Diphtheria

In October 2010, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation for Tdap vaccination -- the booster vaccine that provides protection against tetanus, diphtheria, and pertussis (whooping cough). While the vaccine had previously been recommended as a one-time booster for adults up to age 64, replacing an individual tetanus booster, the committee voted to expand that recommendation: anyone older than 65 who had not received a prior dose of Tdap should receive one if they expected to have close contact with an infant younger than 12 months old.

This recommendation was made partially in light of the California whooping cough epidemic. While whooping cough is typically less severe in adults, the infection can still be passed to infants, for whom infections are much more severe. Study data has indicated that grandparents, for example, are the ultimate source of the infection in 6-8% of cases. However, the committee noted that there was a direct benefit to the individual as well, since whooping cough tends to be more severe in adults older than 65 than in younger adults. (For more details, see "Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations" from the History of Vaccines blog.)

Although this recommendation was issued last October, some adults older than 65 who wanted to receive a Tdap booster had difficulties obtaining one due to confusion between the ACIP's recommendation and the FDA's approved label usage for the vaccine at the time. Neither of the two Tdap vaccines (Sanofi Pasteur's Adacel and GlaxoSmithKline's Boostrix) was approved by the FDA for use in adults older than 65. More

National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog will feature posts about several diseases that can be prevented by vaccination of infants.

Diphtheria, now nearly unknown in the United States, was once a common childhood affliction. In 1921 the country recorded more than 200,000 cases and more than 15,000 deaths, with the highest percentage of fatal cases among children younger than five. Although the last recorded case in the United States was in 2003, diphtheria remains endemic in many countries.

The disease is caused by a bacterium, Corynebacterium diphtheria, although the actual damage is not done by the bacterium itself. Instead, it secretes a toxin that damages the body's tissues. The most unique symptom of diphtheria is a thick gray substance that can spread over the nasal tissues, tonsils, larynx, and/or pharynx. This substance, called a pseudomembrane, can block the airways; in fact, diphtheria was known in Spain as "el garatillo" -- "the strangler." The toxin produced by the bacterium can also travel through the bloodsteam and damage other organs. More

The U.S. Supreme Court ruled on February 22 on Bruesewitz vs. Wyeth, upholding a federal law that established protection for vaccine makers from lawsuits and that provides compensation for certain vaccine injuries.

The Bruesewitz suit claimed that a vaccine Hannah Bruesewitz received in 1992 (her third dose of the diphtheria-whole cell pertussis-tetanus vaccine) was defective in its composition and thus resulted in the girl’s seizures and developmental delays. The Bruesewitz family earlier had been denied compensation from the National Vaccine Injury Compensation Program.

Antonin Scalia wrote the majority opinion, stating that "Vaccine manufacturers fund from their sales an informal, efficient compensation program for vaccine injuries; in exchange they avoid costly tort litigation and the occasional disproportionate jury verdict."  He asserted that the intention of the National Childhood Vaccine Injury Act of 1986 (which established NVICP) to exclude drug design defects from liability claims is evident in its “lack of guidance for design defects combined with the expansive guidance for the grounds of liability specifically mentioned.” More

In honor of National Immunization Awareness Month, we look at one of the diseases that immunization has nearly eliminated in the United States…

One of the fascinating things about the history of vaccinology is how quickly late 19th century researchers moved from identifying microbes as the cause of certain diseases to developing ways to treat and immunize people.

Diphtheria is a case in point. Edwin Klebs (1834-1913), a Swiss-German pathologist, identified and described the bacterium that causes diphtheria in 1883. (Just to point out the devastation that diphtheria caused, in 1883, the diphtheria death rate was 125 per 100,000 people in New York City.) A year later, German bacteriologist Friedrich Loeffler (1852-1915) became the first to cultivate Corynebacterium diphtheriae, and he then showed that C. diphtheriae produces a toxin. More