Diphtheria

Disease risk areas

Worldwide,although the disease has virtually been eliminated from the UK.

Transmission

By droplet infection and through contact with articles soiled by infected persons.

Recommendations for travellers

Travellers should have received the normal British Childhood Immunisation Schedule.
Vaccination is especially advised for visits to endemic areas when mixing with the local population (e.g. health workers or teachers) and these groups should receive ten yearly boosters of the adult (low dose) vaccine.

Vaccination

Type: An inactivated toxoid
Doses: 0.5ml i/m or deep s/c
Primary immunisation: 3 doses given at 4 weekly intervals
Boosters: 10 yearly for those at risk
Side effects: Swelling and redness at the injection site. Fever and headache can also occur. Anaphylaxis and neurological problems occur very rarely.
Contraindications: Any febrile illness or a severe reaction to a previous dose.

Notes
Children.
Primary courses are started from 1 month of age in some countries where the risk is considered to be high.
Adults.
Adults require a smaller dose of vaccine than children. Since there has been a shortage of adult, low dose, diphtheria vaccine for some time adults are advised to have a fraction of the childhood monovalent diphtheria vaccine This should be used for both primary courses and boosters.

15/02/99 Children under 2 years of age may need to receive additional Diphtheria Booster. CDC Atlanta has recently notified a diphtheria component potency problem with a specific batch of Connaught vaccine for use in young children. The batch which has been recalled = TripediaO 1694732DTaP vaccine.
The implicated vaccine was distributed only within the US but children who received doses may now be in other countries. It is also possible that vaccine purchased in the US may have been sent by various multi-national entities to sites overseas. (D.O. Freedman, P.E.Kozarsky Go Sentinel Advisory USA)
19/08/98 Low dose diphtheria vaccine - BATCH NO. 139 480 101 (Pack of 10 x 1 DOSE)
This batch has been tested by the National Institute for Biological Standards and Control. This batch has retained its potency and a certificate has been issued extending the shelf life. EXPIRY DATE IS NOW 12/02/1999. There is now no need to revaccinate any patients who received vaccine from this batch subsequent to 12/02/1998 nor is there any need to discard any stock still held. (Dr.D.M/Salisbury, Principal Medical Officer, Dept.of Health, LONDON (circular)
01/07/98 Low dose vaccine for adults. BATCH NO.139 480 101 (Pack of 10 x 1 dose) This batch shows an incorrect expiry date. This should have read 12/02/99.
For further information contact St.Andrew's House, Edinburgh. Tel- 0131 244 2158. (Ref: Scottish Office circular PAL 13038)
05/09/94. New combined diphtheria/tetanus vaccine.Merieux have launched a combined diphtheria and tetanus vaccine which is provided in a pre-filled syringe and is called DIFTAVAX. The previous combined diphtheria and tetanus vaccine was available only on a named-patient basis.
16/09/94. Diphtheria from Pakistan. A recent case of fatal diphtheria in a child recently returned from Pakistan highlights the need to make sure those going to endemic countries have received primary courses of vaccine and boosters when appropriate.