Diptheria

This is an old article from AlJezeerah about the measles epidemic a couple years ago here in the Philippines. 

What caused it? Hysteria about complications from an experimental Dengue vaccine given to children which if given to people who had never had dengue exposure made them more prone to get severe dengue.

all the cases of so-called “severe dengue” were relatively mild. Sanofi’s definition of “severe dengue” also contained much milder symptoms than other international definitions.

So none of the more than 30,000 children in the clinical trial died of dengue:

 yes there were some deaths in children that were blamed on the vaccine, but public health authorities said their deaths were from other causes but the damage had been done, and many parents refused to let their kids get even the routine vaccines that had been around for decades.

 

......, '

Fast forward to today.

A lot of hysteria about measles vaccine in the USA, but I wondered why the autism epidemic blamed on measles vaccine waited 30 years to start causing problems. But never mind. Parents want answers. Hopefully RFKJr will figure it out.

Measles is rarely fatal in well nourished Americans, but it is highly fatal in Africa and Asia, where a lot of children have borderline malnutrition... 

But with millions of unscreened migrants let in by Biden's policies, it may be only a matter of time that we start seeing diseases not seen in the US for a century start popping up.

 

 there has been cases of Diphtheria in migrants in Europe. because many of these were not vaccinated in their own country. But ironically many who caught diphtheria caught it  in Europe, meaning that there are clusters of mild cases, carriers, i.e. patients who carry the germ and spread it to others, or cases treated with antibiotics but not diagnosed as diphtheria in certain communities of migrants.

and so cases will continue to occur. And if the anti vax hysteria stops people from getting these vaccines that have been around since the 1920s, well, it is an epidemic waiting to happen.

so far, unlike Europe, the USA seems to be safe from epidemics:

from Grok:

Diphtheria is extremely rare in the United States due to widespread vaccination. ... a few cases have been noted in recent years: - In 2012, one provisional case was reported. - In 2019, two cases were reported, the most recent data available from sources like Our World in Data (https://ourworldindata.org/grapher/diphtheria-cases-in-the-united-states) - A 2020 case report described a 33-year-old unvaccinated man in Georgia with respiratory diphtheria, likely linked to his recent incarceration and lack of childhood vaccinations.[](https://pmc.ncbi.nlm.nih.gov/articles/PMC7753149/)[](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753149/) These cases are exceptions, often tied to unvaccinated or under-vaccinated individuals, international travel, or contact with travelers from areas where diphtheria is more common, like parts of Africa, Asia, or conflict zones. The disease remains under control in the U.S. thanks to high vaccination coverage with DTaP, Tdap, or Td vaccines.[](https://www.cdc.gov/diphtheria/about/index.html)[](https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/diphtheria)[](https://www.hhs.gov/immunization/diseases/diphtheria/index.html)

more here.

 and the bad news is that unless your doctor worked or trained overseas, they might not recognize it in time for the correct treatment. Of course, if you go to an old fashioned doctor who gives antibiotics for sore throats, you might have it cured before you develop proper symptoms.

what inspired this blog post was a book I ran across while checking Project Gutenberg: a 1919 describing the public health approach to diphtheria.

 And there was a cure: Anti toxin. 

Depending on the way it is treated, diphtheria is one of the least dangerous or one of the most dangerous diseases. It is one of the least dangerous when promptly treated with antitoxin; it is one of the most[8] dangerous when the antitoxin treatment is not given, or is delayed or insufficient.

In the days before we had antitoxin one out of every three children who had diphtheria died. Now, if antitoxin is used on the first or second day of the disease ninety-eight out of every hundred children recover. The sooner diphtheria is attended to the more certain is a cure.

The toxin is the reason for those tough membranes that cause choking. 

Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection — usually, the nose and throat. At that site, the infection produces a tough, gray membrane made up of dead cells, bacteria and other substances. This membrane can obstruct breathing.

there is also a real danger of myocarditis and neurological complications from the toxin produced by the germ.

Nowadays, there is treatment: antibiotics and anti toxin.

 

Alas, diphtheria is still present here in the Philippines, and seen in various Asian and African countries:    right now there is an outbreak of diphteria in the Rohingye refugees in Bengladesh

Luckily, antibiotics will help stop the infection, but the problem is the toxin produced by the germ: For this we still use anti toxin. Here is Grok's answer to diphtheria before treatment available:

In the 19th and early 20th centuries, diphtheria was a major cause of death, especially in children, with mortality rates as high as 20-50% in some outbreaks.

