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What you need to know about diphtheria and the vaccine

This article is professionally consulted by Master, Doctor Nguyen Hai Ha - Head of Vaccine Unit - Pediatric Outpatient Department - Pediatric Center - Vinmec Times City International Hospital.
Diphtheria is an acute infectious disease caused by the rod-shaped bacterium Corynebacterium diphtheriae, which is characterized by an inflammatory process with the formation of a fibrin membrane at the site of entry of the agent, the exotoxin. enters the bloodstream causing toxicity to the body with serious complications.

1. Things to know about diphtheria

1.1. Infectious sources and routes of transmission of diphtheria:

Reservoir: the reservoir of diphtheria bacteria is in sick and healthy people carrying the bacteria; This is both a reservoir and a source of disease transmission. Incubation period: 2 to 5 days, possibly longer. Period of transmission: usually not fixed. Patients shed bacteria from the onset, possibly as early as the end of the incubation period. The period of transmission lasts about 2 weeks or less, rarely more than 4 weeks. Healthy people carry diphtheria bacteria from a few days to 3, 4 weeks, very rarely, up to 6 months. Effective antibiotic treatment quickly stops transmission. Mode of transmission: transmitted directly from an infected person to a healthy person through inhalation or indirectly through contact with toys and objects contaminated with secretions of people infected with diphtheria bacteria. In addition, diphtheria bacteria can also enter through the damaged skin causing diphtheria. Usually the diphtheria bacteria multiply on or near the surface of the mucous membranes of the throat. When a sick person / healthy person carrying the diphtheria bacteria coughs or sneezes, droplets containing the pathogen will be released into the surrounding environment, which people nearby can breathe in the diphtheria bacteria. Diphtheria spreads quickly this way, especially in crowded places...
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1.2. Subjects at risk of diphtheria

Children and adults of all ages who have had contact with someone infected with diphtheria, traveled to areas endemic for diphtheria but have not been vaccinated against diphtheria. Immunocompromised people People living in crowded or unsanitary conditions Immunity after vaccination usually lasts about 10 years, the vaccine's protective effect is high (up to 97%) but resistant to The body's body will gradually decrease over time, so if not repeated injection, there is still the possibility of disease.

1.3. Symptoms of Diphtheria

Initially, infected people will have cold-like symptoms such as sore throat, cough, fever with chills. These symptoms gradually increase from mild to more severe. Depending on the location of the bacteria causing the disease, diphtheria will have different manifestations:
Diphtheria anterior: The patient has a runny nose, mucus discharge, sometimes mixed with blood. On examination, a white membrane can be seen in the nasal septum. This form of the disease is usually mild because bacterial toxins rarely penetrate the bloodstream. Diphtheria and tonsils: Patient fatigue, sore throat, loss of appetite, low-grade fever. After 2-3 days, a necrotic cluster will appear, forming an ivory-white or gray pseudomembranous layer, tough and firmly adhered to the tonsils, or may spread to cover the oropharynx. The pseudomembranous layer is difficult to peel and easy to bleed. In this form of the disease, the toxins are absorbed into the blood a lot and can cause systemic toxicity. Some patients may experience swelling under the jaw, swelling of the lymph nodes in the neck, causing the neck to stretch out like a cow's neck. In severe poisoning cases, the patient will be lethargic, pale, fast pulse, lethargic, comatose. Without active treatment, the patient can die within 6-10 days. Laryngeal diphtheria: This is a rapidly progressive and very dangerous disease. Patients often present with signs of fever, hoarseness, cough like a barking dog. On examination, the doctor may see pseudomembranous membranes at the larynx or down the pharynx. If not treated in time, these pseudomembranous membranes can cause airway obstruction, causing respiratory failure and risk of rapid death. Diphtheria other sites: Very rare and mild, diphtheria bacteria can cause ulcers in the skin and mucous membranes such as the eyes, vagina or ear canal. Disease progression and dangerous complications

1.4. Complications

Most complications of diphtheria are caused by toxins, the most common are myocarditis and neuritis:
Myocarditis: People with diphtheria when not detected and treated in time will lead to myocarditis, damage to the heart's nerve conduction system, arrhythmias, possibly heart failure and death from sudden cardiovascular collapse. Neuritis: paralysis of the soft palate is most common in the first 3 weeks, nerve damage in the throat causing difficulty swallowing, paralysis of the oculomotor muscles, paralysis of the diaphragm, and muscle weakness in the arms and legs. Paralysis of the diaphragm can cause pneumonia and respiratory failure. In addition, the disease can also lead to renal degeneration, tubular necrosis, bleeding of the medulla and adrenal cortex; cause conjunctivitis; cause respiratory failure due to airway obstruction...

