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Diphtheria
Diphtheriaisaseriouscommunicablebacterialdiseasethatcausessevereinflammationofthe nose,throatandwindpipe(trachea).Itiscausedbythebacterium,Corynebacterium diphtheriae. Thebacteriaproducetoxinsthatcauseanabnormalmembranetogrowinthethroat,whichcan leadtosuffocation.Otherdangerouscomplicationsincludeparalysisandheartfailureifthetoxins spreadthroughoutthebody.Around10percentofpeopleexposedtodiphtheriadiefromthe disease. Diphtheriaisextremelyrareinmostdevelopedcountries,includingAustralia,becauseofthe widespreaduseofthediphtheriavaccine.However,itisimportanttocontinuevaccinatingchildren againstdiphtheriabecausethereisariskthattheinfectioncanbebroughtinbypeoplewhohave travelledtoorcomefromdevelopingnations. Symptoms Signsandsymptomsofdiphtheriamayinclude: Runnynose Severesorethroat Fever Generallyfeelingunwell(malaise) Swollenlymphnodesinthethroat Afurrygreyorblackcoatingonthethroatmembranes,whichismadeupofbacteriaand deadcells Breathingproblems Swallowingproblems.

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Skin infection Sometimes,diphtheriacausesaskininfection.Thewoundissore,inflamedandfullofpusandmay besurroundedbygreyishskinpatches.Thisconditionisknownascutaneousdiphtheria.Itisquite rareindevelopedcountries. Complications Withouttreatment,theextremelyseriousandpotentiallylethalcomplicationsofdiphtheriacan include: Suffocation,astheabnormalthroatmembraneobstructsbreathing Heartdamage,includinginflammation(myocarditis)orcongestiveheartfailure Kidneydamage Nervedamage,withhealthproblemsdependingonwhichnervesareaffected.

How it is spread Diphtheriaismostcommonlyspreadwhensomeoneingests(swallows)orinhalesthecoughor sneezedropletsfromaninfectedperson.Symptomsoccurbetweentwoand10daysfollowing infection. Sometimes,apersonhassuchamildcaseofdiphtheriathattheydontrealisetheyaresick; however,theyarestillcontagiousforaboutsixweeksandmayinfectalotofotherpeople.An apparentlyhealthypersonwhospreadsaninfectiousdiseaseiscalledacarrier. High-risk groups DiphtheriaisveryrareinAustralia.Peopleatincreasedriskofdiphtheriainclude: Anyoneexposedtoapersoninfectedwithdiphtheria Anyonewhohasnotbeenimmunised

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Peoplewhohaveimmunesystemproblems Peoplelivinginunhygienicandcrowdedconditions TravellerstoparticularareasknowntoharbourdiphtheriasuchasSouth-EastAsia,Russia andsurroundingcountries,BalticcountriesandEasternEuropeancountries.

Diagnosis Testsusedtodiagnosediphtheriamayinclude: Medicalhistoryincludingimmunisationstatus Travelhistory Physicalexamination Swabsofthethroat(orwound)forlaboratorytesting.

Treatment Ifdiphtheriaissuspected,treatmentbeginsbeforethetestresultsarebackfromthelaboratory. Treatmentmayinclude: Hospitalisation Isolationtopreventthespreadofinfection Antibiotics,suchaspenicillin,todestroythebacteria Antitoxinvaccinegivenintravenouslyorintoamuscle Othermedicinestoreducetheriskofadversereactionstothevaccine:forexample, corticosteroids,adrenalineorantihistamines Surgerytoremovethegreymembraneinthethroat,ifnecessary Treatmentofcomplications:forexample,medicationstotreatmyocarditis Bedrestforaboutsixweeksorlonger,dependingontheseverityoftheillness.