....Antitoxin and antibiotics, developed later in the 1890s and 1940s respectively, drastically reduced mortality, but before these, diphtheria was a terrifying and often fatal illness.

when I first started medical school in the 1960s, we still had an infectious disease hospital in our city and outside there was a bell. We were told if a child came in choking from the membrane, they could be saved by immediate tracheostomy, so they would ring the bell and any doctor in the area would come to the ER and do it.

In Dr. Versghese's book The Covanant of water, there is a description of a child being saved from choking by one of the young protagonists who does a tracheostomy under supervision of a local doctor can't do it due to hand injury.

I am surprised that there isn't more descriptions of this in various historical dramas: Dr Quinn series had one episode, but not a lot of clinical details.

 

The history of treatment is here:

In 1890, an effective treatment for diphtheria – antitoxin – was discovered by Shibasaburo Kitasato and Emil von Behring in Germany...

more HERE. 

it was made by giving the toxin to horses, starting with a small dose then increasing the dosage until the horse provided lots of antibodies, which then were removed and purified to give to people

Horse serums have a danger of severe allergic reactions that can be fatal, so now newer technology is used to produce antibodies. 

Horses were given gradually increased doses of diphtheria toxins, and their bodies built up antitoxins (antibodies) to neutralize those toxins. The horses were only weakly affected by the toxins, yet their bodies were capable of producing large amounts of antitoxin serum. The horses were bled, and the antitoxin serum was harvested from the blood and processed. When given to a human diphtheria patient, the horse’s antibodies neutralized the toxins poisoning the patient. The Department’s laboratories had a stable of serum production horses with which they provided New York and other areas of the country with diphtheria antitoxin.

what brought the treatment to the attention of the public was the outbreak in Nome Alaska:

 

Balto, one of the dogs who carried the serum, became the poster child for publicizing that there was a treatment for sipheria, (but some purists correctly point out that Togo was actually the first dog to arrive with the serum)

Wikipedia article has a lot of details: not a one time delivery, but several deliveries of the needed vaccine.

And Balto became the poster dog for those who risked their lives to save the children of Nome.

This blog has the photo of Balto's statue in Central ParkA low-relief plaque bears the words 

“Dedicated to the indomitable spirit of the sled dogs that relayed antitoxins 660 miles over rough ice, across treacherous waters, through Arctic blizzards from Nenana to the relief of stricken Nome in the winter of 1925.”

the lucky needle stick prank

 there is a story out there that a bunch of girls were stuck with needles in France, supposedly the needles was connected to a syringe. Probably an idea spread via the social media and a prank, but the cops are checking if the syringes were injecting drugs or poisons.

But of course, even a simple needle stick can spread HIV and Hep B, if the needle is used more than once. 

So who knows.

Well, anyway, this reminded me of a story of when I was in private practice 30+ years ago. My partner had a child patient with type I diabetes who carried her syringe with her to Middle school, and one day one of the boys asked to see it, and when she showed it to him, he grabbed an (empty) syringe and went around stabbing several of the girls nearby.

So we had to test our patients who were victims for Hep B and HIV, and arrange a retest in three months if any of those involved tested positive ( these viruses could have spread via needle stick if any one was positive). Luckily they were all negative, so end of the problem.

But one of the girls I saw looked a bit, uh, fat. She had thyroid problems, said mom, so mom was not worried at her putting on weight. 

But she was 14, and even though she had not missed a period, I did a pregnancy test, which was negative.

Now, I wondered if it was an ovarian cyst, 

Usually you can feel the edge of an ovarian cyst, but ten years earlier I had another case where the edge of the cyst was right under the liver, and could not be defined by examination. And in this young lady the examination was similarly vague.

So we did an MRI, which did show it was a cyst. A huge cyst that filled her abdomen, about the size of a seven month pregnancy.

So I sent her to the local Gyn who operated and removed a huge ovarian cyst, luckily non cancerous. And  she kept photos of the cyst so she could show her friends to prove she was not pregnant.

small cysts are common, but these huge cysts are rare: as I mentioned, I only saw two cases in 40 years of practice.

 

The surgery is tricky because you have to remove them intact, so you don't spill the fluid into the abdomen...and serous cystadenoma tumors have a thin wall. Luckily neither patient had a cancerous ovarian cyst, and did well.

But I wonder: there are no coincidences, and what would have happened if the girl hadn't been stuck with a needle in a middle school prank? She was active in sports, so what would have happened if she fell  and the cyst burst?

