Diphtheria outbreaks have spread in several regions in Indonesia. Data from the Ministry of Health shows that 95 districts and cities from 20 provinces reported the outbreak of this disease until November 2017. What is Diphtheria actually? This disease is an upper respiratory tract infection caused by the bacterium Corynebacterium diptheriae. This disease can be very contagious and dangerous because of its transmission through the air, either through sneezing, coughing, eating and drinking from the same place, and so on. In some cases, this disease can cause death. Diphtheria knows no age. It can attack children and adults, especially for children aged one to ten years who are very sensitive to this disease.
According to the World Health Organization (WHO), there were 7,097 diphtheria cases reported worldwide in 2016. Among these figures, Indonesia contributed 342 cases. Since 2011, outbreaks of diphtheria have become a problem in Indonesia. There were 3,353 cases of diphtheria reported from 2011 to 2016 and this number put Indonesia in second place after India with the highest number of diphtheria cases. Of the 3,353 people suffering from diphtheria, 110 of them died. Nearly 90% of people infected, do not have a complete history of diphtheria immunization.
Diphtheria is one of the diseases that can be prevented by immunization and immunization against diphtheria is included in the Indonesian government’s mandatory immunization program. Diphtheria immunization combined with pertussis (whooping cough) and tetanus is called DTP immunization. Before the age of 1 year, children are required to receive 3 DTP immunizations. The coverage of children who received DTP immunization up to 3 times in Indonesia, in 2016, was 84%. The number decreases when compared to the first DTP coverage, which is 90%.
Causes of Diphtheria
Diphtheria is caused by the Corynebacterium diphtheriae bacteria . The spread of these bacteria can occur easily, especially for people who don’t get diphtheria vaccine. There are a number of modes of transmission that need to be watched out, such as:
- Inhalation of the patient’s saliva splashes in the air when the patient sneezes or coughs. This is the most common method of transmission of diphtheria.
- Items that have been contaminated by bacteria, for example toys or towels.
- Direct touch on ulcer wounds due to diphtheria in the patient’s skin. This transmission generally occurs in patients who live in densely populated environments and their cleanliness is not maintained.
Diphtheria bacteria will produce poisons that will kill healthy cells in the throat, eventually becoming dead cells. Sometimes, diphtheria may not show any symptoms so the sufferer does not realize that he is infected. If they do not undergo proper treatment, they have the potential to transmit the disease to people around them, especially those who have not received immunization.
Symptoms of Diphtheria
Diphtheria generally has an incubation period or span of time since the bacteria enter the body until symptoms appear 2 to 5 days. Symptoms of this disease include:
- The formation of a thin, gray layer covering the throat and tonsils.
- Fever and chills
- Sore throat and hoarseness.
- Difficulty breathing or rapid breathing.
- Swollen lymph glands in the neck.
- Nervous and tired.
- Cold. Initially it was runny, but over time it became thick and sometimes mixed with blood.
Diphtheria can also sometimes attack the skin and cause ulcers (ulcers). The ulcer will heal within a few months, but usually will leave marks on the skin.
Immediately consult a doctor if you or your child shows the symptoms above. This disease must be treated as soon as possible to prevent complications.
Diagnosis and Treatment of Diphtheria
If someone is suspected of contracting diphtheria, the doctor will immediately start treatment, even before laboratory results. The doctor will encourage him to undergo treatment in an isolation room at the hospital. Then the treatment step will be carried out with 2 types of drugs, namely antibiotics and antitoxin.
Antibiotics will be given to kill bacteria and cure infections. The dose of antibiotic use depends on the severity of the symptoms and the duration of the patient suffering from diphtheria.
Most sufferers can get out of the isolation room after taking antibiotics for 2 days. But it is very important for them to continue taking antibiotics according to the doctor’s recommendations, namely for 2 weeks.
Patients will then undergo a laboratory examination to see whether there is diphtheria bacteria in the bloodstream. If diphtheria bacteria are still found in the patient’s body, the doctor will continue using antibiotics for 10 days.
Meanwhile, the administration of antitoxin serves to neutralize toxins or diphtheria poisons that spread in the body. Before giving antitoxin, the doctor will check whether the patient has an allergy to the drug or not. When an allergic reaction occurs, the doctor will give a low dose of antitoxin and slowly increase it while looking at the development of the patient’s condition.
