Diphtheria is a highly contagious disease, caused by a bacteria that typically affects the respiratory system causing problems with swallowing and breathing. The most common types of the illness are Classical Respiratory Diphtheria and Cutaneous Diphtheria. Diphtheria is mainly spread by airborne transmission through coughs and sneezes, or from close contact with a person who is infected. It can also be spread by handling or sharing infected items such as cutlery, bedding or clothing. It is possible to have Diphtheria more than once. Diphtheria is fatal in 10% of cases, particularly in those who are unvaccinated or where proper treatment is delayed.
Diphtheria is prevalent in some tropical or developing areas, in 2021 almost 95% of diagnosed cases originated in Ethiopia, India, Yemen, Indonesia and Pakistan.
Those at increased risk of developing Diphtheria include anyone who:
- is travelling or has travelled in an area where Diphtheria is found
- does not have up-to-date vaccinations
- lives in crowded or unsanitary conditions
- lives in the same household or has close contact with an infected person
Symptoms often start 2 to 5 days after exposure. Common signs of Classical Respiratory Diphtheria include:
- throat pain
- weakness or fatigue
- swollen neck glands
- lesions on the tonsils, voice box or in the nose
- problems breathing or swallowing
- grey tissue in the throat or nose (also called pseudomembrane)
In extreme cases if bacteria enters the bloodstream a person can also experience nerve, kidney or heart problems.
In addition to the symptoms above, someone who contracts Cutaneous Diphtheria may also experience skin sores or ulcers covered with grey tissue.
Long term complications can include blockage of air passages, injury to the heart, lungs or nerves and paralysis.
What to do
An infected person is contagious from the onset to day 4 of their symptoms, although some symptoms may remain for up to 10 days.
Symptoms can be relieved by:
- drinking plenty of fluids, such as water
- taking regular pain relief such as paracetamol or ibuprofen
- a person who has sores or lesions will also be advised to regularly clean the infected areas
A doctor may wish to take swabs (from the nose, throat or an open sore) to confirm a diagnosis, but if Diphtheria is suspected they will probably wish to start any treatment immediately. A person may be prescribed antibiotics to kill the bacteria. An anti-toxin may also be prescribed to reduce the impact of the toxins that are released, this is usually required for Respiratory Diphtheria. Tests maybe run after a course of treatment to ensure the infection has fully cleared.
Treatment can last for 2-3 weeks. Skin sores and ulcers can take up to 3 months to heal and may cause some scarring.
It is advisable for a person infected with Diphtheria to isolate and not attend work, school or nursery until they are no longer contagious. They and anyone who is in contact with them, should practice good hygiene to help prevent transmission of the illness to others, this includes:
- washing hands using soap and water or an alcohol-based hand rub
- avoiding touching the eyes, nose or mouth
- regularly cleaning surfaces and objects that could become contaminated using an anti-bacterial cleaner
- using a disposable tissue when coughing or sneezing and disposing of the tissue immediately afterwards
- avoiding close contact with people who are unwell
- remaining away from others if unwell, until recovered
- avoiding sharing clothes or linens such as bedding and towels with others
Vaccination is the best form of prevention against Diphtheria. Due to the widespread childhood immunisation programme, the disease is now rare in the UK. The 6 in 1 vaccine (given at 8, 12 and 16 weeks), pre-school booster (given at 3 years) and the teenage booster (given at 14 years) helps to provide the maximum protection against the illness. It is important for adults and children to have this vaccine to avoid catching Diphtheria.
A person who has been in close contact with someone who has confirmed Diphtheria may be prescribed antibiotics or offered the vaccination to help prevent them developing the disease.
The Public Health Protection Team for North and West Northamptonshire work closely with UKHSA (UK Health Security Agency). They use routine surveillance programmes to monitor the spread of infectious diseases and provide support to prevent and control infection in establishments such as hospitals, care homes and schools.
As Diphtheria is a notifiable disease in England, it is important that health professionals inform East Midlands UK Health Security Agency (UKHSA) of any cases for early identification and management of cases to prevent onward transmission of this disease.
Contact details for East Midlands UKHSA
These are not constantly monitored out of hours.
Last updated 09 January 2023