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.”