Diphtheria is now a rare disease in Europe but when it does occur it is serious and may be fatal in up to 20% of cases. Those most at risk of developing diphtheria are unvaccinated, or partially vaccinated, individuals. The disease is caused by bacteria that can cause heart failure, pneumonia and paralysis of the muscles used for swallowing. In this report we highlight the importance of diphtheria vaccination for children.
In March 2016, a 3-year-old unvaccinated Belgian child died of diphtheria. The child was of Chechnyan origin but had been born and was living in Belgium. The disease was caused by toxigenic Corynebacterium diphtheria. The full report is available on the ECDC website. (1)
This case report follows less than one year after another similar case, also in an unvaccinated child, reported by Spain in 2015.(2)
Summary
In March 2016, a 3-year-old child presented to a Belgian hospital with severe tonsillitis, and was transferred to a university hospital and admitted to the intensive care unit. After initial clinical improvement the child’s condition then deteriorated. The child developed a severe myocarditis (inflammation of the heart muscle) and needed a pacemaker. Despite aggressive treatment the child died 11 days after her initial complaint and seven days after admission to hospital.
Treatment for diphtheria consists of antibiotics and diphtheria anti-toxin (DAT) both of which should be administered as soon as possible once diphtheria is suspected. However, as outlined in this report, there were no supplies of DAT in Belgium when this child was suspected to have diphtheria. Supplies of DAT were subsequently obtained from the Netherlands and administered to the child, but the child died despite administration. The shortage of DAT in Belgium is mirrored in most countries in Europe at this time, further highlighting the importance of prevention through vaccination being more important than treatment, which as in this event, may not be readily available.
The source of this child’s infection was not identified.
Diphtheria vaccine recommendations in Ireland
- Diphtheria vaccine is included in the 6-in-1 vaccine which is given at 2, 4, and 6 months of age (three doses needed).
- A booster dose is given at 4-5 years of age (part of the 4-in-1 vaccine) and another 2nd booster dose is given in early adolescence (usually first year of secondary school) (part of the 3-in-1 vaccine).
- Additional booster doses may be given every 10 years for life and are recommended for
- individuals in contact with a case or carriers of a toxigenic strain
- workers who may handle infected material
- those working with animals (in combination with tetanus vaccine)
- travellers to areas where diphtheria is frequently reported
Further sources of information
1. ECDC. A fatal case of diphtheria in Belgium underlines the importance of immunisation and access to diphtheria antitoxin01 Apr 2016
2. WHO. Diphtheria detected in Spain
3. General information on diphtheria on HPSC website
4. PHE. Public health control and management of diphtheria (in England and Wales). 2015 Guidelines. Diphtheria Guidelines Working Group. March 2015.