Back then, the surgery was a regular laporotomy (big incision on the abdomen) but now apparently they can safely drain the tumor and remove it via laporoscopy.

video  here.

 

Down's syndrome

 

drugs: the back story

 

so where is this discussion in the MSM?

Leprosy predates Colombus

from Science Daily:

Scientists from the Institut Pasteur, the CNRS, and the University of Colorado (USA), in collaboration with various institutions in America and Europe, reveal that a recently identified second species of bacteria responsible for leprosy, Mycobacterium lepromatosis, has been infecting humans in the Americas for at least 1,000 years, several centuries before the Europeans arrived.

Leprosy is a neglected disease, mainly caused by the bacterium Mycobacterium leprae, affecting thousands of people worldwide: approximately 200,000 new cases of leprosy are reported each year.

 

Although M. leprae remains the primary cause, this study focused on another species, Mycobacterium lepromatosis, discovered in the United States in 2008 in a Mexican patient, and later in 2016 in red squirrels in the British Isles. Led by scientists from the Laboratory of Microbial Paleogenomics at the Institut Pasteur, also associated with the CNRS, and the University of Colorado, in collaboration with Indigenous communities and over 40 scientists from international institutions including archaeologists, this study analyzed DNA from nearly 800 samples, including ancient human remains (from archaeological excavations) and recent clinical cases presenting symptoms of leprosy. The results confirm that M. lepromatosis was already widespread in North and South America long before European colonization and provide insights into the current genetic diversity of pathogenic Mycobacteria.

rabies

the previous mayor allocated funding for free rabies shots for those exposed to the disease (dog bites from street dogs or unvaccinated dogs).

Usually there are city wide outreach clinics to give free rabies shots in poorer neighborhoods, but covid sort of messed things up: Lots of dogs ended up out on the street because people couldn't afford to feed them. Sad.

But now, the lack of free rabies vaccine is still a problem: Nearly every week I get a request to help pay for rabies prevention after dogbite. It used to cost seven USD but I am giving them ten USD now because inflation, but I don't know the price at preasent.

Despite this, a young girl who was bit by a street dog in our barangay died of rabies: She didn't tell her mom because she was afraid of shots.

Sigh.

So I am sure that there are rich NGOs out there funding it, right? What about all that USAID money that Trumpieboy canceled? was that funding treatment or dog vaccination outreach?

it turns out that USAID had nothing to do with funding nor did the WHO.

Hello Grok:

Rabies remains a significant public health issue in the Philippines, causing 200–300 human deaths annually, with dogs being the primary source of transmission.

 

The National Rabies Prevention and Control Program (NRPCP), established under the Anti-Rabies Act of 2007 (Republic Act 9482), aims to eliminate rabies through strategies like mass dog vaccination, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and public education.

 

However, funding shortages have severely hampered these efforts. Recent reports indicate that the Bureau of Animal Industry (BAI) received no funding for anti-rabies vaccines from 2022 to 2024, forcing budget reallocations in 2024 to address rising cases.

 

With an estimated 28 million dogs and cats in the Philippines, achieving the 70% vaccination coverage needed for herd immunity is challenging, as only 14% can be vaccinated this year due to insufficient funds, further delayed by an election ban. Local government units (LGUs) are encouraged to allocate budgets for vaccines, but many lack the resources or prioritization.

 

The Department of Health (DOH) provides free PEP in national and local hospitals, but supply shortages are common, with some areas reporting vaccines as "out of stock." This has led to public frustration, as timely PEP is critical to preventing rabies, which is 100% fatal once symptoms appear.

italics mine.

that is what we are running into, and why people are coming here for money for the shots: series of three at 10 dollars each, and an antibody shot if it is high risk, which is 20 dollars. Average salary: 8 dollars a day. 

 

Programs like the BAI-OIE STOP Transboundary Animal Diseases and Zoonoses (STANDZ) project (2014–2017) and initiatives by the Global Alliance for Rabies Control (GARC) have supported vaccination and education campaigns, but sustained funding remains a gap. The lack of consistent funding undermines the NRPCP’s goal of a rabies-free Philippines by 2030, exacerbating challenges like underreporting, limited access to vaccines in rural areas, and low community awareness. Strengthening LGU budgets, improving vaccine distribution, and expanding education are critical to address this preventable disease.

more grok

 Rabies remains a significant public health issue in the Philippines, where it is endemic, particularly due to dog-mediated transmission. The country ranks among the top globally for human rabies cases, with a notable increase in recent years. Below is a detailed overview based on available information:

