Diphtheria cases reported in Loei & Udon Thani

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Diphtheria cases reported in Loei & Udon Thani

Post by bumper » September 27, 2012, 11:56 am

Yesterday I went to the Bangkok Hospital, to get the annual flu shot. The doctor there advised me that I might consider Diphtheria shots as well. Saying there are reported cases in Loei.

Anyone have any other information on that. Bangkok Hospital, does not offer the shots. Udon Hospital does.

Most of us who served in Military were given those shots before going to Vietnam. Is this one of those that would require a booster shot?

Anyone else having anything to offer on the topic?



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Diptheria cases reported in Loei

Post by BobHelm » September 27, 2012, 12:10 pm

Hopefully wazza will advise Bumper.

I did think it was a 1 off shot & I am 99% certain that I have had only 1.

However when I went for an internet search I saw that there were recommendations that people over 65 who spend a lot of time around very young children (grandparents for example) should have a booster.
I can only think that is for the safety of the child rather than the adult though...

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Diptheria cases reported in Loei

Post by bumper » September 27, 2012, 3:29 pm

Thanks Bob, 65 but, not around children. Anyone know how it's spread?

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Diptheria cases reported in Loei

Post by BobHelm » September 27, 2012, 3:42 pm

A 'non medic' answer... :D :D
https://en.wikipedia.org/wiki/Diphtheria

Although, interestingly they say...
Boosters of the vaccine are recommended for adults, since the benefits of the vaccine decrease with age without constant re-exposure; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
So maybe a good idea????

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Diptheria cases reported in Loei

Post by bumper » September 27, 2012, 3:55 pm

Ya I think I will endure Udon hospital and get the shot. Since I was warned about this from a doctor I assume it to be accurate. Nasty stuff not anything to play with:
Diphtheria
From Wikipedia, the free encyclopedia
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Diphtheria
Classification and external resources

Diphtheria causes a characteristic swollen neck, sometimes referred to as “bull neck”.
ICD-10 A36
ICD-9 032
DiseasesDB 3122
MedlinePlus 001608
eMedicine emerg/138 med/459 oph/674 ped/596
MeSH D004165

Diphtheria (Greek διφθέρα (diphthera) "pair of leather scrolls") is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium.[1][2] It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.[3] A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis (about 20% of cases) [4] and peripheral neuropathy (about 10% of cases).[5]

Diphtheria is a contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. Historically quite common, diphtheria has largely been eradicated in industrialized nations through widespread vaccination. In the United States, for example, there were 52 reported cases of diphtheria between 1980 and 2000; between 2000 and 2007, there were only three cases[6] as the diphtheria–pertussis–tetanus (DPT) vaccine is recommended for all school-age children. Boosters of the vaccine are recommended for adults, since the benefits of the vaccine decrease with age without constant re-exposure; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
Contents

1 Signs and symptoms
2 Diphtheria toxin mechanism
3 Diagnosis
3.1 Laboratory criteria
3.2 Clinical criteria
3.3 Case classification
4 Treatment
5 Epidemiology
6 History
7 References
8 Further reading

Signs and symptoms

The symptoms of diphtheria usually begin two to seven days after infection. Symptoms of diphtheria include fever of 38°C (100.4°F) or above, chills, fatigue, bluish skin coloration, sore throat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foul-smelling bloodstained nasal discharge and lymphadenopathy.[7][8] Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.[citation needed]
Diphtheria toxin mechanism
A diphtheria skin lesion on the leg

Diphtheria toxin is produced by C. diphtheriae only when infected with a bacteriophage that integrates the toxin-encoding genetic elements into the bacteria.[9][10]

Diphtheria toxin is a single, 60,000 molecular weight protein composed of two peptide chains, fragment A and fragment B, held together by a disulfide bond. Fragment B is a recognition subunit that gains the toxin entry into the host cell by binding to the EGF-like domain of heparin-binding EGF-like growth factor (HB-EGF) on the cell surface. This signals the cell to internalize the toxin within an endosome via receptor-mediated endocytosis. Inside the endosome, the toxin is split by a trypsin-like protease into its individual A and B fragments. The acidity of the endosome causes fragment B to create pores in the endosome membrane, thereby catalyzing the release of fragment A into the cell's cytoplasm.

Fragment A inhibits the synthesis of new proteins in the affected cell. It does this by catalyzing ADP-ribosylation of elongation factor EF-2—a protein that is essential to the translation step of protein synthesis. This ADP-ribosylation involves the transfer of an ADP-ribose from NAD+ to a diphthamide (a modified histidine) residue within the EF-2 protein. Since EF-2 is needed for the moving of tRNA from the A-site to the P-site of the ribosome during protein translation, ADP-ribosylation of EF-2 prevents protein synthesis.

