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| |    Diphtheria: Who Gets It? by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Some parents in developed countries, including the United States, think that because only a few cases of diphtheria are reported each year in their countries, they don't need to have their children immunized. They may believe that the odds of their child's getting sick are so slim, it's not worth the time and expense to guard against it. Unfortunately, this reasoning can leave their children at risk for a preventable and potentially deadly infection. The fact is that even in countries where diphtheria infections are rarely seen, you never know when your child will be exposed to one of the few cases that still do occur or to someone who brings the bacterium from a country with a diphtheria epidemic. It is important for parents to understand who is susceptible to this disease and how it is spread. Who gets diphtheria? Anyone who hasn't been fully immunized with diphtheria toxoid vaccine (including booster shots) can get diphtheria. It is most commonly seen in children under 15 years who have never been immunized or who have been only partially immunized (that is, they have received some, but not all, of the recommended doses). Occasionally people who have been fully immunized get diphtheria, but such cases generally are mild, without serious complications. Unimmunized international travelers who go to parts of the world where there are epidemics--Russia or Eastern Europe, for example--are at particularly high risk. How is diphtheria spread? The bacterium that causes diphtheria normally lives in the nose, throat, and mouth, and is transmitted from person to person by close contact with respiratory secretions (e.g., sneezing, coughing) and infected skin sores. This explains why the infection spreads best in crowded living conditions. Diphtheria is only rarely spread by contact with contaminated surfaces or objects (referred to as fomites), or by food. The time from exposure to the beginning of symptoms (incubation period) is ordinarily two to seven days, but can be a few days longer. In general, a person with diphtheria who goes without treatment is contagious for anywhere from two to six weeks; with treatment, he usually is contagious for only about two to four days. A few people become long-term carriers and are capable of spreading diphtheria for prolonged periods of time--even more than six months, in some cases. It is important to know that people who have been immunized typically are protected from getting sick. But if they come into contact with the disease, they can still become carriers and spread it to other people. Diphtheria is found throughout the world, but only in people, not animals. In temperate climates, it occurs most commonly in the winter and spring.
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