[News] WHO: Six questions to understand diphtheria and its recent reappearance in Peru

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The Ministry of Health confirmed the appearance of diphtheria, after 20 years of not detecting a case of the bacteria, in a 5-year-old girl in Lima. The same one that is under observation at the Hospital 2 de Mayo.

Given this, the Minsa has raised its alert for the presence of this epidemic, already present in some countries of the region, which has a mortality incidence of 10% on the cases presented.

It should be noted that the Vice Minister of Health, Luis Suárez, detailed that 40% of the population would be protected by vaccines, when it should be 70%.

In Peru, diphtheria is included in the vaccination plan for children under 1 year of age

Given this, the World Health Organization (WHO) responds to six inquiries about this disease.

What is diphtheria?
Diphtheria is an infection caused by the bacteria Corynebacterium Diphtheriae. Its signs and symptoms, which usually appear 2 to 5 days after exposure, can range from mild to severe. Symptoms often come on gradually, starting with a sore throat and fever. In severe cases, the bacteria generate a toxic product (toxin) that gives rise to a thick gray or white plaque in the back of the throat, plaque that sometimes, by blocking the airways, makes breathing or swallowing difficult and it can also cause a dry cough. Hypertrophy of the lymph nodes can cause swelling of part of the neck.

Sometimes the toxin passes into the bloodstream and causes complications such as myocardial inflammation and injury, inflammation of the nerves, kidney problems, or bleeding disorders due to a drop in platelets. Injuries to the myocardium can cause heart rhythm disturbances and inflammation of the nerves, sometimes leading to paralysis.

How is diphtheria spread?
Diphtheria is easily transmitted from one person to another, either by direct contact or by air, through respiratory droplets emitted for example by coughing or sneezing. It can also be spread through contaminated fabrics or objects.

How is diphtheria diagnosed?
In general, the clinical diagnosis of diphtheria is based on the presence of a grayish membrane lining the throat. Although a laboratory study is recommended to confirm suspected cases, treatment should begin immediately.

How is diphtheria treated?
Diphtheria antitoxin solution is given by intravenous or intramuscular injection to treat this infection. Antibiotics are also given to kill the bacteria, stop toxin production, and prevent it from spreading to others.

Is vaccination against diphtheria recommended?

Every child in the world should be immunized against diphtheria. A basic round of 3 doses, administered within the first year of life, lays the foundation for acquiring lifelong immunity. Immunization schedules should ensure that later, during childhood or adolescence, each person receives 3 more booster doses of a vaccine containing diphtheria toxoid. At any age, anyone who is not vaccinated against diphtheria, or who is only partially vaccinated, should receive the doses necessary to complete the vaccination.

The recent diphtheria outbreaks in several countries bear witness to insufficient vaccination coverage and have demonstrated the importance of maintaining high levels of coverage in childhood immunization programs. Whatever the external circumstances, any unimmunized person is at risk. It is estimated that 86% of the world's children receive the 3 recommended doses of diphtheria vaccine during breastfeeding, which means that 14% are not covered or partially covered.

Should health personnel take extra precautions?
In endemic settings and in outbreak situations, healthcare personnel may be at greater risk of contracting diphtheria than the general population. Therefore, given the possibility of being exposed to Corynebacterium Diphtheriae in the performance of their work, special attention must be paid to the immunization of health personnel.