ADP-ribosylation of EF-2 is reversed by giving high doses of nicotinamide (a form of vitamin B3), since this is one of the reaction's end-products, and high amounts will drive the reaction in the opposite direction.[citation needed]
Diagnosis

The current definition of diphtheria used by the Centers for Disease Control and Prevention (CDC) is based on both laboratory and clinical criteria.
Laboratory criteria

Isolation of Corynebacterium diphtheriae from a gram stain or throat culture from a clinical specimen [11], or
Histopathologic diagnosis of diphtheria by a stain called "Albert's Stain".

Clinical criteria

Upper respiratory tract illness with sore throat
Low-grade fever (>102 °F (39 °C) is rare)
An adherent true membrane on the tonsil(s),which may extend to pillars, palate and pharynx(post. pharangeal wall).

Case classification

Probable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed case
Confirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed case

Empirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.
Treatment

The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit and be given a diphtheria antitoxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.[6]

Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends[12] either:

Metronidazole
Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

In cases that progress beyond a throat infection, diphtheria toxin spreads through the blood and can lead to potentially life-threatening complications that affect other organs, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, eventually leading to paralysis. About 40% to 50% of those left untreated can die.
Epidemiology
Disability-adjusted life year for diphtheria per 100,000 inhabitants.
no data
≤ 1
1-2
2-3
3-4
4-5
5-6
6-7
7-9
9-10
10-15
15-50
≥ 50
Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend)

Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under five years and adults over 40 years, the fatality rate may be as much as 20%.[6] Outbreaks, though very rare, still occur worldwide, even in developed nations, such as Germany and Canada. After the breakup of the former Soviet Union in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991, there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths.[13] This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease".[citation needed]
History

The disease was named by French doctor Pierre Bretonneau in 1855 (substituted for his earlier term diphthérite).

In 1878, Queen Victoria's daughter Princess Alice and her family became infected with it, causing two deaths, Princess Marie of Hesse and by Rhine and Princess Alice herself.

In the 1920s, there were an estimated 100,000 to 200,000 cases of diphtheria per year in the United States, causing 13,000 to 15,000 deaths per year.[6] Children represented a large majority of these cases and fatalities. One of the most famous outbreaks of diphtheria was in Nome, Alaska; the "Great Race of Mercy" to deliver diphtheria antitoxin is now celebrated by the Iditarod Trail Sled Dog Race.
A poster from the United Kingdom advertising diphtheria immunisation.

One of the first effective treatments for diphtheria was discovered in the 1880s by U.S. physician Joseph O'Dwyer (1841–1898). O'Dwyer developed tubes that were inserted into the throat, and prevented victims from suffocating due to the membrane sheath that grows over and obstructs airways. In 1884, Friedrich Loeffler discovered the causative organism (Corynebacterium diphtheriae). In December 1890, the German physician Emil von Behring developed an antitoxin that did not kill the bacterium, but neutralized the toxic poisons the bacterium releases into the body. Von Behring discovered that animal blood has antitoxins in it, so he took the blood, removed the clotting agents and injected it into human patients. "The paper shook the scientific world. Work on diphtheria at a level of intensity heretofore unknown proceeded in laboratories. Over the Christmas holiday in 1891 in Berlin, the first attempt to cure a person of diphtheria was made. It succeeded. . . . It was the first cure." [14] Von Behring was awarded the first Nobel Prize in Medicine for his role in the discovery, and development of a serum therapy for diphtheria. (Americans William H. Park and Anna Wessels Williams, and Pasteur Institute scientists Emile Roux and Auguste Chaillou also independently developed diphtheria antitoxin in the 1890s.) The first successful vaccine for diphtheria was developed in 1913 by Behring. However, antibiotics against diphtheria were not available until the discovery and development of sulfa drugs.

The Schick test, invented between 1910 and 1911, is a test used to determine whether or not a person is susceptible to diphtheria. It was named after its inventor, Béla Schick (1877–1967), a Hungarian-born American pediatrician. A massive five-year campaign was coordinated by Dr. Schick. As a part of the campaign, 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to "Save your child from diphtheria." A vaccine was developed in the next decade, and deaths began declining in earnest in 1924.[15]

In early May 2010, a case of diphtheria was diagnosed in Port-au-Prince, Haiti after the devastating 2010 Haiti earthquake. The 15-year-old male patient died while workers searched for antitoxin.[16]
References

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Diptheria cases reported in Loei

Post by maaka » September 27, 2012, 5:29 pm

Concerns over diphtheria outbreak in northern region

CHIANG MAI, 17 September 2012 (NNT) - Dr. Attapol Cheepsattayakorn, deputy director of the Office of Disease Prevention and Control, in Chiang Mai, stated that following an outbreak of diphtheria in the Lao People’s Democratic Republic in May this year, there arose two suspected cases of the disease in Loei and Petchabun provinces in Thailand two months later. In the upper northern region, there are two suspected cases of diphtheria in Chiang Rai province. Both patients are not of Thai nationality.

To prevent the spread of diphtheria in the northern region, which stands next to the Lao People’s Democratic Republic, the Chiang Mai Office of Disease Prevention and Control has issued warnings to citizens to watch out for the infectious disease, which causes acute illness in the respiratory system, including inflammation and pseudomembrane in the throat. In its severest form, it can cause constriction of the airways, which may lead to death.

