Diphtheria in Children

What is diphtheria?

Diphtheria, a childhood disease that was common in the 1930s, is an acute bacterial disease that can infect the body in 2 areas:

  • The throat, nose, and tonsils (respiratory diphtheria)

  • The skin (skin or cutaneous diphtheria)

A vaccine against diphtheria has made it very rare today in the U.S. and other developed countries.

How is diphtheria transmitted?

The diphtheria bacterium can enter the body through the nose and mouth. However, it can also enter through a break in the skin. It is transmitted from person-to-person in close contact by aerosol route. This means breathing in respiratory secretions or droplets that contain diphtheria bacteria from an infected person coughing, sneezing, or laughing. After being exposed to the bacteria, it usually takes 2 to 4 days for symptoms to develop.

What are the symptoms of diphtheria?

The following are the most common symptoms of diphtheria. However, each child may experience symptoms differently. Symptoms may include:

  • Respiratory diphtheria. When a child is infected with diphtheria, the bacterium usually multiplies in the throat. This leads to respiratory diphtheria. A membrane may form over the throat and tonsils, causing a sore throat. Other common symptoms of respiratory diphtheria may include:

    • Breathing difficulty

    • Low grade fever

    • Husky voice

    • Stridor (a shrill breathing sound heard during inspiration, or breathing in)

    • Enlarged lymph glands of the neck

    • Increased heart rate

    • Nasal drainage

    • Kidney damage

    • Swelling of the palate (the roof of the mouth)

    Children may die from asphyxiation when the membrane obstructs breathing. Other complications of respiratory diphtheria are caused by the diphtheria toxin released in the blood. This leads to kidney or heart failure.

  • Skin (cutaneous) diphtheria. With this type of diphtheria, the symptoms are usually milder. They may include yellow spots or sores (similar to impetigo) on the skin.

The symptoms of diphtheria may resemble other problems or medical conditions. Always talk with your child's healthcare provider for a diagnosis.

How is diphtheria diagnosed?

A healthcare provider can usually diagnose the illness based on clinical exam. A swab culture of the mouth or affected mucous membrane may also be used to confirm the diagnosis.

What is the treatment for diphtheria?

Your child's healthcare provider will figure out the best treatment for your child based on: 

  • How old your child is

  • His or her overall health and past health

  • How sick he or she is

  • How well your child can handle specific medicines, procedures, or therapies

  • How long the condition is expected to last

  • Your opinion or preference

Antibiotics are usually effective in treating respiratory diphtheria early on before it releases toxins in the blood. An antitoxin can be given in combination with the antibiotics, if diphtheria is suspected. Sometimes a tracheostomy (a breathing tube surgically inserted in the windpipe) is necessary if the child has severe breathing difficulties.

How is diphtheria prevented?

In their first year of life, children in the U.S. are routinely given a triple vaccine (DTaP) that includes diphtheria. Because diphtheria still prevails in underdeveloped countries, the vaccine remains necessary in case of exposure to a carrier visiting from another country.

What are the facts about immunization against diphtheria, tetanus, and pertussis?

Diphtheria, tetanus, and pertussis vaccines prevent these diseases. Most children who receive all of their shots will be protected during childhood. A combination vaccine is given to babies and children and provides protection against all 3 diseases. There are several types of the vaccine; however, the newer form is the DTaP:

  • DTaP vaccine:

    • Protects against diphtheria, tetanus, and pertussis.

    • Is a newer form of the vaccine and is less likely to cause reactions than earlier types given.

When are DTaP vaccines given?

The CDC recommends that children need 5 DTaP shots. The first 3 shots are given at 2, 4, and 6 months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at 4 to 6 years of age. At regular checkups for 11- or 12-year-olds, a preteen should get a booster dose of another form of this vaccine called Tdap. Always talk with your child's healthcare provider for advice.