What diphtheria is and how it spreads
Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae. The bacteria release a toxin, and the toxin is what makes the illness dangerous: it can damage the heart and nerves. The infection spreads through the air when an infected person coughs or sneezes. Less often it spreads through contaminated objects or through skin sores that carry the bacteria.
Symptoms usually start 2 to 5 days after exposure. Children and adults can both get sick, but unvaccinated children under 5 are at the highest risk of severe disease.
Diphtheria symptoms
The first days look like an ordinary sore throat or cold, which is why the diagnosis is often delayed:
- sore throat, worse when swallowing;
- fever and weakness;
- swollen, tender glands in the neck;
- after 2 to 3 days, a thick gray-white coating on the tonsils and throat that does not wipe away easily and may bleed;
- in severe cases, neck swelling, hoarseness, a barking cough and trouble breathing.
There is also a skin form of diphtheria, with slow-healing sores covered by a coating. If you see a thick coating in a sore throat, do not wait for it to pass on its own. A runny nose and sore throat without any coating are far more often a routine viral infection. See more on runny nose.
Why diphtheria is dangerous
The danger comes from the toxin and from the coating and swelling that can block the airway. Possible complications include:
- inflammation of the heart muscle (myocarditis) and heart rhythm problems;
- nerve damage, causing trouble swallowing or speaking and, later, weakness in the arms and legs;
- breathing failure from swelling and coating in the throat;
- kidney damage.
According to WHO, untreated diphtheria in unvaccinated people is fatal in about 30% of cases. Early treatment greatly improves the outlook.
Diagnosis and treatment
Doctors confirm the diagnosis by examination and a swab from the throat and nose that is tested for the bacterium. Treatment takes place in a hospital under an infectious disease specialist. Patients receive diphtheria antitoxin, which neutralizes the toxin, plus antibiotics, which stop the bacteria from multiplying and reduce contagiousness. Gargles and home remedies do not help and only waste time. People who were in close contact with a patient may be monitored and offered preventive treatment.
Diphtheria vaccine in Georgia
Vaccination is the only reliable protection. The diphtheria component is part of several vaccines in Georgia's national preventive vaccination calendar (Minister's Order No. 01-60/n, current version of July 13, 2023):
- at 2, 3 and 4 months: the six-in-one (hexavalent) vaccine, which covers diphtheria, pertussis, tetanus, Hib, polio and hepatitis B; three doses with at least 4 weeks between them;
- at 18 months and 5 years: a booster against diphtheria, pertussis, tetanus and polio (DTaP/P);
- at 14 years: the tetanus-diphtheria vaccine (Td), then a Td booster every 10 years up to age 55.
Unvaccinated children aged 2 to 13 receive DTaP/P in three doses on a catch-up schedule. Clinics list products such as Hexaxim, Infanrix hexa, Tetraxim, Adacel, Boostrix, Td and DT. Vaccination prices at clinics in Georgia are shown further down this page. For children under 18, national calendar vaccines are free under the state program, and adults can get Td for routine boosters through the state immunization program as well. Your polyclinic can tell you where to go.
Protection fades over time, which is why adults need repeat Td doses. If you cannot remember your last one, ask your family doctor or polyclinic. In most cases the series can be continued rather than restarted, but that is the doctor's decision. It is worth checking your status before travel to countries where diphtheria still occurs.
When to see a doctor urgently
- a sore throat with a thick gray-white coating that will not wipe off;
- neck swelling, hoarseness, a barking cough, or noisy or labored breathing;
- contact with a diphtheria patient when you are unvaccinated or unsure of your status;
- sores that do not heal after a trip to a country where diphtheria occurs.
If breathing is difficult, call an ambulance at 112.
