Toddler Dies of Diphtheria because Parents Rejected Vaccination

JOHOR BAHRU: A 14-month-old baby girl has died, believed to be due to diphtheria on 15 Oct 2018. The child started out having fever and sore throat on 4 Oct and was taken to a private clinic by her mother for initial treatment on 11 Oct. The next day, the child was taken to the emergency unit of a hospital after having breathing difficulties and loss of appetite.

Multiple Organ Failure

The girl was then admitted into the pediatric ward and later the pediatric’s intensive care unit on 13 Oct as she had become weaker and needed respiratory aid. On Monday, 15 Oct, the patient succumbed to severe diphtheria with multi organ failure.

Health director-general Datuk Dr Noorhisham Abdullah in a statement said that test was done on a throat swab sample of the patient and it showed the presence of the corynebacterium diphtheriae bacteria and the ministry was now waiting for lab confirmation.

The baby did not receive diphtheria immunisation because the family had refused it.

The Johor health authorities have quarantined eight people, including the girl’s mother, who had come into contact with the baby girl .

What is Diphtheria

Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms may vary from mild to severe. Diphtheria can cause serious life threatening complications including death in children who are not immunised. They usually start two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever. In severe cases, a grey or white patch develops in the throat. Diphtheria is usually spread between people by direct contact or through the air. It may also be spread by contaminated objects.

Signs and Symptoms

Diphtheria bacteria usually live in the nose and the throat of an infected person. Some infected individuals may become carriers of the bacteria with no symptoms.

Symptoms usually appear within two to four days of the infection and may include:

• Sore throat, hoarseness
• Low-grade fever and general body weakness
• Difficulty in swallowing (due to a thick membrane that forms at the back of the throat)
• Difficulty in breathing (due to a thick membrane that blocks the breathing passage)
• Neck swelling (due to enlarged lymph glands in severe cases)
• Only toxin-producing strains of the bacteria can cause severe disease by spreading the toxin in the bloodstream of the infected person. The non toxin-producing strains of the bacteria may infect the skin, producing skin sores.

How is Diphtheria Treated?

Treatment involves administering antitoxin medicine as well as antibiotics. Anyone suspected of having diphtheria will be put in isolation when they are admitted to hospital.

Importance of Vaccination

Immunisation is the best prevention against diphtheria. Routine childhood immunisations and adult booster doses also prevent the disease.

The diphtheria vaccine which is usually given in a combination with pertussis and tetanus vaccines, is known as the DTaP vaccine.

In Singapore, vaccination with DTaP/ Tdap is compulsory by law. It is recommended as a part of the National Childhood Immunisation Schedule.

A child should receive the first dose at the age of three months, the second dose at the age of four months and the third dose at the age of five months. The first booster dose is given at 18 months of age followed by a top-up booster above the age of 11 years to maintain continued protection against diphtheria.

Booster doses of diphtheria should be given every ten years after recommended immunisation for continued protection.

Booster doses are particularly recommended for those traveling to areas where the disease may still be present.