Several cases of diphtheria are observed in France at the start of 2023. This disease, which had disappeared in the country, is a very contagious angina which can be fatal in the event of complications. Should we fear it in France? What are the symptoms to watch out for?
diphtheria, a bacterial infection supposed to have disappeared in France in the early 1990s thanks to compulsory vaccination, was again detected in the country with 38 cases recorded since January 2022 in metropolitan France, 13 case in Mayotte and 4 cases in Reunionaccording Public health France. “Compared to other years, the number of cases is clearly higher than average“, reports the health authority. This disease is highly contagious and is transmitted from person to person. Should we be worried about the return of this disease? How do you catch diphtheria? What are symptoms of this disease? Dangers for the body ? Can we die of it ? How to treat?
What is diphtheria?
Diphtheria is an infectious disease caused by several species of bacteria (Corynebacterium) which can produce diphtheria toxin. She provokes a respiratory infection (whose symptoms resemble angina) which can affect the central nervous system, the throat and other organs. Without treatment, it can lead to death by asphyxiation.
What is the bacterium in question?
Diphtheria is caused by several species of genus corynebacteria diphtheriae:
- Corynebacterium diphtheriae
- Corynebacterium ulcerans
- Corynebacterium pseudotuberculosis
Should we be afraid of diphtheria in France?
Until the 1930s, diphtheria was responsible for several thousand deaths per year (45,000 cases of diphtheria and 3,000 deaths in 1945 according to the Montpellier University Hospital). Diphtheria then disappeared in mainland France in the early 1990s.”Thanks to very high vaccination coverage, diphtheria caused by Cornybacterium diphtheriae disappeared in metropolitan France. Since 2002, with the exception of one case, all reported cases were imported cases. The latest cases are due to strains imported from Madagascar, Russia, West Africa and Pakistan“, reports Public Health France. But since January 2022, the health authority reports:
- 30 cases of Corynebacterium diphtheriae in metropolitan France (the cases were diagnosed in 9 regions. The region Normandy was the most affected with 7 reported cases)
- 8 cases of Corynebacterium ulcerans in France
- 13 cases of Corynebacterium diphtheriae in Mayotte
- 4 cases of Corynebacterium diphtheriae in Reunion.
In mainland France, the majority of cases were reported in migrants and travelers, not or poorly vaccinated (not up to date with their vaccinations). However, “occurrence of severe or clustered cases in the general population appears extremely low in mainland France and Reunion“, would like to reassure Public Health France. Cases still remain sporadic in France and not fatal (as proof, in Europe, a case of fatal diphtheria was reported in a child in Spain in 2015 and a case in Belgium in 2016. These two children were not vaccinated), especially since vaccination against diphtheria has been compulsory in France since 1938. As a result, the French population is protected. It should be noted that in certain regions of the world, diphtheria is still rife, particularly in Southeast Asia and Africa.
What are the symptoms of diphtheria? Angina ?
Diphtheria generally causes ENT impairment with so-called “diphtheria” angina whose characteristics are as follows:
- pharyngitis
- A fever
- a pallor
- Pain when swallowing (dysphagia)
- Lymphadenopathy under the jaws (or swelling of the neck)
- Headaches
- Tonsils covered with “whitish false membranes“, of cream or greyish color, which may bleed if the angina becomes complicated.
Among the cases reported in France: 25 cases were cutaneous forms, 3 were asymptomatic carriers (at the oropharyngeal level), 1 was a respiratory form with few symptoms (autochthonous case) and 1 other presented the symptoms of classic respiratory diphtheria (migrant person).
How is diphtheria transmitted?
The bacterium Corynebacteriumdiphtheriae spreads directly through nasopharyngeal secretions or some skin wounds and very rarely by indirect contact with objects soiled by secretions of patients. The bacterium C. ulcerans is transmitted through milk and contact with cattle (contacts with cats or dogs have been described). Human-to-human transmission has not been documented. The bacterium C. pseudotuberculosis can also be transmitted to humans by goats.
What is the incubation period of the bacteria?
The incubation period varies from 2 to 5 days.
What are the dangers of an infection?
The most serious consequences come from the toxin that the bacteria can secrete. The bacterium then carries the gene encoding the toxin (tox+). The main manifestation of the disease is angina which can be complicated by cardiac or neurological damage and lead to death (by asphyxiation or croup), reports Public Health France.
Is there a diphtheria vaccine?
Yes, there is a diphtheria vaccine (DTCaPolio or DTPolio depending on age) composed of purified and inactivated diphtheria toxin. Vaccination is mandatory for all children: primary vaccination is now mandatory for children at 2 and 4 months. The first booster is done at the age of 11 months and the other boosters are done at 6 years, 11/13 years, 25 years, 45 years, 65 years and then every 10 years. Vaccination is also mandatory among health professionals (reminders carried out at the same fixed ages (25 years, 45 years and, depending on the pursuit of professional activities, 65 years), with a vaccine containing a reduced dose of diphtheria toxoid (dTPolio) and is particularly recommended in travelers in endemic areas.
What treatment to treat diphtheria?
The treatment of classic diphtheria is to administer as soon as possible anti-diphtheria serum by intramuscular injection and/or antibiotics (antibiotic therapy with amoxicillin is recommended, or with macrolides in case of allergy to beta-lactams). The management of a case of diphtheria carrying the gene encoding diphtheria toxin, in addition to specific treatment, also includes respiratory isolation in the event of ENT impairment and updating the vaccination status, explains Public Health France.
► In France: diphtheria must be the subject ofa notice assoon as Corynebacterium diphtheriae, ulcerans or pseudotuberculosis has been isolated and the toxin gene has been demonstrated. Prevention involves the rapid detection of cases and their human contacts and their immediate management.
Sources:
– Diphtheria sheet, Institut Pasteur
– Diphtheria sheet, Public Health France
– National reference center for Corynebacteria of the complex diphtheriae
– Document on what to do in the event of diphtheria published by the High Council for Public Health.