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A Physician's Duty: Serving in Pestilence and in War
National Infant Immunization Week: Spotlight on Diphtheria
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.
Diphtheria can be prevented by vaccination. In the United States, this vaccine is available as part of the combination DTaP vaccine (diphtheria, tetanus, and pertussis). The recommended immunization schedule for children between 0 and 6 years of age recommends five doses of the DTaP vaccine, with the first dose at two months of age. Adults are also recommended to receive a booster Tdap dose (tetanus, diphtheria, and pertussis) vaccine every 10 years, as immunity from the vaccine is not lifelong.
For more information about diphtheria, you can see our diphtheria article or diphtheria timeline. One entry in particular, "The Plague Among Children," demonstrates the deadly toll the disease once took, documenting a 1735 diphtheria epidemic in New England.