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Appropriate outpatient follow-up must be arranged upon discharge from a hospital. A health-care provider will need to monitor the patient's progress, especially if they have experienced cardiac or neurologic complications during the course of illness. Nasopharyngeal cultures should be repeated post-treatment to make sure the bacterium has been eradicated, and their immunization schedule for diphtheria should be updated, if not previously done.
Universal immunization is the best measure to prevent diphtheria. The diphtheria toxoid vaccine, which is generally combined with the tetanus and pertussis vaccine, is currently recommended for administration to infants, adolescents, and adults. Immunization for infants and children consists of five DTaP vaccinations generally given at 2, 4, and 6 months, with the fourth dose being administered between 15-18 months, and the fifth dose at 4-6 years of age. Because immunity to diphtheria wanes over time, booster shots are recommended. The adult form of the vaccine, Tdap, is recommended for adolescents 11 or 12 years of age, or in place of one Td booster in older adolescents and adults 19-64 years of age. Whereas diphtheria primarily affected younger children in the pre-vaccination era, an increasing proportion of cases today occur in unvaccinated or inadequately immunized adolescents and adults, a problem which underscores the importance of keeping a current immunization schedule.
The prognosis for diphtheria depends on the severity of the disease and the presence of systemic involvement. Cardiac involvement and bacteremia (blood infection) are especially associated with a poor prognosis. The fatality rate for respiratory diphtheria is between 5%-10%, although it appears to be higher in patients less than 5 years of age and older than 40 years of age (~20%). Airway obstruction leading to suffocation and cardiac complications are the most commons causes of death.
The prognosis for treated cutaneous diphtheria is good, with complications and death only occurring rarely.
Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease
Medically Reviewed by a Doctor on 12/23/2015
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