MANILA -- A health department official allayed fears of a diphtheria outbreak in the wake of the death of a Grade 4 student in Manila last week, and amid the emergence of the disease in some parts of the country.

“We do not have a diphtheria outbreak,” Dr. Anthony Calibo, OIC-chief of the Department of Health (DOH) Children’s Health Development Division-Disease Prevention and Control Bureau, said.

Still, Calibo said, “the mortality is unacceptable” because the disease is “readily preventable through vaccination.”

Calibo also said the number of reported diphtheria cases is “relatively falling within the usual range” that the health department tracks every year.

From January 1 to Sept. 7 this year, the DOH monitored 167 cases of diphtheria nationwide, 40 of which led to deaths.

In the same period last year, the agency monitored 122 diphtheria cases and 30 deaths due to the disease.

For full-year 2018, 183 diphtheria cases and 38 deaths were reported nationwide—three cases lower than the 186 reported in 2017.

Of the reported diphtheria cases in 2018, 38 individuals died, lower than the 44 deaths the year prior.

Fatal without immediate treatment

Diphtheria is an infectious disease caused by the bacteria Corynebacterium diphtheria, which affects the throat and the upper airways. Initial symptoms include sore throat, low fever, and swollen glands in the neck.

Calibo said that severe diphtheria cases can lead to death, especially among infants, due to “respiratory compromise.”

The bacteria produce a “pseudomembrane” or a membrane of dead-tissue buildup over the throat and tonsils. This can block the throat and air passageway, cause breathing difficulties, and if not treated right away can eventually lead to death.

An infected person can spread the disease to another person through droplets, by sneezing, coughing, and close personal contact.

While both children and adults are susceptible to the disease, Calibo said that children are more vulnerable because of their weaker immune system compared to adults who are assumed to have been vaccinated against diphtheria.

“So if children are not vaccinated and they are exposed to the bacteria, there is a bigger risk that they will acquire the disease. This may lead to death if not treated immediately,” Calibo said.

Immunization below target

According to Calibo, a 95% vaccine coverage nationwide is needed to attain herd immunity against diphtheria and reduce the threat of an outbreak.

However, DOH data over the last 10 years show that the proportion of children below 1-year-old who were fully immunized against diphtheria has never reached that target.

In 2018, only 65% of infants were fully immunized against diphtheria or received the required three doses of Pentavalent vaccine—a combination of vaccines against Diphtheria, Pertussis, Tetanus, Hepatitis B, and Haemophilus influenza B.

The vaccine is administered to infants at 1½ months, 2½ months, and 3½ months as part of DOH’s Expanded Program on Immunization.

In addition, booster shots of tetanus and diphtheria are given to Grade 1 and Grade 7 students as part of the DOH’s School-Based Immunization Program.

Prior to 2014, the diphtheria vaccine was included in the DPT (Diphtheria, Pertussis, Tetanus) vaccine, which was also part of the Health department’s immunization program.

Declining immunization for all vaccines

Among the regions, Eastern Visayas recorded the lowest coverage for Pentavalent vaccine in 2018 at only 58.42%. It was followed by Zamboanga Peninsula and CALABARZON with 59.85% and 60.94%, respectively.

Meanwhile, the then-Autonomous Region in Muslim Mindanao (ARMM) recorded the highest percentage of infants given the three doses of Pentavalent vaccine at 70.57%. It was followed by Northern Mindanao and Davao Region with 70.30% and 69.34%, respectively.

The low rate of immunization against diphtheria reflects the generally declining rate of immunization in the country over the last two decades.

The rate of fully immunized children—those who received one dose of BCG, three doses each of OPV, DPT, and Hepatitis B vaccines, and one dose of measles vaccine before reaching one year of age—has been declining by an annual average of 1.22 percent from 1995-2018.

The lowest rate of fully immunized children was recorded in 2018 at only 66%.

Anti-toxin injection and antibiotics

Calibo advised that any manifestation of diphtheria symptoms should be treated immediately.

“If a child suffers from cough, fever, and sore throat, which are manifestations of diphtheria, the first thing to do is to bring the child to a doctor, a health center, or a health service provider in other facilities, whichever is available,” he said.

In some cases, it is necessary to have the patient injected with diphtheria antitoxin right away to prevent the spread of the disease, he added.

“There is an antibiotic and a diphtheria anti-toxin available at the San Lazaro Hospital and RITM,” he said.

Aside from complete vaccination, Calibo said that proper hygiene, especially oral hygiene, maintaining a clean environment, and good nutrition will help prevent the spread of the disease.

“Use rags with a mixture of disinfectant to mop floors, wipe tables, doorknobs, and chairs. Because the bacteria live on those areas, and that may spread the disease,” he said.