A dreaded diphtheria from the past. How it manifests and when to revaccinate

For a long time it seemed that we did not have to worry about diphtheria as a disease. However, in the past two years, units of cases have started to reappear in the Czech Republic, and yesterday the state health agency announced that an eighty-two-year-old patient had died as a result of the disease. It was the first death from diphtheria since 1969.

In the first two months of this year, six patients were infected with diphtheria in the Czech Republic, compared to 7 in the whole of last year.

“It worries me, we'll see how it develops. Of course, it can't be evaluated yet, so far these are basically very low numbers. Compared to the trend of the last 30 years, they still worry me a lot,” says the Institute of Bacterial Pathogens of the Academy of Sciences of the Czech Republic's Institute of Microbiology. Peter Sebo, head of the Molecular Biology Laboratory.

“I don't think there's any reason to panic yet. But it will be over soon,” says the microbiologist.

How does the disease manifest itself?

Diphtheria (diphtheria) is an infectious disease caused by bacteria Corynebacterium diphtheriae. The disease mainly affects the upper respiratory tract and is spread mostly through droplets when talking, coughing or sneezing.

“There can be many forms of diphtheria, but perhaps the most dangerous is the throat form, which, if identified early, is very treatable. But if it is not detected in time, the problem arises, because the disease turns into a malignant form, when the bacterial toxin is already released into the patient's bloodstream with all the consequences,” said Epidemiologist Katerina Fabianova from the State Institute of Health explains.

As toxins are released into the bloodstream, they can affect nervous system, heart and kidney function.

“It's really a very dangerous disease, for people of all ages, not just for children, like whooping cough. If it starts to spread, it can become very dangerous. Diphtheria scares me,” says Sebo of the Institute of Microbiology of the Academy of Sciences.

What is the course of diphtheria?

The first symptoms can be seen after 2 to 5 days. Initially, this disease starts like angina. It is manifested by sore throat, weakness, patients may have tonsils, increased temperature or breathing difficulties, which is caused by swelling of the neck and lymph nodes.

“Grey pustules form in the throat and nose, which form on the mucous membrane, which are visible even to the naked eye and cannot be separated from the mucous membrane. If we try to do so, we get bleeding. These bubbles then spread towards the lower respiratory tract, contributing to the narrowing of the airway, which causes the patient to suffocate. lead,” explains Dr. Fabianova.

This disease, which is now highly preventable, was once a great fear. If we walk around the old cemeteries, we will see the graves of children between 3 and 5 years of age from the First Republic and Austro-Hungarian period, the cause of which was whooping cough and measles. or diphtheria.

Kateřina Fabiánová, Epidemiologist of the State Institute of Health

Why is diphtheria dangerous?

If treatment is not started within 2 to 3 days of infection, the disease will have a more serious course.

“If diphtheria is not treated, in the first week it turns into a non-malignant, that is, a malignant form. In the case of the skin form, for example, the disease remains on the surface of the wound for a relatively long time. When it is transferred from the wound to the patient's blood, when the bacteria begin to circulate in the blood,​​​​ “The problem is when it contributes to the deterioration of the patient's health,” says Fabianova.

World Health Organization (WHO) In the statesMortality of the disease ranges from 5 to 10%.

How is the treatment?

The breakthrough in the treatment of diphtheria was the discovery of antibiotics, which are still treated today. 48 hours after their administration, the patient usually stops the infection.

When to seek medical help?

Fabianova admits that she recognized diphtheria at an early stage It can be complicated even for doctors – without a more detailed examination. If you notice the above symptoms, it is better to consult a specialist.

“Respiratory infections are usually problematic, they start the same way, whether it's a viral flu or whooping cough, it's like diphtheria – whether it's bacterial. At first it looks the same. You don't feel well, your whole person aches, your muscles ache, you have a headache, but in the beginning It's very difficult to tell the difference,” says Fabianova, adding that it's not good to underestimate these symptoms.

Diphtheria in the last century

Since the mid-1920s the number of cases in Czechoslovakia has been on the rise. However, the most sick people were recorded during World War II. 1943 was a record year in this regard, with 347 cases recorded per 100,000 population, a total of nearly 40,000 people infected with diphtheria, and a mortality rate of between 5-8%.

Severity of diphtheria is indicated by CZSO data; Since 1919, several hundred people have died each year from diphtheria, mostly children under the age of 14. A positive change was brought about by treatment with the help of antibiotics and the introduction of compulsory vaccination of children starting in 1946.

The last two deaths from diphtheria were recorded in the Czech Republic in 1969. Since 1974, only isolated cases of this disease have occurred.

Source: State Institute of Health

How about vaccines?

Vaccination against diphtheria began in the Czech Republic in 1946. “This is a reaction to the huge epidemic that happened during the Second World War. We had big problems here, there were thousands of patients and, unfortunately, many deaths,” explains Fabianova.

Vaccination is mandatory in the Czech Republic and the first dose of the vaccine is given at the 9th week of life, and the child receives two doses in the following months. Revaccination takes place between 5 and 6 years, and the child receives the fifth dose between 10 and 11 years.

Who should consider revaccination?

After the fifth dose of vaccine, further revaccination is no longer mandatory. However, like the tetanus vaccine, doctors recommend it roughly every 10 to 15 years. “Almost any vaccine does not protect us for life, the immunity decreases, which means that the antibodies decrease and we become infected again,” explains the epidemiologist.

There is no mono-vaccination against diphtheria in the Czech Republic, so re-vaccination in combination of three – diphtheria, tetanus and whooping cough – is recommended. However, the rehabilitation is not paid by public health insurance companies, but by the patient himself.

The Ministry of Health said today that more than 70,000 vaccines are currently available from suppliers and distributors. In addition, additional extraordinary deliveries from Great Britain should be received in March.

“People who don't have a good immune system against it can be relatively adequate. Different old people like me who haven't been vaccinated for 40, 50 years, their immunity is not what it is. The system works like a used car,” says microbiologist Sebo.

How did diphtheria come about after all these years?

It is true that diphtheria has not occurred in the Czech Republic for more than two decades. Over the years, the last case was registered in 1995. Then the infection reappeared in 2022, and doctors diagnosed a total of 5 cases. Last year there were 7.

According to Fabianova, it is a combination of several factors. “First, I emphasize that diagnosis has improved. It is like other diseases, what is sought is discovered. If we have improved diagnosis, we can basically detect complex cases that were not investigated before,” he outlines a reason.

According to the doctor, another aspect is the aging population and the associated decline in immune status.

Fabianova disputes the fact that cases of diphtheria in the Czech Republic are related to high population migration. “Since during the investigation in recent years no cases in our country were connected with immigrants, I completely reject it. In addition, diphtheria occurred in Europe without the wave of immigrants that began in 2015. Although we were not in our territory before that, diphtheria was here,” says Fabianova.

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