Complications of Diphtheria
Myocarditis, polyneuritis, and airway obstruction are common complications of respiratory diphtheria, death occurs in a few cases involving the respiratory tract. Complications and deaths are much less frequent in cutaneous diphtheria.
Prevention of Diphtheria
Immunization of Close Contacts
If the close contact has not been immunized at all against diphtheria, then he/she should receive prophylactic penicillin or erythromycin, diphtheria antitoxin, actively immunized against diphtheria. If the primary immunization or booster dose was received within the previous two years, no further action would be needed. If the diphtheria toxoid was received more than two years before, only a booster dose of diphtheria toxoid need be given.
The vaccines are available in a combined form with other vaccines. Thus, it is available as DPT (Diphtheria, Pertussis, Tetanus) or DT (Diphtheria Tetanus)
DPT/DT vaccines should not be frozen. They should be stored in a refrigerator between 4 to 8 degrees C.
There are two types of the DPT vaccine – plain and adsorbed. Adsorption is usually carried out on a mineral carrier like aluminum phosphate or hydroxide. Adsorption increases the immunological effectiveness of the vaccine. The first dose of the vaccine should be given when the infant is about six weeks old.
It has been found that young infants respond well to immunization. Therefore, the first vaccination is recommended at about six weeks. Three doses of DPT each of which is usually 0.5 ml, should be considered optimal for primary immunization. Starting at six weeks, three doses should be given at one month intervals for optimum immunization. A booster injection at one–and–a–half years to two years is recommended, followed by another booster (DT only) at the age of five to six years.
What are the possible adverse reactions to diphtheria injection?
Fever is the most common side–effect. It is estimated that 2 to 6% of vaccines develop fever of 39 degrees centigrade or higher. A small number of patients may develop localized swelling at the site of an injection. These can usually be managed by analgesics and antipyretics given orally. The most severe complications following DPT immunization are neurological (encephalitis/encephalopathy), prolonged convulsions, infantile spasms and Reye’s syndrome and are thought to be due primarily to the pertussis component of the vaccine – the estimated risk is 1:170,000 doses administered.
The vaccine should not be given to seriously ill children who are usually hospitalized. Minor illnesses such as cough, cold, mild fever are not considered contraindications to vaccination. If there is a history of a severe adverse reaction with a previously administered vaccine, it should not be given to the child. Such reactions may include convulsions, produce a shock–like state or extremely elevated temperatures. Local reactions at the site of the injection or mild fever do not by themselves preclude the further use of DPT. For immunizing children over 12 years of age, and adults, the preparation of choice is DT, which is an adult type of diphtheria tetanus vaccine.