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Diphtheria and Diphtheria Toxoid

Diphtheria and Diphtheria Toxoid. Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention. Revised March 2002. Diphtheria. Greek diphtheria (leather hide) Recognized by Hippocrates in 5th century B.C.

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Diphtheria and Diphtheria Toxoid

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  1. Diphtheria and Diphtheria Toxoid Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised March 2002

  2. Diphtheria • Greek diphtheria (leather hide) • Recognized by Hippocrates in 5th century B.C. • Epidemics described in 6th century • C. diphtheriae described by Klebs in 1883 • Toxoid developed in 1920s

  3. Corynebacterium diphtheriae • Aerobic gram-positive bacillus • Toxin production occurs only when C. diphtheriae infected by virus (phage) carrying tox gene • If isolated, must be distinguished from normal diphtheroid

  4. Diphtheria Clinical Features • Incubation period 2-5 days (range, 1-10 days) • May involve any mucous membrane • Classified based on site of infection • Anterior nasal • Tonsillar and pharyngeal • Laryngeal • Cutaneous • Ocular • Genital

  5. Pharyngeal and Tonsillar Diphtheria • Insidious onset of exudative pharyngitis • Exudate spreads over 2-3 days and may form adherent membrane • Membrane may cause respiratory obstruction • Fever usually not high but patient appears toxic

  6. Diphtheria Complications • Most attributable to toxin • Severity of generally related to extent of local disease • Most common complications are myocarditis and neuritis • Death occurs in 5%-10% for respiratory disease

  7. Diphtheria Antitoxin • First used in 1891 • Produced in horses • Used only for treatment of diphtheria • Neutralizes only unbound toxin

  8. Diphtheria Epidemiology • Reservoir Human carriers Usually asymptomatic • Transmission Respiratory Skin and fomites rarely • Temporal pattern Winter and spring • Communicability Up to several weeks without antibiotics

  9. Diphtheria - United States, 1940-2001* *2001 provisional data

  10. Diphtheria - United States, 1980-2001* *2001 provisional data

  11. Diphtheria – United States, 1980-2000 Age Distribution of Reported Cases N=49

  12. Diphtheria in the Newly Independent States • Outbreak began in 1990 in the Russian Federation • All 15 NIS affected by 1994 • >157,000 cases and 5000 deaths • Adults accounted for many cases

  13. Diphtheria 7-8 Lf units 2 Lf units Tetanus 5-12.5 Lf units 5 Lf units DTaP, DT Td (adult) DTaP, DT, and Td Pertussis vaccine and pediatric DT used through age 6 years. Adult Td used for persons 7 years and older.

  14. Diphtheria Toxoid • Formalin-inactivated diphtheria toxin • Schedule Three or four doses + booster Booster every 10 years • Efficacy Approximately 95% • Duration Approximately 10 years • Should be administered with tetanus toxoid as DTaP, DT, or Td

  15. Dose Primary 1 Primary 2 Primary 3 Primary 4 Age 2 months 4 months 6 months 15-18 months Interval --- 4 wks 4 wks 6 mos Routine DTaP Primary Vaccination Schedule

  16. Children Who Receive DT • The number of doses of DT needed to complete the series depends on the child’s age at the first dose: • if first dose given at <12 months of age, 4 doses are recommended • if first dose given at >12 months, 3 doses complete the primary series

  17. Routine DTaP ScheduleChildren <7 years of age • 4-6 years, before entering school • 11-12 years of age if 5 years since last dose (Td) • Every 10 years thereafter (Td) Booster Doses

  18. Dose Primary 1 Primary 2 Primary 3 Interval --- 4 wks 6-12 mos Routine Td Schedule Persons >7 years of age Booster dose every 10 years

  19. Diphtheria and Tetanus ToxoidsAdverse Reactions • Local reactions (erythema, induration) • Exaggerated local reactions reactions (Arthus-type) • Fever and systemic symptoms uncommon • Severe systemic reactions rare

  20. Diphtheria and Tetanus ToxoidsContraindications and Precautions • Severe allergic reaction to vaccine component or following prior dose • Moderate to severe acute illness

  21. National Immunization Program • Hotline 800.232.2522 • Email nipinfo@cdc.gov • Website www.cdc.gov/nip

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