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Division of Public Health Services  Disease Handbook for Childcare Providers 
Bureau of Infectious Disease Control   REVISED –January 2018 
DIPHTHERIA 
 
Diphtheria is a potentially serious bacterial 
infection of the nose and throat. 
 
Who gets this disease? 
Diphtheria occurs primarily among unimmunized 
or inadequately immunized people. 
 
How is it spread? 
The bacteria are spread by direct contact with 
discharge from the nose, throat, skin, eyes, or 
from sores of infected persons.  Articles or food 
contaminated with discharge can also spread 
infection. 
 
What are the symptoms? 
Diphtheria causes a sore throat and swollen 
tonsils, with a grayish cov ering and swollen 
glands in the neck.  It can lead to severe throat 
swelling that can block breathing.  The bacteria 
also produce a toxin (a type of poisonous 
substance) that can cause severe and permanent 
damage to the nervous system and heart.   
 
What is the Treatment? 
Diphtheria is treated primarily with an antitoxin, 
along with antibiotics.  Antibiotics are also given 
to the carriers of the diphtheria (e.g., people who 
test positive for diphtheria but who are not sick). 
Individuals who have been in cont act with an 
infected person and are not adequately vaccinated 
should receive a booster.  
 
How can the spread of this disease be 
prevented? 
The combination vaccine Diphtheria, Tetanus and 
acellular Pertussis (DTap), is required  for both 
childcare and school  attendance.  The Advisory 
Committee on Immunization Practices (ACIP) 
recommends immunizing children against 
diphtheria, along with pertussis and tetanus, 
beginning as early as six weeks of age.  The five 
dose series should be completed at 2 months, 4 
months, 6 months, and 15- 18 months, and 4- 6 
years of age.  
Patients and carriers of diphtheria should receive 
appropriate treatment and not return to childcare 
until two (2) cultures from both the nose and 
throat (and from skin sores in cutaneous 
diptheria), a re negative for the bacteria.  These 
cultures should be taken at least 24 hours apart 
and no sooner than 24 hours after finishing 
antibiotic treatment.  Where culture is impractical, 
isolation may be ended after 14 days of 
appropriate treatment. 
 
Who should be excluded? 
Children and staff should be excluded until 
bacteriological examination proves them not to be 
carriers. 
 
Reportable? 
Yes, Diphtheria is reportable by New Hampshire 
law to the Division of Public Health Services, 
Bureau of Infectious Disease C ontrol at (603) 
271-4496.