Prevention Thebestpreventionagainstdiphtheriaisimmunisation.Peoplewhoarecaringforsomeonewith diphtheriashouldpracticestricthygieneforexample,washhandsfrequently,particularlybefore handling,preparingoreatingfoodandgetabooster.Allcontactsshouldalsoreceiveacourseof antibiotics. Vaccination is available InVictoria,thediphtheriavaccineisavailableinacombinedvaccinethatalsocontainsvaccines againstotherseriousandpotentiallyfataldiseases.Thediphtheriavaccinecontainsaweakened formofthebacterialtoxin,calledatoxoid.Itworksbypromptingthebodytoproducean antitoxinaspecificantibodythatneutralisesdiphtheriatoxin.Anumberofdosesareneededto offergoodprotectionagainstdiphtheria. Differentvaccinesareavailabledependingonthepersonsagegroup.Afreecombinedvaccinethat offersprotectionagainstdiphtheriaisavailableforallVictorianchildrenwhentheyare: Two, four and six months of ageintheformofadiphtheria,tetanus,whooping cough,hepatitisB,polioandhaemophilus influenzaetypeb(Hib)vaccine Four years of ageintheformofadiphtheria,tetanus,whoopingcoughandpolio vaccine In Year 10 at secondary schooladolescentsreceiveaboosterdoseofdiphtheria, tetanusandwhoopingcoughvaccine.

Catch-upimmunisationsarealsoavailablefree-of-chargetoanyschool-agechildovereightyears whohasnotbeenfullyvaccinatedagainstthedisease. Adult booster Immunityagainstdiphtheriareduceswithtimeandfurtherboostershotsmaybeneeded.Acourse ofdiphtheria-containingvaccineisrecommendedforanyonewhohasneverbeenvaccinated. Threedosesaregivenatmonthlyintervalsandtwofurtherboosterdosesaregiven10yearsapart. Thefirstvaccinecanbegivenasacombinationwithdiphtheria,tetanusandwhoopingcough. Followingdosesshouldbegivenasdiphtheriaandtetanus. Adiphtheriaandtetanusboosterisrecommendedat50yearsofageandprovidedfree-of-charge inVictoria.Seeyourdoctororconsultwithyourlocalgovernmentimmunisationserviceprovider formoreinformation.

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Before immunisation Beforeimmunisation,makesurethatyoutellyourdoctorornurseifyou(oryourchild): Areunwellonthedayofimmunisation(temperatureover38.5C) Havehadaseriousreactiontoanyvaccineinthepast Havehadasevereallergytoanything Arepregnant.

Possible side effects of the vaccine Thevaccineiseffectiveandsafe.However,allmedicinescanhaveunwantedsideeffects.Side effectsfromthediphtheriavaccineareuncommonandusuallymildbutmayinclude: Fever Tiredness Irritability Headache Sorenessandrednessattheinjectionsite.

Treating mild side effects Sideeffectsusuallyresolvequickly.However,thereareanumberoftreatmentoptionstoreduce thesideeffectsofthevaccination: Paracetamoltoreduceanyfevercheckthelabelforthecorrectdose(especiallyfor children) Acold,wetclothheldagainsttheinjectionsite Extradrinks Appropriateclothingdonotoverdress.

Anaphylaxis is an extremely rare side effect Thereisaverysmallriskofaseriousallergicreactiontoanyvaccine.Thisiswhyyouareadvised toremainattheclinicormedicalsurgeryforatleast15minutesfollowingvaccinationincase furthertreatmentisrequired. Ifreactionsaresevereandpersistent,orifyouareworried,contactyourdoctorforfurther information. Where to get help Yourdoctor AlwayscallanambulanceinanemergencyTel.000 Emergencydepartmentofyournearesthospital Yourlocalcouncilimmunisationservice DepartmentofHumanServicesImmunisationProgramTel.1300882008 NurseonCallTel.1300606024forexperthealthinformationandadvice(24hours,7 days) TheMaternalandChildHealthLineisavailable24hoursadayTel.132229 NationalImmunisationInfolineTel.1800671811

Things to remember

Diphtheriaisaseriousbacterialdiseasethatcausessevereinflammationofthenose, throatandwindpipe(trachea). DiphtheriaisextremelyrareindevelopednationsincludingAustraliabecauseofthe widespreaduseofthediphtheriavaccine. Thebestpreventionagainstinfectionisimmunisation.

This page has been produced in consultation with, and approved by:

DHS-CommunicableDiseaseControl

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Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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