Death of a child infected with diphtheria in London

8 May 2008

The Health Protection Agency has been responding to the death of a child in London. The most likely explanation for the child’s death is an infection with diphtheria. The Agency is recommending that people ensure that they are up to date with their routine immunisations.

Diphtheria is extremely rare in the UK due to the success of vaccinations children receive as part of the childhood immunisation programme. The few isolated cases that are seen are usually in unvaccinated people who have travelled to countries where the disease is still common. These cases do not usually spread the infection to others in the UK because the population is well protected through immunisation.

Professor Peter Borriello, from the Health Protection Agency said, “It is rare for people to die from diphtheria as severe infection is prevented by immunisation and the majority of children are routinely immunised against diphtheria in the UK. This child had not been immunised.

“We have taken action to prevent the infection spreading to others. The bacterium that causes diphtheria can be carried without it causing any symptoms and therefore as a precautionary measure, samples have been taken from those who came into close contact with the child. All these contacts have been prescribed antibiotics and booster immunisations where necessary.

“Due to these measures and the protective effect of immunisation we believe that it is unlikely that others will be affected.

“It is important that we maintain high levels of immunisation to prevent diphtheria in the UK. This is because whilst it is uncommon here, cases occur more frequently in other countries and therefore diphtheria can be introduced into the UK by people travelling.

“We recommend that if people are not up to date with their routine immunisations they should contact their GP to arrange them.”

Diphtheria affects the upper respiratory tract, nose, throat, voice box and upper windpipe and occasionally, the skin. It is spread by being in very close contact over a period of time with someone who has the illness or is a carrier of the germ. Symptoms of diphtheria include a sore throat, fever and swollen lymph glands in the neck. More severe symptoms can occur if the diphtheria is caused by a strain that produces toxins. These include heart failure and paralysis.

Professor Borriello concluded, “Our thoughts are with this child’s family and friends at this difficult time.”

Notes to Editors:

For further information contact the HPA London Press Office on 0207 759 2824/2834, or the Centre for Infections Press Office on 0208 327 7098/6647
Diphtheria is an uncommon infection caused by the bacterium Corynebacterium diphtheriae and Corynebacterium ulcerans. Some diphtheria germs are more dangerous than others and can cause serious illness. Only germs that produce diphtheria toxin (poison) cause the classical disease we call diphtheria.
In the UK, babies are routinely immunised against diphtheria as part of the three dose diphtheria, tetanus, pertussis, polio and Hib vaccination. They receive this at two, three and four months old. Booster doses of diphtheria are given before starting school and then again between the age of 16 and 18 years.
Primary vaccination coverage (three doses) in the UK for children aged two has been 94% since 2001, just below the World Health Organization target of 95%. However, there is regional variation and coverage in London is lower than elsewhere in the UK with 86% coverage for 2006/07.
Diphtheria became rare in England and Wales following the introduction of mass immunisation in 1942 when the average number of notifications of diphtheria was about 60,000 with 4,000 deaths. Between 1986 and 1997 there were eight cases of classical respiratory diphtheria caused by toxigenic C. diphtheriae, all of whom had a history of travel to endemic countries, and none since caused by this organism. The last death from C diphtheriae in 1994 was a child who became infected in Pakistan who was unimmunised.
Classic respiratory diphtheria can be caused by Corynebacterium ulcerans and cases which have occurred in England and Wales since 1997 have all been due to this organism rather than C. diphtheriae. There were 2 deaths from respiratory diphtheria caused by C ulcerans; one in 2000 and one in 2006.

Diphtheria Q&As

Last reviewed: 24 December 2008