Diphtheria is a highly contagious bacterial infectious disease. Since the introduction of a preventative vaccination, it has occurred rather rarely. Nevertheless, there are still cases of illness and death – including in Germany. Find out more about vaccination against diphtheria and typical symptoms here.
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Quick overview: diphtheria
definition: Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae and particularly affects the upper respiratory tract.
Symptoms: Signs include sore throat, fever, or shortness of breath. In addition, the lymph nodes may become swollen and a grayish-white coating may form in the throat.
Vaccination: Preventive protection should be provided with three doses of vaccine at two, four and 11 months of age. Refreshers are provided between the ages of five and six and nine to 17 years. Adults are recommended to get vaccinated every ten years.
Treatment: Therapy usually involves the administration of antibiotics. Hospital treatment may be necessary.
Article contents at a glance:
The most important vaccinations
What is diphtheria?
Diphtheria is a serious infectious disease with a high risk of infection. It is caused by the bacterial species Corynebacterium diphtheriae, or the toxin diphtheria toxin that the bacteria secrete.
There are two main types, and the forms can merge into one another:
respiratory diphtheria: In the more common form, the pathogen primarily affects the upper respiratory tract. The throat and/or larynx and nose are affected.
cutaneous diphtheria: It is also known as cutaneous diphtheria and occurs primarily in the tropics. This form also includes conjunctival and wound diphtheria.
According to the Infection Protection Act (ifSG), diphtheria is one of the infectious diseases that must be reported in Germany.
Frequency of diphtheria
Diphtheria was a common cause of death in young children decades ago. Since the introduction of a preventative vaccination, the disease has become rare in industrialized nations.
However, there has been an increase in cases in Europe since 2022: from January 1, 2022 to August 2023, 281 cases were registered. For comparison: between 2017 and 2021 there were an average of 55 confirmed reports per year. These are predominantly infections with cutaneous diphtheria.
Diphtheria: Typical symptoms and signs
The symptoms of diphtheria differ depending on the form. With throat diphtheria, the symptoms initially resemble those of a severe cold or flu. Possible are:
- Fever up to 39 degrees Celsius
- difficulties swallowing
- Sore throat
As the progress progresses, symptoms such as:
In severe cases, the soft palate can become paralyzed. The tonsils and the entire throat become inflamed. Gray-white or brownish coating (pseudomembranes) forms. When attempts are made to remove it, bleeding usually occurs.
If the throat swells significantly, there is a risk of shortness of breath and suffocation. This complication is called croup. A sweetish bad breath is also typical.
Additional symptoms of other forms of diphtheria
Depending on the type of diphtheria, there are additional symptoms:
Laryngeal diphtheria: Initially, coughing, hoarseness and shortness of breath are the dominant symptoms.
Nasal diphtheria: There is often a purulent-bloody discharge from the nose.
Wound or cutaneous diphtheria: Symptoms are similar to other bacterial skin diseases. Purulent inflammation and abscesses are typical.
Conjunctival diphtheria: Signs include severe redness of the conjunctiva and bloody-watery discharge. The cornea is also often affected.
Prevent diphtheria through vaccination
Diphtheria can only be prevented through vaccination. A so-called toxoid vaccine is used. It protects against the poison of the bacteria and thus against an outbreak of the disease. However, anyone who has been vaccinated can still become infected with diphtheria pathogens and pass them on to other people.
Diphtheria: Which vaccination schedule applies?
According to the Standing Vaccination Commission (STIKO) should
the first vaccination at the age of two months,
the second vaccination at the age of four months and
the third vaccination should be given at the age of eleven months.
According to STIKO, this basic immunization should be carried out with a 6-fold vaccine, which also protects against, among other things, whooping cough, tetanus and polio.
Refreshers are then recommended for children between the ages of five and six and between the ages of nine and 17. Further vaccinations should be given routinely every ten years.
STIKO recommends protection for all infants, small children, teenagers and adults.
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Diphtheria: treatment with antibiotics
Treatment of diphtheria should be carried out as quickly as possible. Treatment measures include antitoxins, which render the bacterial toxins harmless, and antibiotics.
It is important to take the medication against diphtheria for a sufficient period of time and in the correct dose.
Severe cases with complications such as kidney failure, respiratory failure or cardiac arrhythmias are treated in hospital. If breathing is severely impaired, mechanical ventilation must be provided.
Diphtheria: cause and infection
Diphtheria is mainly caused by an infection with strains of the bacterium Corynebacterium diphtheriae, rarely Corynebacterium ulcerans and Corynebacterium pseudotuberculosis.
The toxigenic Corynebacteria secrete a poison, diphtheria toxin. It attacks the mucous membranes and body cells and causes the typical symptoms of the disease.
Infection via droplet infection
Like the pathogens that cause a cold, the diphtheria bacteria are also transmitted via droplet infection, i.e. through coughing, sneezing, talking or kissing. In the case of cutaneous diphtheria, infection can also occur via smear infection.
On average, it takes two to five days between the time of infection and the outbreak of the disease (incubation period), less often a week. If appropriate treatment with antibiotics is given, those affected are contagious for two to four days; without treatment, they are contagious for two to four weeks.
How is diphtheria diagnosed?
Medical professionals usually recognize diphtheria based on its typical symptoms. To confirm the diagnosis, the doctor can take a swab of the mucous membranes, for example from the throat, and have it examined for pathogens in the laboratory.
Diphtheria: course and prognosis
The course and prognosis of the disease depend on the general condition of the affected person and the time of treatment. The sooner therapy begins, the better the chances of complete healing.
If the infection is severe, the mucous membranes in the throat can swell so much that there is a risk of suffocation. The toxin can also damage the heart, kidneys and nervous system. This can result in serious complications:
The lethality (mortality) of respiratory diphtheria is between five and ten percent. After an infection has healed, there is no lifelong immunity, so the vaccination should be refreshed in these cases too.
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