Diphtheria is contracted by inhaling the bacterium Corynebacterium diphtheriae from an infected person; symptoms usually appear two to five days after infection and can include fatigue, sore throat, loss of appetite, and low-grade fever. The symptoms can progress as a membrane grows and covers anywhere from a small patch to most of the throat, potentially blocking the airway. A cutaneous form of diphtheria can also occur. Diphtheria infection can lead to heart failure and paralysis, and if enough toxin from the membrane is absorbed into the bloodstream, coma or even death can occur in as little as a week. Most diphtheria complications are attributable to the toxin.

The disease is still common in many countries, and some strains of the bacteria continue to circulate in parts the U.S. Maintaining up-to-date immunity with a Td booster keeps the disease from recurring among the general domestic population, and protects people who travel to any of the 87 countries where the risk of diphtheria exposure is high.

A recent case of a U.S. citizen who died from diphtheria after returning from foreign travel illustrates the importance of maintaining protection through routine booster immunization. In Fall 2003, the Pennsylvania Department of Health issued an advisory to public health officers about a case of respiratory diphtheria in a 63-year-old Pennsylvania male. Upon returning to Pennsylvania, he was diagnosed with respiratory diphtheria and died, only 17 days after he was first exposed. The clinical efficacy of the diphtheria vaccine is 97%, but the Pennsylvania man had never been immunized.

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www.cdc.gov/nip/diseases/disease-chart-hcp.htm