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    Childhood Illnesses Up Close: Diphtheria

    July 5, 2007 by Brandy Vencel

    One of the reasons I am doing this series is that it is my belief that if a family is going to choose to avoid immunizations, in whole or in part, for any reason, that family has a responsibility to know their diseases. Just like pertussis, diphtheria has a known remedy. But diphtheria is very dangerous if it goes untreated. However, with the virtual eradication of the disease, most parents {like me} don’t even know how to discern if a child has diphtheria or not. However, Americans no longer exist in a vacuum {not that we ever did}.

    Illegal immigration is a huge problem when it comes to stopping the spread of disease.

    Diphtheria is most common in areas where people live in crowded conditions with poor sanitation. [snip] Diphtheria is still common in many other parts of the world, including the Caribbean and Latin America. During the last few years, large epidemics of diphtheria have occurred in the former Soviet republics. Outbreaks have also been reported in Algeria, China, and Ecuador. {source}

    Our government {so far} refuses to enforce our borders and make sure that the flow of people in and out of the country in maintained in a way that avoids the disastrous spread of disease. Therefore, we parents cannot assume that diphtheria, a word some of us are unsure how to pronounce, is not a threat to our families.

    What is diphtheria?
    According to the Mayo Clinic,

    Diphtheria {dif-THEER-e-uh} is a serious bacterial infection, usually affecting the mucous membranes of your nose and throat. Diphtheria typically causes a bad sore throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray covering in the back of your throat that can make breathing difficult. Diphtheria can also infect your skin.

    If you are looking for one way to easily distinguish diphtheria from other infectious diseases, it would be the color gray. If the throat is infected with diphtheria, it will be fuzzy gray or black colored {rather than the bright red we all associate with strep throat}. If a wound is infected with diphtheria, it will often have areas of it that are sticky and gray.

    Diphtheria is dangerous because it is highly toxic. As the bacteria finds a nice little home inside the patient’s body, it begins to produce a toxin that starts to float around the body, attacking first the immediate area and, if left untreated, eventually the heart, kidneys, or nerves.

    Is diphtheria treatable?
    Diphtheria requires a two-prong plan of attack because there are two issues involved: the bacteria causing the sickness plus the toxin the bacteria is producing as a byproduct. So, if you or a loved one contract diphtheria, be prepared to be hospitalized. This is the treatment plan:

    An antitoxin. After doctors confirm that a person has diphtheria, the infected child or adult receives a special antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein {intravenously} or into a muscle {intramuscular injection}. But first, doctors may perform skin allergy tests to make sure that the infected person doesn’t have an allergy to the antitoxin. Persons who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage.

    Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.

    How do I avoid diphtheria?
    Time and time again in my research, I noticed that diphtheria {and actually almost all frightening contagious diseases} are more common within populations that have that winning combination of poor sanitation and close living quarters. Also, people with poor immunity in general are more vulnerable. I have noticed that our country seems to take the basic germ theory for granted. For instance, a friend of ours who works in hospitals has told us that many of the secondary infections {the ones that people contract by being in the hospital} are a result of nurses neglecting basic protocols like washing hands. When my husband worked at a hospital, he sprayed Lysol on his shoes before entering our house.

    So if you want to protect your family, keep your home sanitary and well-ventilated. Teach the children to wash their hands. We require independent handwashers to count slowly to fifteen. Close the toilet lid before flushing. Sanitize the bathrooms and kitchen regularly. Sanitation is the best way to protect against disease.

    Also, work to keep immunity up. As an aside, I think it is worthwhile to mention that the body does not have an “Immune System.” However, it does have a Lymphatic System, and knowledge concerning this system can aid a parent in understanding how disease is fought by the body and, therefore, how a person’s lifestyle can influence the functioning of the system.

    What are the possible side-effects of the vaccine?
    Almost every website I looked at treated vaccines as the only known way of preventing diphtheria infection. Most completely ignored their own admission that diphtheria hurts some communities {those with poor nutrition and poor sanitation} more than others {those with good nutrition and proper sanitation}. That is why I added the above section on disease prevention as a whole.

    However, this series was supposed to be about trade-offs. As we learn about the dangers of various diseases and compare them to the dangers of the vaccines for the diseases, we are able to make some decisions. Of course, the trade-off is partially imagined. Obviously, every person who refuses the vaccine does not automatically become infected with the disease, and every person who is vaccinated does not necessarily avoid contracting the disease.

    But in a perfect system, what would be the trade-off? The side-effects of the DTaP were discussed in the pertussis posting. However, there is also a shot without the pertussis called the DT {diphtheria and tetanus} shot:

    Adverse reactions may be local and include redness, warmth, edema, induration, with or without tenderness, as well as urticaria, and rash. Malaise, transient fever, pain, hypotension, nausea and arthralgia may develop in some patients after the injection. Arthus-type hypersensitivity reactions, characterized by severe local reactions {generally starting 2 to 8 hours after an injection} may occur, particularly in persons who have received multiple prior boosters.

    Rarely, an anaphylactic reaction {i.e., hives, swelling of the mouth, difficulty breathing, hypotension, or shock} and death have been reported after receiving preparations containing diphtheria and tetanus antigens.

    [snip]

    Deaths due to causes other than SIDS, including deaths from serious infections, have been reported in temporal association with the administration of diphtheria and tetanus toxoids containing vaccines. On rare occasion, anaphylaxis has been reported following administration of products containing diphtheria and tetanus toxoids. Upon review, a report by the Institute of Medicine {IOM} concluded the evidence established a causal relationship between diphtheria and tetanus toxoids and anaphylaxis.

    [snip]

    The following neurologic illnesses have been reported as temporally associated with vaccine containing tetanus toxoid: neurological complications including cochlear lesion, brachial plexus neuropathies, paralysis of the radial nerve, paralysis of the recurrent nerve, accommodation paresis, Guillain-Barré syndrome {GBS},and EEG disturbances with encephalopathy. The IOM following review of the reports of neurologic events following vaccination with tetanus toxoid, Td or DT, concluded the evidence favored acceptance of a causal relationship between tetanus toxoid and brachial neuritis and GBS. {source}

    I know that part of the complications reported are more associated with tetanus, but there is not isolated diphtheria vaccine, so complications from the tetanus toxoid must be considered when making decisions about the DT vaccine.

    Is the trade-off worth it?
    My opinion is that this is an area for wisdom. 40-50% of diphtheria patients who do not get treatment die. The overall death rate is 10%. Of course, there were only 41 cases of diphtheria {total} reported between 1980 and 1995. So contraction is unlikely, unless you take into consideration the long-term complication of spreading diseases through illegal immigration.

    If you are concerned about the ethics of the vaccine, let me assure you that there is an ethical version of the DTaP+polio+HiB vaccine available. It is called Pediacel. If you don’t know the difference between ethical and unethical versions of vaccines read my article about vaccine ethics and then also my article of the outcome of unethical vaccine acceptance by the public.

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