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BETHESDA, Md. -- According to the Jan. 9, 2004 issue of the CDC's Morbidity & Mortality Weekly Report (MMWR), a recent case of fatal diphtheria was diagnosed in a U.S. citizen after he returned from foreign travel, which illustrates the importance of maintaining protection against the disease through routine tetanus-diphtheria (Td) booster immunization. While the United States has done an excellent job of reducing the prevalence of diphtheria in this country but the U.S Centers for Disease Control and Prevention (CDC) cautions that many people in the U.S. are still at risk for this communicable and often deadly disease.
On Oct. 27, 2003, the Pennsylvania Department of Health issued an advisory to public health officers about a case of respiratory diphtheria in a 63-year-old Pennsylvania male.(1) This man and several others traveled to Haiti, where diphtheria is still a common disease, to work in a rural village Oct. 3-10, 2003. Upon returning to Pennsylvania, the man was admitted to a hospital with a severe sore throat and respiratory distress. He was diagnosed with respiratory diphtheria and died. The clinical efficacy of the diphtheria vaccine is 97 percent, but the man had never been immunized.
"With 53 percent of adults in the U.S. lacking up-to-date diphtheria immunizations, there is a risk that the disease could become re-established in the general population," said Susan J. Rehm, MD, president of the National Foundation for Infectious Diseases (NFID). "Diphtheria is an infectious disease that can easily be passed from one person to another and it is still a big problem in many countries. With our world getting increasingly smaller, we really need to take our protection against this disease seriously."
The mortality rate for diphtheria can be as high as 20 percent and the disease is still active in more than 80 countries. It is contracted by inhaling the bacteria directly from an infected person, and can lead to heart failure, paralysis and coma; even death can occur in as little as a week.
Another example that highlights how easily diphtheria can spread in an unprotected population occurred in the former Soviet Union. Beginning in 1990, a major diphtheria epidemic occurred after the government failed to keep its citizens up-to-date with vaccinations. By 1994, there were more than 157,000 cases and more than 5,000 deaths reported. This outbreak is a reminder that even a well-controlled infection can re-emerge when population immunity is not maintained. Currently, health officials in Latvia, a former Soviet state and now a popular destination for Baltic Sea cruises, are concerned that the diphtheria prevalence exceeds levels found in other parts of Northern Europe. They are working to increase immunization rates.
In 2004, international travel to the U.S. is forecast to grow by 5 percent, reaching a total of 42.2 million visitors.(2) According to the CDC, diphtheria is a serious health problem in Algeria, Egypt, sub-Saharan Africa, Brazil, Dominican Republic, Ecuador, Haiti, Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Iran, Iraq, Laos, Mongolia, Myanmar, Nepal, Pakistan, Philippines, Syria, Thailand, Turkey, Vietnam, Yemen, Albania and all countries formerly in the Soviet Union. The popularity of eco-tourism and adventure vacations is also bringing people to some remote and less industrialized countries.
To minimize the risk of diphtheria, all U.S. residents should receive a primary series of diphtheria vaccination and a routine booster every 10 years. The combined tetanus/diphtheria vaccine (Td) can be used for both the primary series in adults and adolescents and routine booster shots in all people over the age of seven years. Currently, at least 95 percent of U.S. children under the age of three years are protected against diphtheria and tetanus through routine pediatric program efforts, but by age 20 years, only 47 percent of Americans are protected against both diseases.(3)
NFID and the National Coalition for Adult Immunization (NCAI) have developed a variety of initiatives to drive awareness and increase discussions between the public and health care professionals about the importance of immunization against tetanus and diphtheria. For more information about your risks for tetanus and diphtheria, visit www.nfid.org.
Founded in 1973, NFID is a non-profit organization dedicated to public and professional education programs about, and in support of research into the causes, treatment and prevention of infectious diseases.
(1) Pennsylvania Department of Health, Health Advisory #11, October 27, 2003 http://www.dsf.health.state.pa.us/health/CWP/view.asp?A=171&QUESTION_ID=235525
(2) Travel Industry of America, Travel Statistics and Trends, 2003
(3) McQuillan GM, Kruszon-Moran D, Deforest A, Chu Sy, and Wharton M,
Serologic Immunity to Diphtheria and Tetanus in the United States,
Annals of Internal Medicine, May 7, 2002, vol 136, p. 660.
Source: National Foundation for Infectious Diseases