By Adaobi Rhema Oguejiofor
Ever heard about the strangler-disease that causes the neck to swell and the throat to close up, making it difficult to breathe, thus, slowly suffocating and stifling life out of its victims? This is the case of the Victorian killer disease Diphtheria, which has been nicknamed “the Strangler or the Strangling Angel.”
Diphtheria is a highly contagious vaccine-preventable disease that is caused by a bacterial infection called “Corynebacterium Diphtheriae.” It affects the nose and throat, and sometimes the skin. The disease is most common in children under the age of five, but can also affect people of all ages. It is spread through close contact with an infected person and from respiratory droplets produced from coughs or sneezes of an infected person. The disease is also transmitted by sharing items, such as cups, cutlery, clothing or bedding, with a victim of the illness.
The World Health Organization (WHO) estimates that on a global level, there were about 5,856 reported cases of Diphtheria in 2022 and the top five countries with the highest number of cases were India, which had 3,286 cases, Niger, which had 1,170 cases, Indonesia, with about 734 cases, Pakistan, with about 383 cases, and Nepal with 297 cases. These five countries accounted for 85.52 percent of all the reported cases of Diphtheria in 2022.
According to the National Health Service, United Kingdom (NHS, UK) Diphtheria affects the nose and throat and sometimes the skin and can be fatal in some instances, particularly in children, hence the early administering of vaccines.
The disease is not a new one in the medical scenery as many years ago, during the Victorian era of the 1880s, the disease killed a lot of people, especially children, without minding their class or status. Diphtheria made no preferences in choosing its victims. It didn’t even spare the royal family as it claimed the life of Queen Victoria’s daughter Alice, who happened to be 35 years old at the time. She was not the only one in the royal family to get stricken by Diphtheria, her husband Grand Duke of Hesse-Darmstadt, and 4 of her 7 kids were also affected by the same disease. At the time, in the absence of vaccination, the disease killed an estimated number of 100,000 children in England and Wales each year during the late 19th century.
In recent times, although the Diphtheria is still a serious disease in some parts of the world, it is rare in countries with high vaccination rates. For instance, in the United States, there were only 11 cases of Diphtheria reported in the whole of 2022. However, Diphtheria outbreaks have occurred in recent years in other countries, such as Nigeria and Haiti.
It is more common in countries with low vaccination coverage. It is therefore, important to ensure that all children and adults are up-to-date on their vaccinations, including the Diphtheria vaccine in such countries. In countries with high vaccination coverage, outbreaks of the disease are generally small and confined to unvaccinated individuals or those with weakened immune systems. It is a serious and potentially deadly disease and without treatment, the mortality rate can be as high as 50 per cent. Nevertheless, with early diagnosis and treatment, the mortality rate can be reduced to less than 10 per cent.
The symptoms of Diphtheria usually start to show up within two to five days after becoming infected. The symptoms of Diphtheria are known to include a thick grey-white coating that may cover the back of a patient’s throat, nose and tongue, a high temperature or fever, sore throat, swollen glands in the neck, difficulty breathing and swallowing. The infection can also lead to heart failure and paralysis as well.
There are two main types of Diphtheria, which are the respiratory Diphtheria and the cutaneous Diphtheria. The Respiratory Diphtheria is the most common type and it affects the nose and throat. Cutaneous Diphtheria is less common and it affects the skin. This kind of Diphtheria is most often seen among people with poor hygiene, people who live in crowded conditions. Skin infections with Diphtheria are still common in tropical countries and they are even more contagious than the respiratory Diphtheria. Such skin wounds are characterized by a scaling rash, sores or by blisters, which can occur anywhere on the body. These wounds may be painful, swollen and reddened. The skin infection is treated by thorough cleansing with soap and water and appropriate antibiotics.
People who are at an increased risk of getting Diphtheria include unvaccinated people, people with weakened immune systems, people who live in crowded or unsanitary conditions, and people who travel to countries with low vaccination coverage.
There is no specific treatment for Diphtheria, but antibiotics can be used to shorten the course of the illness, to kill the Diphtheria bacteria, and to also prevent complications. Vaccination is the best way to protect against Diphtheria. Also, it is advisable to thoroughly clean any infected wounds for victims with Diphtheria affecting the skin. Treatments for Diphtheria usually last 2 to 3 weeks. Any skin ulcers usually heal within 2 to 3 months, but may leave a scar. A person who has been in close contact with someone who has Diphtheria may also need to take antibiotics, or may be given a dose of the diphtheria vaccination to prevent the disease from having effect on them.
However, the best way to be safeguarded from Diphtheria is to get vaccinated. The Diphtheria vaccine is usually given as part of the DTaP vaccine, which is a combination vaccine that protects against Diphtheria, Tetanus, and Pertussis. The DTaP vaccine is recommended for all children at two, four, six, and 15-18 months of age, with a booster dose at four to six years of age. Adults should also get a tetanus, diphtheria, and acellular pertussis (Tdap) booster every 10 years.
Diphtheria is a dangerous disease that affects people of all ages. It is a killer disease from the Victorian era that has resurfaced in the 21st century with the same effect as before. World Health Organization (WHO) recommended the early reporting and management of suspected Diphtheria cases in order to initiate timely treatment of cases and follow-up of contacts to ensure the supply of Diphtheria antitoxin. They also advised that case management should be carried out following guidelines recommended by WHO and involve administering antitoxin to neutralize the toxin and antibiotics in order to kill the bacteria, thereby reducing complication and mortality.