Diphtheria is a bacterial infection that primarily affects the mucous membranes of the nose and throat, and can sometimes affect the skin. It is highly contagious and a serious, potentially life-threatening infection.
According to World Health Organization (WHO), there were 7,097 cases of diphtheria reported worldwide in 2016. Of these, Indonesia contributed 342 cases. Since 2011, extraordinary events (KLB) for diphtheria cases have been a problem in Indonesia. 3,353 cases of diphtheria were reported from 2011 to 2016, placing Indonesia second after India in terms of the number of diphtheria cases. Of the 3,353 people who suffered from diphtheria, 110 died. Nearly 90% of those infected did not have a complete diphtheria immunization history.
Diphtheria is a preventable disease, and immunization against it is included in the Indonesian government's mandatory immunization program. This diphtheria immunization, combined with pertussis (whooping cough) and tetanus, is called the DPT immunization. Children under one year of age are required to receive three DPT immunizations. In 2016, 841 children received three doses of DPT in Indonesia. This figure decreased compared to the initial DPT coverage of 901 children.
Diphtheria is caused by bacteria Corynebacterium diphtheriae. This bacteria can spread easily, especially in people who haven't received the diphtheria vaccine. There are several transmission methods to be aware of, such as:
Diphtheria bacteria produce a toxin that kills healthy cells in the throat, eventually causing them to die. These dead cells form a gray membrane (thin layer) in the throat. Furthermore, the toxin can spread into the bloodstream and damage the heart, kidneys, and nervous system.
Sometimes, diphtheria may not show any symptoms, so sufferers are unaware they are infected. If they don't receive proper treatment, they can potentially transmit the disease to those around them, especially those who haven't been immunized.
Diphtheria generally has an incubation period, or the time between the bacteria entering the body and the appearance of symptoms, of 2 to 5 days. Symptoms include:
Diphtheria can also sometimes affect the skin, causing ulcer-like sores. These ulcers will heal within a few months, but they usually leave scars on the skin.
See a doctor immediately if you or your child exhibits any of the above symptoms. This condition requires prompt treatment to prevent complications.
To confirm a diagnosis of diphtheria, the doctor will initially ask several questions about the patient's symptoms. The doctor may also take samples of mucus from the throat, nose, or skin ulcers for laboratory testing.
If a person is strongly suspected of having diphtheria, the doctor will begin treatment immediately, even before laboratory results are available. The doctor will recommend that the person undergo treatment in an isolation room at the hospital. Treatment will then involve two types of medication: antibiotics and antitoxin.
Antibiotics will be given to kill the bacteria and cure the infection. The dosage depends on the severity of symptoms and how long the patient has had diphtheria.
Most patients can be discharged from isolation after taking antibiotics for two days. However, it is crucial for them to complete the full course of antibiotics as recommended by their doctor, which is two weeks.
The patient will then undergo laboratory tests to check for the presence of diphtheria bacteria in the bloodstream. If diphtheria bacteria are still found in the patient's body, the doctor will continue administering antibiotics for 10 days.
Meanwhile, antitoxin administration serves to neutralize the diphtheria toxin or poison that has spread throughout the body. Before administering antitoxin, the doctor will check for any allergies to the drug. If an allergic reaction occurs, the doctor will administer a low dose of antitoxin and gradually increase the dose as the patient monitors the patient's condition.
For patients experiencing difficulty breathing due to a gray membrane obstructing the throat, the doctor will recommend removal of the membrane. Diphtheria patients with skin ulcers are advised to thoroughly clean the ulcers with soap and water.
In addition to the patient, those in close contact with the patient are also advised to see a doctor, as this disease is highly contagious. This includes family members living in the same house or medical personnel treating diphtheria patients.
The doctor will recommend tests and prescribe antibiotics. Sometimes, a repeat diphtheria vaccine is also given if needed. This is done to increase protection against the disease.
Diphtheria treatment must be initiated promptly to prevent the spread and serious complications, especially in children. An estimated 1 in 5 children under five and those over 40 years of age die from complications of diphtheria.
If not treated promptly and appropriately, the toxins from diphtheria bacteria can trigger several potentially life-threatening complications. Some of these include:
The most effective preventive measure for this disease is vaccination. Diphtheria prevention is included in the DPT vaccine. This vaccine covers diphtheria, tetanus, and pertussis (whooping cough).
The DPT vaccine is included in the mandatory immunization program for children in Indonesia. This vaccine is given five times at the ages of 2 months, 3 months, 4 months, 1.5 years, and 5 years. Subsequent doses can be given at various times. booster with a similar vaccine (Tdap/Td) at ages 10 and 18. The Td vaccine can be repeated every 10 years to provide optimal protection.
If the DPT immunization is delayed, the catch-up immunization will not be repeated from the beginning. Children under 7 who have not received the DPT immunization or who have incomplete immunizations can still receive catch-up immunizations according to the schedule recommended by their pediatrician. However, for those who are already 7 years old and have not received the DPT vaccination, a similar vaccine called Tdap can be administered.
This protection can generally protect children against diphtheria for life.
