Immunisation & Vaccine Preventable Diseases

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Immunisation and Vaccines

Diphtheria

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