source) showing signs/symptoms of suspected airborne illness plus an activity that would place you at risk of droplet or airborne exposure. 

  • Source of Exposure: Any aerosolized exhalation, sputum, or saliva, either by source coughing, spitting, breathing;

Or any pulmonary (lung) secretions either brought forth by patient (source) themselves or by suctioning while you were not wearing appropriate barrier protection. 

  • High Risk Activities: The following activate the gag/cough reflex. Manual suctioning of naso-pharyngeal airway, insertion of nasogastric tube, and endotracheal intubation.

 

Other factors to consider:

Transport time, proximity to the source, ventilation, and PPE used

 

Immediately Following Exposure:

Seek medical attention. Doctors usually decide if a person has diphtheria by looking for common signs and symptoms. They can use a swab from the back of the throat and test it for the bacteria that cause diphtheria. It is important to start treatment right away if a doctor suspects diphtheria and not to wait for laboratory 

confirmation

 

Post Exposure Treatment:

Post exposure prophylaxis for anyone who has encountered diphtheria includes immunization with the diphtheria toxoid or a booster if they have been previously vaccinated. After the provisional clinical diagnosis has been made and appropriate cultures are obtained, persons with suspected diphtheria should be given antitoxin and antibiotics in adequate dosages. And at all times respiratory status and airway maintenance should be closely monitored while providing interventions as needed.

The recommended antibiotic treatment for diphtheria is erythromycin, or penicillin. Diphtheria patients are usually kept in isolation, until they are no longer contagious — this usually takes about 48 hours after initiation of the antibiotics. After the completion of antibiotic therapy, the doctor will run tests to make sure there is complete elimination of the organism, this should be verified by two consecutive negative cultures results.

 

Paperwork Required:

  1. OC Public Health Communicable Disease Exposure Form (policy 330.96) with Fire incident number on top. Must be faxed while still in the hospital Fax: (714) 564-4050

OC Public Health Communicable Disease Exposure Form 

  1. The City “Report of Employee Injury” form

  2. Medical Service Order- RM -67 (when medical care is required)

**Immediate telephonic reporting of disease exposure must be made to OCHCA Epidemiology even prior to laboratory confirmation. Telephone: (714) 834-8180. For urgent reports on holidays, weekends, or after regular work hours, contact the public health official on call at (714) 628-7008.

Call

M: 949-769-1162

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