By: Tuhin Choudhary, MD, MPH, MS
Diphtheria is a rare but very serious bacterial infection that spreads easily between people. It can cause breathing and swallowing difficulty and may damage the heart, nerves, kidneys and other organs.
Before a vaccine became available in the 1940s, diphtheria was a common childhood illness in the United States. One out of every five children who got it died.
Read on to learn more about diphtheria in children, including symptoms, causes, treatment and why the DTaP vaccine is so important. Find out how diphtheria spreads, when to call a doctor and how to protect your child.
How do children get diphtheria?
Diphtheria is caused by bacteria that release a powerful toxin (poison). This toxin can create a thick gray coating in the throat that can block the airway and make breathing difficult. The toxin can also spread to other parts of the body.
Children can get diphtheria easily when an infected person coughs or sneezes near them. The bacteria that cause diphtheria live in mucus and saliva droplets. When children breathe them in, they get sick. Children can also get diphtheria when they touch a contaminated surface or someone’s open sores.
Diphtheria is more common in fall and winter, but there are some outbreaks during summer in warm climates.
Diphtheria symptoms in children
The symptoms of diphtheria infection begin 2 to 5 days after exposure. Children who are not treated can spread the disease to others for up to 2 to 6 weeks after infection.
Usually, diphtheria affects the throat and tonsils. It causes hoarseness and a barking cough along with the thick gray tissue that can block the airway.
Sometimes diphtheria affects the nose or skin instead. It may cause thick—sometimes bloody—nasal discharge or a rash and sores.
A massive swelling in the neck (often called "bullneck") is a sign of a very serious infection. Diphtheria can cause life threatening problems very fast. Children can experience breathing obstruction, heart damage and facial nerve damage.
Untreated severe diphtheria infections usually cause death.
Children with a diphtheria infection may have symptoms including:
A thick gray coating on the back of the throat, tonsils or larynx (voice box)
A blocked airway that makes it difficult to breathe
Sore throat
Nasal discharge
Swollen lymph nodes (swollen glands) in the neck
Fever
Weakness and fatigue
Hoarseness or a husky voice
A shrill, high-pitched sound when breathing in (stridor)
A less common type of diphtheria causes a rash, sores or blisters on the skin.
What parents can do to prevent diphtheria
Thanks to routine childhood vaccination, diphtheria is now uncommon in the United States. But it is still common in other parts of the world where people don’t have as much access to the vaccine.
Almost all cases of diphtheria in the United States are linked to travel. When someone who is not vaccinated comes back home after getting infected in another country, they spread the disease.
When do children need the DTap vaccine?
The DTaP vaccine is one of the recommended childhood immunizations. It’s a combination vaccine that includes protection against diphtheria, tetanus and whooping cough.
Five doses teach your child’s immune system to recognize and resist the germ that causes diphtheria
Pediatricians recommend that children get DTaP at 2 months, 4 months, 6 months, 15-18 months and between 4 and 6 years old.
At age 11 or 12, your child needs a slightly different version of the vaccine called Tdap, to extend protection against diphtheria.
On-time immunization with the DTaP vaccine keeps diphtheria from making a comeback in our communities. It keeps us all protected. It is recommended that adults get DT or TdaP booster every 10 years to maintain protection against diphtheria.
What to do if your child may have diphtheria
If your child has been exposed to someone with diphtheria, it’s important to talk with your pediatrician right away.
If your doctor thinks your child has diphtheria, they will test them. The doctor will swab your child’s nose and throat and then send the samples to a lab.
Doctors sometimes recommend starting treatment for diphtheria without waiting for the test results. Treatment includes antibiotics for the bacterial infection and a medication that stops toxins from causing organ damage.
Often, someone with diphtheria is hospitalized and kept away from others to avoid the spread of new infections.
Why the DTaP vaccine is important for all of us
Before there was a vaccine, at least 150,000 children got sick with diphtheria every year in the U.S. It was a common cause of death for children and teens. Thanks to the vaccine, now we see fewer than one case a year.
The vaccine against diphtheria was included in the combined DTaP vaccine in the 1940s. That made it easier for parents to protect children not only against diphtheria but also against pertussis and tetanus.
From 1996 to 2018, only 14 cases of diphtheria and 1 death were reported in the United States.
Talk with your doctor
Tell your doctor if your child has known life-threatening allergies. Children with minor illnesses, with or without low-grade fever, can get vaccinated, but you should always consult first with your doctor.
Possible effects after vaccination
Sometimes people have redness, swelling or feel soreness where they got the shot. A few children might get a fever. For any signs that concern you, call your doctor.
If someone has a serious reaction to a vaccine, there are two government agencies that monitor vaccine reactions and safety through the Vaccine Adverse Reporting System (VAERS).
Remember
Diphtheria is a serious, life-threatening illness, but vaccines can keep your child safe. Make sure your child gets all recommended shots and watch for signs like a sore throat or trouble breathing. If your child may be sick, call their pediatrician right away.
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About Dr. Choudhary
Tuhin Choudhary, MD, MPH, MS, is a second year combined Internal Medicine-Pediatrics resident at Tulane University School of Medicine. Her professional interests include infectious disease and tropical medicine, health equity, global health, mentorship for first generation and nontraditional students, and medical education.