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An Old Plague Coming Back to Haunt Us.: Diphtheria: What is that

© Neal Rolfe Chamberlain

During the 1990's approximately 550 deaths per year resulted from the diphtheria epidemic in the former Soviet Union. The epidemic began in 1990 in Russia and spread to all of the remaining New Independent States (NIS) of the former Soviet Union by the end of 1994. More than 150,000 cases and 5,000 deaths have been reported from the NIS in 1990 - 1998. Widespread immunization campaigns since 1994 have largely controlled the epidemic although over 2,700 cases were still reported in 1998.

Diphtheria can be a very serious infection. Even if patients with diphtheria are treated correctly, 5-10% die! Fortunately, for us diptheria is very rare in the United States; only 41 people have contracted it in the United States in the past 15 years.

Diptheria is normally an infection of the throat caused by a bacterium, Corynebacterium diphtheriae. The bacteria grow in our throats and produce a protein. This protein causes our cells to die by stopping protein production by our cells. This bacterial protein is called diphtheria toxin.

The first symptom of infection is very sore throat. A lot of swelling can also occur in the patient's neck region (the Bull-neck appearance). When the cells in the patient's throat die , a grayish membrane forms that can sometimes close off their throat and prevent air from getting into the patient's lungs. This is a bad thing! The toxin also can get in our bloodstream and cause heart damage, which is the most common cause of death in diphtheria patients.

This infection is so rare in the United States because we vaccinate our children to prevent this disease. It is part of the vaccine called DTP that we get when we are infants. Unfortunately, if we ever stop vaccinating our children the disease will comeback. When the Soviet Union's "Iron Curtain" fell in 1989 the health care system also suffered tremendously. As a result, the citizens did not get their shots. Within a very short period of time diphtheria began to occur again.

Why do we still need to vaccinate people to prevent diphtheria from coming back? After all we don't vaccinate for smallpox anymore. Why can't we eradicate this organism from the face of the earth also? We can't eradicate diptheria because the smallpox vaccine and diphtheria vaccines are different.

The smallpox vaccine is a live virus vaccine. The virus used to vaccinate people, the vaccinia virus, is a close relative to the smallpox virus. The vaccinia virus does not cause smallpox. If a person is infected with the vaccinia virus before they are infected with smallpox

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