With winter fast approaching, a lot of people are dreaming of a winter holiday, escaping the snow and the rain in favour of somewhere a little warmer, brighter and more tropical.
Regardless of when you travel, however, it is always a good idea to visit your local travel clinic and see if you need any vaccinations or protective medications ahead of time, in order to help protect you from serious infectious diseases that can be found in some parts of the world.
One of these is diphtheria, a disease that is part of the childhood vaccination schedule but may require a booster vaccination if you travel to some parts of the world.
Here is everything you need to know about diphtheria and how to prevent it from ruining your holiday.
What Is Diphtheria?
A highly infectious bacterial infection, diphtheria releases a toxin when it enters the body and can cause tissue damage, painful ulcer and potential heart and nerve damage. Its exact effects can vary depending on how it infects the body.
The most common way in which it transmits is through the air, either as a result of close contact or coughs and sneezes, which leads to respiratory diphtheria.
Somewhat less commonly, it can spread through cuts in the skin and cause it to become infected, which causes cutaneous diphtheria.
Because of the high risk of infection, it is considered to be a notifiable disease, meaning that any health professional who suspects a case of diphtheria in the UK must inform health protection teams to control its spread.
What Are The Symptoms Of Diphtheria?
In some cases, it causes no symptoms at all, although it can still be spread to other people even if you are asymptomatic yourself.
The most common symptoms of respiratory diphtheria include a sore throat, fever, difficulty swallowing, swellings around the neck that can affect breathing and a grey membrane coating that can cover the nose, tongue and the back of the throat.
Alternatively, cutaneous diphtheria tends to manifest as painful ulcers that can become infected with other bacteria and pus-filled blisters.
In both cases, symptoms start to show between two and five days after infection, with some of the more serious symptoms appearing two to three weeks after infection.
The toxin emitted by diphtheria bacteria can also potentially lead to nerve and heart inflammation, both of which are potentially serious complications that must be treated as an emergency. It can also potentially lead to kidney and liver failure, pneumonia, sepsis and paralysis.
According to the WHO, 30 per cent of diphtheria cases can be fatal in people who have not been vaccinated and do not receive adequate treatment quickly enough.
Where Is Diphtheria Found?
There is a negative correlation between high standards of sanitation and vaccine coverage and rates of diphtheria, so it is extraordinarily rare to find it in the UK and most of Europe, but it can still be found whilst travelling, and it is worth checking if the country you are going to is at risk or has recently had an outbreak.
The most common places where it is found include parts of Eastern Europe, sub-Saharan Africa, Indonesia, Southeast Asia, India and parts of South America.
It tends to be most commonly found in places without a strong immunisation schedule or that have issues with hygiene that cause the bacteria to spread. Other cases tend to be the result of people vulnerable to diphtheria arriving from somewhere where the disease is more endemic.
How Is Diphtheria Treated?
As a bacterial infection, it will typically not go away on its own, so it will need to be treated with antibiotics, specific antitoxins that will stop the effects of the toxins and by cleaning any infected wounds.
This treatment can last up to two weeks, with skin ulcers sometimes taking up to three months to fully heal.
How Can It Be Prevented?
You can protect against diphtheria thanks to a highly effective vaccination routine that has been undertaken since the 1940s in the UK.
The routine vaccination schedule has no fewer than five doses of diphtheria vaccine; three of these doses are as part of the 6-in-1 vaccine (at 8 weeks, 12 weeks and 16 weeks), one is as part of the 4-in-1 pre-school vaccine (at three years, four months), and the last dose is as part of the 3-in-1 teenage vaccine (at 14 years old).
Make sure to check with your GP and your travel clinic if you have been fully vaccinated, but if it has been a decade or more since your last diphtheria vaccine, you may need an additional booster.
Frequently Asked Questions
Many adults require a diphtheria booster if they have not received one within the last ten years and are travelling to areas where diphtheria remains a risk. Your travel health pharmacist can review your vaccination history and advise whether a booster is recommended.
Diphtheria remains more common in parts of Asia, Africa, Eastern Europe, and some regions with lower vaccination coverage. Risk can vary over time, so it is important to obtain destination-specific advice before travelling.
Vaccination provides excellent protection against severe diphtheria disease, but no vaccine offers 100% protection. Maintaining up-to-date boosters and practising good hygiene while travelling further reduces your risk of infection.