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Diphtheria (D) Diphtheria is an infection of the respiratory system, which predominantly affects children. It continues to be a major killer amongst infants today, despite the fact that a safe and effective vaccine is available. Diphtheria is a major problem in our country even though the diphtheria vaccine is part of the national immunization program of the Government of India. However the disease is on the decline in most areas. An estimated 1200 cases were detected in 1995. 5653 cases of diphtheria were reported in India in the year 1994. Reported cases in the states and union territories in 1995 in India – 4658, with 353 deaths. Routine vaccination of children has reduced Diphtheria to a minor problem in most of the developing countries today. Worldwide, WHO estimates about 1 lakh cases and 8000 deaths. What causes the disease Diphtheria is caused by Corynebacterium diphtheriae, a bacterium that mostly infects children aged 1 to 5. It spreads from person to person via droplets formed while sneezing, coughing, etc. It may spread by objects such as cups, thermometers, etc. but only for short periods. Diphtheria sometimes produces skin lesions, which are infective as well. Some people infected with the bacteria are called ‘carriers’ and they clinically appear healthy. They form an important unrecognized source of infection to others and do require treatment. What are the common symptoms Low-grade fever, sore throat and pain on swallowing are seen early in the disease. Finding a grayish-white membrane covering the tonsils or back of the throat is an important clue in the diagnosis of diphtheria. Hoarseness of voice, cough, or even severe pneumonia may also occur in diphtheria. Enlargement of lymph nodes in the neck may lead to a visible lump, which is painful on pressure. The toxin produced by the bacteria can cause shock with a low blood pressure and rapid, weak pulse requiring immediate medical attention. What treatment is given Diphtheria anti-toxin is administered to all cases to rapidly reverse the symptoms caused by the toxin. Penicillin is the antibiotic employed to kill the bacteria. Erythromycin is used to treat carriers. Isolation of the patient, usually in a hospital setting, is required for at least 14 days or until proved free on infection. The Diphtheria vaccine is generally given to infants at 6, 10 and 14 weeks of age, in conjunction with the tetanus and pertussis vaccines (DPT). DPT vaccine is a combined vaccine to protect against diphtheria, tetanus and pertussis. Tetanus (T) Tetanus is a disease that affects the central nervous system. It is caused by the bacterium Clostridium tetani. Spores of the bacterium live in the soil and are distributed worldwide. Infection begins when the spores are introduced into an injury or wound. Tetanus often begins with mild spasms in the muscles of the jaw, neck and face. Rigidity rapidly develops in the chest, back and abdominal muscles and sometimes the laryngeal muscles. Muscular spasms cause sudden, powerful and painful contractions of muscle groups. Other symptoms are irritability, fever, sweating, swallowing difficulty, hand or foot spasms, drooling, uncontrolled urination and defecation. Without treatment 1 out of 3 affected people die. The mortality rate for untreated newborns is higher, 2 out of 3. Pertussis (P) Pertussis or whooping cough is a highly contagious bacterial disease that affects the respiratory system and produces spasms of coughing characterized by a ‘whooping sound’. Pertussis is caused by infection with the Bordetella pertussis bacteria. The infection can affect individuals of all ages, though most cases are seen in infants younger than six months. The bacteria invade the nose and throat, trachea and the bronchial tubes of the lungs. The infection starts with symptoms similar to the common cold and progresses to spasms of coughing after 10 to 12 days. The cough is characterized by repeated coughing; two or three coughs without inhaling and then a characteristic inspiratory whoop. Typically the face becomes redder with each cough and then subtly bluish (cyanotic). Children may momentarily loose consciousness at end of each coughing episode. During this stage there is heavy mucus production and coughing spells may induce vomiting. In infants, choking spells are common. The disease has a 1 per cent to 2 per cent death rate. Death may occur from lack of oxygen to the brain and bronchopneumonia. DPT Vaccine All three diseases are preventable by the DPT vaccination. It can be administered to children below 7 years of age. DPT immunization is usually a series of vaccinations given to children at ages 2 months, 4 months, 6 months, and 15-18 months. A booster is given between 4 to 6 years of age. DPT is recommended unless there is a reason the child should not receive the pertussis vaccine (such as allergic reaction). After the initial series of vaccinations a booster of TD vaccination should be given at 14- 16 years of age and every 10 years thereafter. DPT vaccines can be safely given to infants and pregnant women. Side Effects Minor side effects seen after DPT vaccinations are mild fever, irritability, and tenderness of the injection site for a few days. Less than 1 per cent of vaccinations may be followed by severe complications like high fever (more than 105 degrees F) and high pitched crying. In rare cases, DPT vaccination causes severe complications like convulsions, febrile seizure (children), shock or collapse (blue or pale, limp nonresponsive). DPT vaccination should not be given to a child who has suffered from convulsions, other brain disorders or seems not to be developing normally. The vaccine may need to be discontinued if the child shows any of the following complications after receiving any of the vaccine doses:
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