Diphtheria Outbreak in Pakistan – All You Need to Know

Diphtheria is a highly contagious bacterial disease that is responsible for pandemics and epidemics around the world. It affects the mucous membranes of the nose and the throat, and the skin and can affect the rest of the body in severe cases.

This usually occurs in the spring or winter season. With a mortality rate of 5-10%, it has a higher incidence in children less than 5 years of age and adults older than 40 years of age. It is treatable with antibiotics and preventable with the help of vaccination which dramatically reduces the mortality rate of this diphtheria. 

What Is Diphtheria?

Diphtheria is caused by an anaerobic (meaning it survives without oxygen) bacteria Corynebacterium diphtheria that affects the upper respiratory system and the skin. If left untreated, it can prove to be fatal by affecting the nervous system, the heart, and the kidneys. 

Diphtheria has an incubation period of 2-5 days and it is communicable for 2-6 weeks for people who are not taking any treatment. It spreads through close contact, coughing, sneezing, and sharing clothes, cups, and cutlery with the patient. A carrier, a person who is infected but does not show symptoms, is also responsible for spreading this disease. 

Diphtheria Outbreak in Pakistan

According to surveys, there were 37 reported cases of diphtheria in Pakistan in 2010, 820 cases in 2018, and 169 cases in 2021. Currently, Pakistan is being warned about another Diphtheria outbreak. 

Causes of Diphtheria

Overcrowding, substandard living conditions, poor hygiene, Incomplete or absent immunization, and compromised health care system is the major reason that contributes to the spread of this disease. 

The unavailability of anti-toxins also contributes to the spread of diphtheria. Low herd immunity, meaning a low percentage of the population is immune to the disease, is also the reason for the prevalence of diphtheria. Traveling to endemic or current epidemic regions is responsible for the spread of this illness. 

Diphtheria Symptoms

Diphtheria affects the upper respiratory, cutaneous, and general body and produces the symptoms according to the system affected by it. 

Some of the general signs and symptoms of Diphtheria are below:

• A low-grade fever
• Weakness and headache
• Severe sore throat
• Swelling of glands in the neck
• Difficulty in swallowing or breathing
• Hoarseness
• The most important sign is a thick white-grey membrane covering the back of the throat, nose, or tongue.

The cause of this grey membrane is the toxin that the bacteria releases after infection. This is the toxin that is responsible for the complications that affect the rest of the body. 

Cutaneous symptoms on the skin include:

• Blisters filled with pus on the legs, feet, and hands
• Presence of ulcers on the skin

Complications of Diphtheria

Diphtheria if untreated, spreads to the nervous system, circulation, kidneys, and heart. 

• Breathing problems in severe diphtheria.
• Endocarditis, which means that the bacteria has infected the walls and valves of the heart. This can lead to heart failure and death.
• Kidney failure
• The toxin of the bacteria affects the nerves, particularly of the throat but also of the arms and legs. This causes weakness and paralysis.

Diagnosis

The signs and symptoms are usually telling of the fact that the person has diphtheria but confirmation is important. The most important diagnosing test is to grow a culture of C. diphtheria in a lab by taking a sample from the grey membrane around the throat or the infected skin lesion or ulcer. Treatment begins immediately without waiting for the lab results. 

Diphtheria Treatment

In case of any of the symptoms above, a physician must be consulted right away. The doctor observes the signs and symptoms of the disease and if he or she suspects that the person is infected, the treatment begins. Diphtheria is treatable with antitoxin and antibiotics which include erythromycin or penicillin. The antitoxin neutralizes the toxin released by the bacteria and the

antibiotic kills the bacteria itself and prevents its further multiplication in the body. Early intervention is extremely important to treat this disease and prevent it from worsening.  

Children and adults suffering may need to be hospitalized to keep them isolated due to the highly infectious nature of the disease, or if the infection is spreading in the body. 

Lifestyle Changes and Home Remedies

Treating Diphtheria at home can be done by isolating the patient in a room and making sure to separate towels, utensils, bed sheets, and clothes. Always wear a mask and gloves while approaching the patient and make sure to get yourself tested and treated after having contact with the infected person. 

Bed rest and avoiding exertion are important to recover from this disease. Consuming food in the form of liquids is important because this disease causes difficulty in swallowing. 

Vaccination Against Diphtheria

Immunization dramatically reduces the incidence of this disease. Vaccination in Pakistan according to the EPI schedule is the DPT vaccine. It has 3 doses and is given to the baby via the intramuscular route. It has the following schedule

• 1st dose at 6 weeks
• 2nd dose at 10 weeks
• 3rd dose at 14 weeks

DPT vaccine combats 3 kinds of diseases which include diphtheria itself, pertussis, and tetanus. This means that this vaccine alone keeps 3 diseases at bay. Complications of this vaccine are very rare and include an allergic reaction, rash, etc which if they occur are treatable. 

Booster shots for this vaccine are recommended at ages 11-12 and then they should be repeated after every 10-year interval. These shots are very important in maintaining immunity. A vaccinated person can only be infected if they have not taken their booster shots regularly or if their immunity is low. 

Diphtheria Meaning in Urdu

The meaning of Diphtheria in Urdu is “خناق” and it is also written as “ڈفتھیریا” in Urdu script. Diphtheria is a serious and potentially fatal bacterial infection characterized by breathing difficulties, headache, and fatigue, among other symptoms.

Conclusion

In conclusion, diphtheria is a disease of bacterial origin that affects the upper respiratory tract in children and adults in later life. It is a highly contagious but treatable disease. It spreads by contact, coughing, and sneezing, and its mortality can be reduced significantly by vaccination. 

Moreover, better living conditions and improvements in the healthcare system also contribute to the prevention of this disease. This achieves good herd immunity which means more and more people are immunized to diphtheria which eventually leads to the elimination of this disease.