Recent Cases and Trends

• 2025 Update: From January 1 to May 17, 2025, the Philippines Department of Health (DOH) reported 124 human rabies cases, a 32% decrease from 183 cases in the same period in 2024.
• 2024 Data: In 2024, the DOH recorded 426 human rabies cases, with nearly half attributed to domestic pet exposure. All reported cases were fatal, highlighting the disease's 100% fatality rate once symptoms appear.
• 2022–2023 Surge: Cases rose to over 350 per year in 2022 and 2023, up from previous years, partly due to disruptions from the COVID-19 pandemic, which limited access to post-exposure prophylaxis (PEP), dog vaccination efforts, and community engagement.
• Historical Context: In 2017, around 400 human deaths were reported annually. From 2020 to 2024, a total of 1,750 patients died due to rabies.

Epidemiology

• Demographics: Most cases occur in males (70–72%) and adults aged 20–59, though children under 15 and low-income individuals are also significantly affected.
• Transmission: Dog bites account for 71–88% of human cases, with cats responsible for about 2–29%. Contrary to common belief, 88% of cases are linked to owned dogs, not strays. Other animals like cattle, pigs, bats, and monkeys can also transmit rabies.
• Geographic Distribution: Central Luzon reported the highest number of cases in 2025 (21 cases by May 17). The National Capital Region (NCR), Region III, and Region IV-A are hotspots, with San Lazaro Hospital in Manila admitting 60–80 cases annually, about 20% of the national total. Recent outbreaks have also occurred in previously rabies-free areas like Marinduque and Romblon.

Clinical Features

• Rabies is a viral zoonosis affecting the central nervous system, starting with fever, pain, and sensations at the bite site, progressing to fatal encephalitis. Symptoms may appear weeks to years after exposure, depending on the viral load.
• Once symptoms manifest, rabies is almost universally fatal, with rare recoveries often involving severe neurological damage.

Prevention and Control Efforts

• Vaccination: The Philippines has an ongoing mass vaccination program for dogs and cats, aiming for 70% coverage, though actual coverage is often lower (e.g., 32.3% in NCR, 49.9% in Region III in 2015). Free PEP is available at over 500 animal bite treatment centers, with over one million people receiving it annually.
• Legislation and Programs: The Anti-Rabies Act of 2007 mandates PEP provision, dog vaccination, and pet registration. The National Rabies Prevention and Control Program (2020–2025) targets rabies elimination by 2030, aligned with the global “Zero by 30” strategy.
• Challenges: Limited vaccine availability for animals, inadequate control of free-roaming dogs, and low public awareness hinder progress. The COVID-19 pandemic exacerbated these issues by disrupting vaccination campaigns and PEP access. Cultural practices, like consuming raw dog meat, also pose risks.
• Innovations: The Global Alliance for Rabies Control (GARC) supports initiatives like the Integrated Bite Case Management (IBCM) program and tools like the Vaccination and Sterilization Tracker (VST). Genomic surveillance has helped trace outbreaks, such as in Romblon, to human-mediated introductions.

Public Health Recommendations

• Immediate Action: After an animal bite or scratch, individuals should wash the wound with soap and water and seek PEP immediately. Delays, as seen in the tragic case of a 13-year-old girl in Manila in 2024, can be fatal.
• Education: Public awareness campaigns emphasize responsible pet ownership, reporting suspected rabid animals, and recognizing symptoms, including the less-known paralytic form of rabies.
• One Health Approach: Mass dog vaccination, population control, and robust surveillance are critical. The DOH and Department of Agriculture continue to prioritize these strategies.

Specific Incidents

• Marinduque (April 2024): A rabid dog bit cattle, leading to culling of infected animals.
• Romblon Outbreak (2024): Genomic studies confirmed multiple introductions from endemic provinces, with two human deaths within six months.
• Killua Case (March 2024): A golden retriever in Camarines Sur tested positive for rabies, prompting warnings for those exposed to seek PEP.

Conclusion

While the Philippines has made strides in rabies control through legislation, vaccination programs, and international collaboration, the disease remains a persistent threat due to high case numbers, low vaccination coverage, and systemic challenges. The recent decline in cases in early 2025 is promising, but sustained efforts in vaccination, education, and surveillance are essential to achieve the 2030 elimination goal. For further details on vaccination or support, contact the DOH or visit https://x.ai/grok for general inquiries, though specific pricing or subscription details for programs like SuperGrok are unavailable here.