Causative Agent
Corynebacterium diphtheriae (toxin producing strains).
Clinical Description
Diphtheria is an acute bacterial disease resulting from toxigenic
C. diphtheriae or more rarely C.ulcerans infection
of the upper respiratory tract and occasionally the skin. An inflamed
thick greyish adherent membrane forms at the site of infection, which,
in severe cases, may cause respiratory obstruction (croup). Other severe
complications can include toxin-induced myocarditis and peripheral neuritis.
The case fatality ratio for respiratory diphtheria is 5-10%.
Transmission
Respiratory transmission through contact with an infectious individual,
or, rarely, indirectly via fomites. The incubation period is usually
two to five days. A patient with clinical diphtheria is infectious for
two to four weeks after onset, although rarely chronic carriers may
shed bacteria for up to six months.
Surveillance in Scotland
- Laboratory reports of toxigenic Corynebacterium diphtheriae.
- Statutory notification of respiratory diphtheria by clinical diagnosis.
Definition for Surveillance Notification (suggested)
Any person with one of the following:
- laryngitis or
- pharyngitis or
- tonsillitis
and
- adherent membrane of the tonsil(s), pharynx, and/or nose.
(Centers for Disease Control and Prevention/World Health Organisation)
Laboratory Report
Laboratory reports of toxigenic Corynebacterium diphtheriae
or Corynebacterium ulcerans
Incidence
Notifications for diphtheria and laboratory reports of toxigenic C. diphtheriae are extremely rare. However the threat from imported organisms remains, most notably in recent years from the former Soviet Union states.
Diphtheria Notifications and Vaccine Uptake
Scotland 2000-2009
Year |
Vaccine Uptake* (%) |
Notifications (all ages) |
2000 |
97.6 |
0 |
2001 |
97.5 |
0 |
2002 |
97.4 |
0 |
2003 |
97.6 |
0 |
2004 |
97.6 |
0 |
2005 |
97.4 |
0 |
2006 |
97.9 |
0 |
2007 |
98.0 |
1 |
2008 |
98.2 |
0 |
2009 |
98.4 |
0 |
* Uptake rates by 24 months |
Prevention
Vaccination against diphtheria was introduced in the 1940's. Diphtheria
vaccine is still included in the UK childhood immunisation schedule,
with routine primary vaccination recommended at two, three and four
months, a booster dose at three to five years and a low dose booster
at 13-18 years.
Further Information
Vaccine Uptake
This can be found on the Information Services Division (ISD) website:
Notifications of infectious diseases
European Diphtheria Surveillance Network
Global perspective on diphtheria from the World Health Organisation
Last reviewed: 14 December 2010
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