In Spain a little boy is being kept alive by machines and eight other children have been hospitalized after being infected with a deadly toxin. This toxin can cause the nose of an infected individual to drip blood and pus-filled infection, the roof of their mouth to bleed and turn green and black, can obstruct their airways, and can cause patches of skin to become scaly and leather-like.

The toxin invades the body’s mucus membranes, enters the blood stream, and multiplies rapidly. Most alarming is that the first symptoms this toxin in the body are similar to that of a cold, until the inside of the victim’s mouth turns gray and scaly, by which point the toxin has likely already entered the bloodstream and attacked the other mucus membranes in the body, and the patient has likely already infected other people.

Twenty percent of infected patients under the age of five will die and 5-10% of patients over the age of five will die. That mortality rate has remained unchanged for 50 years, despite medical advances.

This toxin is caused by a naturally occurring bacteria of the same name called Corynebacterium diphtheriae, better known as diphtheria.

Diphtheria is one of those diseases we think about in the same way we think about cholera, typhoid, and consumption (TB). We think of it as a disease that people used to die from on The Oregon Trail, but that it’s not actually a thing anymore. Except that it is.

In the 1930s, diphtheria killed between 13,000 and 15,000 individuals annually in the United States. A diphtheria vaccine was developed in the 1920s, and became widely available in the ‘40s and ‘50s. The disease’s prevalence rate dropped off to a statistical zero by the 1980s.   Most people are vaccinated against diphtheria in childhood as a part of the DTaP vaccine, which protects against diphtheria, tetanus and pertussis (whooping cough). People older than the age of 11 need a Tdap booster shot every seven to nine years. The differences between the DTaP and Tdap vaccines are the antigen concentrations in each shot.

Diphtheria InfocardDiphtheria is in the news again due to a cluster of cases in Spain; in the Girona province of Catalonia, Spain (very close to the border of France), the index case (“patient zero”) is an unvaccinated little boy. Heartbreakingly, as of the writing this post the boy is in critical condition on life support, and his parents have expressed that they “feel terrible guilt” over not vaccinating their son and feel hoodwinked by the antivaccine community. Several months ago Tara Hills, a mother of seven, wrote on our blog about the guilt she felt after not vaccinating her children and their subsequent battle with whooping cough.

While the index patient in Spain was not vaccinated, initial reports of the subsequent eight infections indicate that the other patients were vaccinated. The reports, however, don’t indicate the age of the new patients (diphtheria is particularly virulent in those under age five) or if the eight had completed the World Health Organization’s full vaccination schedule. Additionally, those who have been vaccinated against diphtheria tend to develop a milder form of the disease as their bodies already have some of the antibodies needed to fight the bacteria and the toxin.

Treating diphtheria is complicated, many impacting factors including the age of the individual, their vaccination status, when in the disease’s progress they sought medical treatment, and how the bacteria entered the body can all vary the severity of the illness. Prevention is the first line of defense (get your shots, people!) but once infected, antitoxins, antibiotics and supportive care are the standard treatment. Complicating matters even further is that the diphtheria antitoxin is not a standard drug that hospitals keep on hand. In fact it’s only available through the CDC directly for us here in the US. The antitoxin also won’t neutralize existing pockets in the mucus membranes, it will only prevents the progression of the disease by neutralizing the toxin that’s circulating in the bloodstream. This is why the death rate from diphtheria remains so high.

As Rene Najera pointed out on Monday, many diseases are just a plane ride away. This disease could even easily spread to areas of southern France given its proximity to the border and the nature of cross-European transit, which is largely train and short-flight based. Even if you don’t plan to travel to Spain any time soon, now may be a good idea to check in with your doctor and make sure you and your family are up to date on your Tdap and DTaP shots. Heck, most health departments give them away for free (FREE!).

Editor’s note: Since the publication of this post, the little boy has since passed away. You can read more here.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health