# Presentation: 909047

## Diphtheria and Diphtheria Toxoid

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Center for Immunization and Respiratory Diseases**
**Centers for Disease Control and Prevention**

**Revised March 2008**

## Note to presenters:

**Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at ****http://www.vaccineinformation.org/photos/index.asp**

## Diphtheria

**Greek *****diphthera *****(leather hide)**
**Recognized by Hippocrates in ****5th century BCE**
**Epidemics described in ****6th century**
***C. diphtheriae***** described by Klebs in 1883**
**Toxoid developed in 1920s**

## Corynebacterium diphtheriae

**Aerobic gram-positive bacillus**
**Toxin production occurs only ****when *****C. diphtheriae***** infected by virus (phage) carrying tox gene**
**If isolated, must be distinguished from normal diphtheroid**

## Diphtheria Clinical Features

**Incubation period 2-5 days ****(range, 1-10 days)**
**May involve any mucous membrane**
**Classified based on site of infection**
**anterior nasal**
**pharyngeal and tonsillar**
**laryngeal**
**cutaneous**
**ocular**
**genital**

## Pharyngeal and Tonsillar Diphtheria

**Insidious onset of exudative pharyngitis**
**Exudate spreads within 2-3 days and may form adherent membrane**
**Membrane may cause respiratory obstruction**
**Fever usually not high but patient appears toxic**

## Diphtheria Complications

**Most attributable to toxin**
**Severity generally related to extent of local disease**
**Most common complications are myocarditis and neuritis**
**Death occurs in 5%-10% for respiratory disease **

## Diphtheria Antitoxin

**Produced in horses**
**First used in the U.S. in 1891**
**Used only for treatment of diphtheria**
**Neutralizes only unbound toxin**

## Diphtheria Epidemiology

**Reservoir****	****	****  ****	****Human carriers****	****	****	****	****  ****	****Usually asymptomatic**** **
**Transmission****	****  ****	****	****Respiratory****	****	****	****	****  ****	****Skin and fomites rarely**
**Temporal pattern****	****	****Winter and spring**
**Communicability****	****	****Up to several weeks****	****	****	****	****	****without antibiotics**

## Diphtheria - United States, 1940-2006

**Diphtheria - United States, 1940-2006**

**Year**

## Diphtheria - United States, 1980-2006

**Diphtheria - United States, 1980-2006**

**Year**

## Diphtheria – United States, 1980-2004Age Distribution of Reported Cases

**Diphtheria – United States, 1980-2004****Age Distribution of Reported Cases**

**N=53**

## DTaP, DT, and Td

**DTaP, DT**
**Td, Tdap (adult)**

_**Diphtheria**_
**7-8 Lf units**
**2-2.5 Lf units**

_**Tetanus**_
**5-12.5 Lf units**
**5 Lf units**

**DTaP and pediatric DT used through age 6 years.  Adult Td for persons 7 years and older. Tdap for persons 10-18 years (Boostrix) or 11-64 years (Adacel)**

## Diphtheria Toxoid

**Formalin-inactivated diphtheria toxin**
**Schedule****	****  Three or four doses + booster****	****	****	****  Booster every 10 years**
**Efficacy****	****  Approximately 95%**
**Duration****	****  Approximately 10 years**
**Should be administered with tetanus toxoid as DTaP, DT, Td, or Tdap**

## Routine DTaP Primary Vaccination Schedule

**Primary 1**
**Primary 2**
**Primary 3**
**Primary 4**

_**Age**_
**2 months**
**4 months**
**6 months**
**15-18 months**

_**Interval**_** **** **
**---**
**4 wks**
**4 wks**
**6 mos**

**Routine DTaP Primary Vaccination Schedule**

## Children Who Receive DT

**The number of doses of DT needed to complete the series depends on the child’s age at the first dose:**
**if first dose given at <12 months of age, 4 doses are recommended**
**if first dose given at **_**>**_**12 months, 3 doses complete the primary series**

**Notes:**
Recommendation from the 1991 DTP ACIP statement

## Routine DTaP Schedule for Children Younger Than 7 Years of Age

**4-6 years of age, before entering school**
**11-12 years of age if 5 years since last dose (Tdap)**
**Every 10 years thereafter (Td)**

**Booster Doses**

## Routine Td Schedule for Unvaccinated Persons 7 Years of Age and Older

**Booster dose every 10 years**

***ACIP recommends that **_**one**_** of these doses (preferably the first) be administered as Tdap**

## Diphtheria and Tetanus ToxoidsAdverse Reactions

**Local reactions (erythema, induration)**
**Exaggerated local reactions (Arthus-type)**
**Fever and systemic symptoms not common**
**Severe systemic reactions rare**

## Diphtheria and Tetanus ToxoidsContraindications and Precautions

**Severe allergic reaction to vaccine component or following a prior dose**
**Moderate or severe acute illness**

## CDC Vaccines and ImmunizationContact Information  

**Telephone     800.CDC.INFO**** **
**Email****	****	****    nipinfo@cdc.gov**** **
**Website****	****    www.cdc.gov/vaccines**