For patients who have difficulty breathing due to gray membrane blockages in the throat, the doctor will recommend the process of removing the membrane. While patients with diphtheria with symptoms of ulcers on the skin are recommended to clean boils with soap and water thoroughly.
In addition to sufferers, people who are nearby are also advised to see a doctor because this disease is very contagious. For example, a family living in a house or a medical officer who handles diphtheria patients.
The doctor will advise them to take the test and give antibiotics. Sometimes a diphtheria vaccine is also returned if needed. This is done to improve protection against this disease.
The treatment of diphtheria must be done immediately to prevent the spread as well as serious complications, especially in sufferers of children. It is estimated that 1 in 5 sufferers of toddlers and elderly people over 40 years die from complications of diphtheria.
If not treated quickly and precisely, toxins from diphtheria bacteria can trigger several potentially life-threatening complications. Some of them include:
- Respiratory problems Cells that die from toxins produced by diphtheria bacteria will form a gray membrane that can inhibit breathing. Membrane particles can also decay and enter the lungs. This has the potential to trigger an inflammatory reaction in the lungs so that its function will decrease dramatically and cause respiratory failure.
- Heart damage. In addition to the lungs, diphtheria toxin has the potential to enter the heart and cause inflammation of the heart muscle or myocarditis. These complications can cause problems, such as irregular heartbeat, heart failure, and sudden death.
- Nerve damage. Toxins can cause sufferers to experience problems with difficulty swallowing, urinary tract problems, paralysis or paralysis of the diaphragm, and swelling of the nerves of the hands and feet. Paralysis of the diaphragm will make the patient unable to breathe so that it requires a breathing apparatus or respirator. Diaphragmatic paralysis can occur suddenly at the onset of symptoms or weeks after the infection has healed. Therefore, diphtheria sufferers of children who experience complications are generally recommended to remain in the hospital for up to 1.5 months.
- Hypertoxic diphtheria. This complication is a very severe form of diphtheria. In addition to the same symptoms as regular diphtheria, hypertoxic diphtheria will trigger severe bleeding and kidney failure.
Prevention of Diphtheria by Vaccination
The main prevention of Diphtheria is immunization. Indonesia has implemented immunization programs including diphtheria immunization since more than 5 decades. This vaccine includes diphtheria, tetanus, and pertussis or whooping cough. For Diphtheria immunization there are 3 types, namely DPT-HB-Hib vaccine, DT vaccine, and Td vaccine given at different ages. Diphtheria immunization is given through Basic Immunization in infants (under 1 year) as many as 3 doses of DPT-HB-Hib vaccine with a distance of 1 month. Furthermore, booster is given to children aged 18 months as much as 1 dose of DPT-HB-Hib vaccine; for grade-1 elementary school children given 1 dose of DT vaccine, then in grade 2 students given 1 dose of Td vaccine, then in 5th grade students were given 1 dose of Td vaccine.
The success of prevention of Diphtheria by immunization is largely determined by immunization coverage, which is at least 95%.
The emergence of Diphtheria Outbreaks can be related to the existence of an immunity gap , namely the gap or emptiness in the population in a region. This immune vacuum occurs due to the accumulation of groups susceptible to Diphtheria, because this group does not get immunized or does not have complete immunization. Lately, in several regions in Indonesia, resistance to immunization has emerged.
If DTP immunization is late, immunization given chases will not repeat from the beginning. For children under the age of 7 who have not done DTP immunization or who do not complete immunizations, they can still be given a chase immunization with a schedule according to your child’s doctor’s advice. But for those who are 7 years old and have not yet completed their DTP vaccine, there is a similar vaccine called Tdap to give.
Such protection can generally protect children against diphtheria for life.
Even though it occurs more at the age of children, it does not mean that adults cannot be infected or transmit. The Chair of the Indonesian Pediatrician Association (IDAI), Dr. Aman Bakti Pulungan, SpA said that adults can become carriers.
Therefore, Dr. Aman recommends that adults also get a diphtheria vaccine because everyone’s immune system can decline at any time, so it can prevent the spread of this disease. “(Immunization) every 10 years, because of antibodies. Ideally given (vaccine), “he added.