2. Vaccinate against diphtheria

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Diphtheria vaccine is important in preventing diphtheria. For this purpose, a diphtheria toxoid is used, which is the diphtheria toxin that has been de-toxicated, which is absorbed in aluminum hydroxide. Currently, in Vietnam, there is no monovalent diphtheria vaccine, only a combination diphtheria vaccine which contains diphtheria antigen components such as:
6-in-1 vaccine against diphtheria, cough chickens, tetanus, polio, pneumonia caused by Hemophilus Influenza type b, hepatitis B (Infanrix hexa, Hexaxim). 5-in-1 vaccine against diphtheria, pertussis, tetanus, polio, pneumonia caused by Hemophilus Influenza type b (Pentaxim), prevention of diphtheria, pertussis, tetanus, pneumonia caused by Hemophilus Influenza type b, pneumonia hepatitis B (Combe Five, Quinvaxem. SII) 4-in-1 vaccine against diphtheria, pertussis, tetanus, and polio (Tetraxim). 3-in-1 vaccine against diphtheria, pertussis, and tetanus (Adacel, Boostrix, DPT) The 2-in-1 diphtheria, tetanus and diphtheria vaccine for high-risk adults should only be used in the campaign when there is an epidemic, not universal injection.
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2.1. Subjects of vaccination

Diphtheria vaccine is indicated for children and adults depending on the type of vaccine. Contraindications to diphtheria vaccine are almost nonexistent, only contraindicated if there is a severe reaction to the vaccine with the same component in the previous injection or an allergy to the components of the vaccine.

2.2. Vaccination schedule

In Vietnam, diphtheria vaccine is recommended for all children, 3 doses at 2, 3, 4 months of age and 1 booster at 18 months of age. Children aged 4-6 years can repeat the 4-in-1 vaccine against diphtheria, pertussis, tetanus, and polio. For older children, adults, women before pregnancy or pregnant at 27 weeks to less than 35 weeks of pregnancy can repeat vaccines against diphtheria, pertussis, tetanus; then it can be repeated every 10 years to maintain long-term protective antibodies against diphtheria.
Children as well as adults need to be fully vaccinated according to the recommended vaccination schedule to be able to protect themselves from diphtheria.
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2.3. Possible side effects after vaccination

After receiving the diphtheria vaccine, there may be some side effects such as fever, redness, pain at the injection site and usually disappear after 1-2 days. When noticing unusual symptoms of the body such as high fever unresponsive to antipyretic drugs, skin rash, difficulty breathing, cyanosis, constant fussing, poor feeding, aborting, lethargy, coma ... need to immediately go to a medical facility for timely examination and treatment.

2.4. Is there a risk of getting diphtheria after being vaccinated?

After being fully vaccinated, the body will produce antibodies to help protect us from diphtheria. However, there are a few people who do not create enough antibodies to protect the body after being vaccinated, still at risk of getting diphtheria. The cause may be non-compliance with the vaccination regimen, not receiving the full dose, or due to immunosuppression after contracting infectious diseases. This is more common in children than in adults. In some cases, because the vaccine is too long, the antibody level in the blood drops low, not enough protection, they can also get diphtheria. That's why experts recommend getting vaccinated every 10 years.

