Spain: First Case of Diphtheria Since 1986

In early June, Spain recorded its first case of diphtheria since 1986 [1]. The first case in 28 years is a six-year old boy from Olot, a town located in the Catalonia region of the country [1]. The case investigation has led health authorities to conduct testing on individuals who had close contact with the boy. This testing resulted in the detection of the bacterium in eight contacts [1-3]. Despite testing positive, the eight children have not developed the disease because they have been previously vaccinated against diphtheria, they are therefore not considered clinical cases [3]. It has been widely reported in various news media outlets that the six-year old boy from Olot was not previously vaccinated from diphtheria [7].

Transmission

According to the Center for Disease Control (CDC), diphtheria is an “acute, toxic-mediated disease caused by the bacterium Corynebacterium diphtheriae” [2]. Transmission of diphtheria often happens via person-to-person, usually through respiratory droplets from coughing and sneezing [4]. Though rare, transmission can happen through skin lesions or clothing contaminated with diphtheria-infected bodily discharge [4]. Transmission can also occur through fomites – inanimate objects such as toys – that have been contaminated with the bacteria that causes the disease [4].

Symptoms

The bacterium that causes diphtheria invades a person’s respiratory system and usual symptoms of the disease include: weakness, sore throat, fever, and swollen glands in the neck [5]. The diphtheria bacterium produces a toxin, which kills human body tissue, leaving dead tissue in the form of a “pseudomembrane” [5]. This forms as a result of the bacterial infection and can happen in a little as two to three days; the “pseudomembrane” coats the throat or nose, causing difficulty breathing and swallowing [5]. In addition, the toxin can absorb into an individual’s blood stream, causing damage to other organs such as the heart, kidneys, and nerves [5].

Treatment & Prevention

Treatment for diphtheria consists of a diphtheria antitoxin to neutralize the toxin produced by the bacteria, used in conjunction with antibiotics to further destroy and eliminate the diphtheria bacteria [6]. Often, treatment for diphtheria is initiated as soon as possible and patients being treated are kept in isolation for 48 hours after antibiotic treatment begins [6]. This is to ensure that the infected individuals are no longer able to further infect others [6].

Vaccination against diphtheria is often available in four combination vaccines: DTap, Tdap, DT, and td [9]. These vaccinations prevent diphtheria, tetanus, and pertussis (also known as whooping cough) [9]. DTap and DT are given to children younger than seven years of age, while Tdap and Td are given to older children and adults [9]. In Spain, immunization services are free and widely available, and the population is often conducted and covered through systematic vaccination programs [1]. The parents of the six year old boy have publicly reported that they did not vaccinate their child against diphtheria, though reasons behind their decision are unknown [1,7].

Spain’s Case of Diphtheria

It has been reported that Spain’s first case in twenty-eight years, required Spain’s Health Ministry to request the antitoxin from the World Health Organization and the United States, as there was not a dose available on hand – a dose was finally found to be available in Russia [1]. The antitoxin was delivered by the Russian ambassador to Spain on a plane from Moscow on June 8^th[1]. Difficulty tracking down a dose has been contributed to the following sentiment expressed by Spain’s general secretary for the health service, Ruben Moreno, during an interview with Spanish news outlet El Pais, “The problem is that these days, no one has this illness. Everyone is vaccinated” [1].

The initial case of diphtheria – the six-year old boy – first exhibited symptoms of the disease on May 25^th[7]. Currently in the intensive care unit at Vall d’Hebron Hospital in Barcelona, Spain, his condition has been described as “critical, but stable” [3]. The eight children who had tested positive for the bacteria have been quarantined and are being prophylactically treated with antibiotics [8]. Family members of those eight children are currently undergoing testing for the disease to ensure that it is contained [8].

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