The Dirt on Diphtheria

Just this week, I read about a case of diphtheria in Spain, in a young child whose parents had apparently decided that immunizations weren’t necessary. I have to say, it’s not the news I expected with my coffee and granola. Honestly, I kind of thought diphtheria was dead. Anyway, it’s a disease I never care to see, but I’ll go ahead and fill you in.

Diphtheria is a disease caused by the bacterium Corynebacterium diphtheriae. It’s transmitted in much the same way as the common cold—through respiratory droplets from coughing or sneezing, either through direct inhalation or from touching a contaminated object. Diphtheria may start off like many other respiratory diseases, with fever, muscle weakness, and sore throat. But then it gets worse—a lot worse. After invading, the bacteria begin to produce a toxin that kills the cells lining the respiratory pathway. These dead cells conglomerate into a thick, gray sheet, called a “pseudomembrane,” which can prevent air from getting where it needs to go, or from being absorbed by the lungs. If you’ve ever taken CPR, you may recall that breathing is pretty important…so for those unfortunate people who can’t get oxygen where it needs to go, things can get nasty fast. But diphtheria doesn’t stop there. The toxin can cause destruction of heart muscle or nerves, potentially resulting in heart failure or paralysis (which, to be fair, matters only if you’re still breathing).

The history of diphtheria is fascinating. The disease was first recognized in the 1600’s, but the cause was still unknown, and nobody could do a thing about it. The lucky kids survived, and the unlucky ones didn’t. In the 1730’s, an outbreak in New England killed a third of all children under 10. A third of them. It wasn’t until the late 1800’s that we discovered the bacterium that causes the disease; soon after that, the first treatment was developed. It involved giving a toned-down form of the disease to animals (can you say: “vaccination?”) in order to get them to make an anti-toxin that could be used to treat people with the disease. That was a huge advancement, and Emil von Behring won the first Nobel Prize in Medicine for this work.

Research in this area continued (not without some pitfalls), and in the 1920’s, the first large-scale vaccination efforts began. Strangely, it wasn’t all that hard to convince parents to vaccinate their kids when diphtheria infected 200,000 people per year and killed 10 percent of them. When your reality includes diseases like diphtheria, there is no anti-vax movement. Since its development, the vaccine has been through several revisions, but it remains a major part of our vaccination program. We’ve gone from hundreds of thousands of cases per year to a single case in the past 10 years. Smells like success to me.

Another highlight from diphtheria’s history was a 1925 outbreak in Nome, Alaska, which created an urgent need for diphtheria antitoxin. The antitoxin was available hundreds of miles away in Anchorage, but couldn’t be delivered by any means but dog sled; the unlikely team of medical professionals and dog sled mushers saved numerous lives, inspiring the modern-day Iditarod.

Perhaps the best part about the history of diphtheria is that diphtheria is history…or was anyway. Which is why I was puzzled to hear of an outbreak in Spain this week (where, incidentally, they hadn’t had a case for 29 years). Although they seem to regret it now, this child’s parents had chosen to forgo vaccinations, leaving him vulnerable to this deadly disease. And he’s not the only one affected; 8 other children have tested positive for the bacteria (so far). Fortunately, they were all immunized, so while the bacteria may be present, its ability to cause disease is shut down. (The diphtheria vaccine is a little different from many other vaccines in that it doesn’t train your immune system to fight the bacteria; it trains it to inactivate the toxin.)

The good news is that we can prevent diseases like diphtheria, through vaccines that have been shown for many years to be safe and effective. And fortunately, if you choose not to vaccinate your child, and he happens to get diphtheria, we can treat it. We have an antitoxin. (I mean, the CDC keeps it locked up in Atlanta, because nobody really gets diphtheria, right? But we can get it.) We have antibiotics. We have ventilators, and dialysis, and ICUs where we can do a lot to keep a kid alive. I wish the best to this child and his family and pray that the efforts of his medical team result in full recovery. But no matter how hard we fight, sometimes we lose. Why risk it?