3. Caring for someone infected with diphtheria

Diphtheria can be prevented by vaccination against diphtheria. However, in case the patient has not been vaccinated and is infected or suspected of being infected, it is necessary to go to a medical facility for diagnosis and treatment. Patients should be:
Bed rest, ensure nutrition: Because the heart can be affected, you need to rest and avoid strenuous activities. You may need to lie down for a few weeks or until fully recovered.
Isolation from people: Diphtheria is a dangerous infectious disease, with a mortality rate of about 3% and can be transmitted through respiratory droplets, so when you suspect you have signs of infection, you need to be isolated. li for antibiotic therapy, appropriate respiratory support (if respiratory failure is present), diphtheria antitoxin therapy; cleaning rooms, personal belongings, toys... with antiseptic solution; Wear a mask to avoid infecting others.
Currently, Vinmec Hospital system is providing diphtheria vaccine with combination vaccines, including:
Infanrix hexa vaccine - (6 in 1) vaccine: vaccine by GSK, made in Belgium. Indicated for primary vaccination and booster vaccination for children from 2 months to under 24 months, preventing 6 diseases: Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B; diseases: pneumonia, meningitis caused by H.Influenzae type b. Hexaxim vaccine - (6-in-1 vaccine): A vaccine of Sanofi Pasteur, manufactured in France. Indicated to vaccinate children from 6 weeks of age to before 24 months of age, recommended 1st dose from 2 months of age, to prevent 6 diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B, Polio and other diseases pneumonia, meningitis caused by H.influenzae type b. Pentaxim vaccine (5-in-1 vaccine): A vaccine of Sanofi Pasteur, manufactured in France. Indicated to vaccinate children from 2 months to under 24 months, to prevent 5 diseases: Diphtheria, Pertussis, Tetanus, Polio and pneumonia, meningitis caused by H.influenzae type b. Tetraxim vaccine 0.5 ml: It is a vaccine of Sanofi Pasteur, manufactured in France. Indicated for vaccination for children from 2 months to under 13 years old, often used booster shots for children from 4-6 years old, to prevent 4 diseases of Diphtheria, Pertussis, Tetanus, and Polio. Adacel vaccine 0.5 ml: It is a vaccine of Sanofi Pasteur-France, manufactured in Canada. Indicated for ages 4 to 64 years old, single dose injection can be given to pregnant women from 27 weeks to under 35 weeks, preventing 3 diseases Diphtheria, Pertussis, Tetanus. Bootrix vaccine 0.5ml : It is a vaccine of GSK- Belgium. Indicated for age from 4 years old up to the elderly without age limit, repeated every 10 years, can be vaccinated for pregnant women from 27 weeks to under 35 weeks, preventing 3 diseases Diphtheria, Cough Chicken, Tetanus. Vinmec International General Hospital uses high-quality vaccines, from leading manufacturers in the world, with clear origins. Vaccination at Vinmec is completely safe from check-in, storage to use. Choosing to vaccinate at Vinmec, customers will be completely assured of the quality of the vaccine as well as the implementation process, because:
Before vaccination, all customers are pre-screened with doctors. Pediatricians, vaccines to ensure the best health when vaccinated. Doctors will advise on age-appropriate preventive vaccines according to the latest recommendations of the Ministry of Health & World Health Organization as well as how to monitor reactions after vaccination. A team of experienced and professional pediatric doctors and nurses who understand children's psychology helps families feel secure during the vaccination process. 100% of vaccinated subjects were monitored and re-evaluated before leaving. Post-vaccination monitoring room is fully equipped with emergency facilities; the team of doctors - nurses are trained in anaphylaxis emergency management to ensure timely and correct treatment when an incident occurs. In addition, Vinmec Hospital system always has an emergency team ready to coordinate with the vaccination room to handle cases of anaphylaxis, respiratory failure - circulatory arrest to ensure the safest vaccination for children. . The vaccination room is airy, with a play area, helping children feel comfortable as if they are walking and have a good mentality before and after vaccination. Vaccines are imported and stored in a modern cold storage system, with a cold chain meeting GSP standards, with a refrigerator containing the vaccine at each injection room being a dedicated refrigerator. can ensure a temperature of +2 degrees Celsius to +8 degrees Celsius when the power is out within 24 hours, in order to keep the vaccine in the best condition to ensure quality. Currently, Vinmec is building software that can check a child's vaccination history or set a reminder so that parents don't forget their child's immunization schedule via their computer or phone conveniently. Your baby's vaccination information will be synchronized with the national immunization information system. Vaccination against leukemia is very necessary to protect health, you should vaccinate at reputable medical facilities.

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