The early symptoms of the disease are a low-grade fever, hoarseness, sore throat, loss of appetite. And in older children, there may be complaints of a sore throat. In some patients, there may be enlargement of lymph nodes near the throat. An examination of the throat may reveal a graying membrane in the area around the tonsils and uvula. Any person with these symptoms should seek immediate medical attention.

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Diptheria cases reported in Loei

Post by bumper » September 28, 2012, 11:27 am

Better information.

Thanks

KB_Texas

Diptheria cases reported in Loei

Post by KB_Texas » September 28, 2012, 2:16 pm

So there are only two reported cases, and doctors are saying that you should get a booster shot?

Something does not add up here. ;)

KB

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Diptheria cases reported in Loei

Post by bumper » September 28, 2012, 3:36 pm

It adds up. But with the better information. I'm going to wait a bit.

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Diptheria cases reported in Loei

Post by maaka » September 29, 2012, 3:48 am

' Diptheria is occurring mainly among unvaccinated, young children. There was a bigger problem in the south in 2010 and now it is largely resolved and the bug is finding susceptibles in the north this past year (and in Lao). It is nasty and deadly, but eminently preventable. If worried, your friends can get a booster dose which usually comes packaged as tetanus/diphteria for adults. ' ( World Health Org, BKK )

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Diptheria cases reported in Loei

Post by IsaanReminiscence » September 29, 2012, 11:49 am

Hello,
Here is information concerning recommanded schedule for DTap, Td, and Tdap: http://www.vaccineinformation.org/tetanus/qui.

and

http://www.cdc.gov/vaccines/recs/acip

Diphtheria can be life threatening for the very young and the very old (over 65 years with underlying medical conditions such as Asthma). If you had Diphtheria vaccine series in the past you can also ask for "Schick test." This test determines degree of immunity to diphtheria.

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Diptheria cases reported in Loei

Post by bumper » October 1, 2012, 6:52 pm

This is what the American Embassy had to say about it. Must not be to important, does recommend getting a booster though, better safe then sorry:

Mr. Fisher,



We don’t hear any outbreak of Diphtheria in any part of Thailand. Diphtheria is the preventive disease and we promote the routine vaccination to children and adult who has risk to expose to patients for many years. Most children received the primary vaccines but do not receive the booster when their age over 10 years old. Some cases of Diphtheria are found in infants and adolescents.



The travel immunization (TRAVAX) has the advice all travelers to Thailand as in attached document. We strongly recommend all travelers to get the vaccinations as in the list of recommendation before travel to Thailand. Tetanus Diphtheria and acellular Pertussis vaccine is last for 10 years for the booster dose.



Regards,



Siwaporn Ratanakhumpaeng

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Diptheria cases reported in Loei

Post by maaka » October 2, 2012, 1:57 am

typical how the Chiangmai Office of Disease Control, WHO BKK, and American Embassy are not on the same song sheet..I will see if I can recify that..

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Diptheria cases reported in Loei

Post by bumper » October 2, 2012, 10:49 am

Ya I think they are like Thailand in that aspect, don't talk to each other a lot I suppose

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Diptheria cases reported in Loei

Post by parrot » October 12, 2012, 6:36 pm

http://www.manager.co.th/Local/ViewNews ... 0000125158

Udon health officials warned of a growing spread of diphtheria in the different regions of the country....with many of the people from those regions traveling through Udon. Some common sense precautions include: don't drink from the same glass as others, be careful around others who sneeze/cough, avoid contact with people who have a fever, sore throat, difficulty swallowing. Ensure your children have all their immunizations. If you have a sore throat, fever, white spots in the mouth/throat......consult a doctor.

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Diptheria cases reported in Loei

Post by FrazeeDK » October 12, 2012, 9:36 pm

hmm.. let's see.. an outbreak in Lao and on weekends hundreds if not thousands of Lao folk descend upon Udon for shopping... Getting coughed on, sneezed on or "aerosoled" is possible in most of the shopping venues....
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Diptheria cases reported in Loei

Post by bumper » October 13, 2012, 6:40 pm

Very dangerous to older people as well. Time for the shot.

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Diptheria cases reported in Loei

Post by Kevro » November 5, 2012, 10:17 am

Just found out about the Diptheria outbreak today from my wife. She said they were doing free immunization in the village medical center so I got my booster done. The doctor advised that there 3 people reported dead from Udon area.

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Diptheria cases reported in Loei

Post by trubrit » November 5, 2012, 12:13 pm

Most schools in Udon area are starting a vaccination programme today for all pupils .
Ageing is a privilige denied to many .

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Diptheria cases reported in Loei

Post by bumper » November 5, 2012, 12:31 pm

This seems to be shaping to be more serious then I thought at first. The only place I know of for a shot is Udon Hospital.

Anyone know of anything else?

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