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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. | |