Joseph P. O'Dwyer introduced the O'Dwyer tube for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced
tracheostomy
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...
as the emergency diphtheric intubation method.
In 1888,
Emile Roux
Emil or Emile may refer to:
Literature
*''Emile, or On Education'' (1762), a treatise on education by Jean-Jacques Rousseau
* ''Émile'' (novel) (1827), an autobiographical novel based on Émile de Girardin's early life
*''Emil and the Detective ...
and
Alexandre Yersin
Alexandre Emile Jean Yersin (22 September 1863 – 1 March 1943) was a Swiss-French physician and bacteriologist. He is remembered as the co-discoverer of the bacillus responsible for the bubonic plague or pest, which was later named in his ...
showed that a substance produced by ''C. diphtheriae'' caused symptoms of diphtheria in animals.
In 1890,
Shibasaburo Kitasato and
Emil von Behring
Emil von Behring (; Emil Adolf von Behring), born Emil Adolf Behring (15 March 1854 – 31 March 1917), was a German physiologist who received the 1901 Nobel Prize in Physiology or Medicine, the first one awarded in that field, for his discover ...
immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an "
antitoxin" made from
serum
Serum may refer to:
* Serum (blood), plasma from which the clotting proteins have been removed
**Antiserum, blood serum with specific antibodies for passive immunity
* Serous fluid, any clear bodily fluid
*Truth serum, a drug that is likely to mak ...
of immunized animals could cure the disease in non-immunized animals. Behring used this antitoxin (now known to consist of
antibodies
An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of ...
that neutralize the toxin produced by ''C. diphtheriae'') for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized.
Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.
In 1895,
H. K. Mulford Company
The H. K. Mulford Company was a pharmaceutical company founded in Philadelphia, Pennsylvania. The company was founded in the late 1880s by Henry K. Mulford after his purchase of the Old Simes drugstore at 18th and Market Streets. The company was pu ...
of Philadelphia started production and testing of diphtheria antitoxin in the United States.
Park
A park is an area of natural, semi-natural or planted space set aside for human enjoyment and recreation or for the protection of wildlife or natural habitats. Urban parks are green spaces set aside for recreation inside towns and cities. ...
and
Biggs described the method for producing serum from horses for use in diphtheria treatment.
In 1897,
Paul Ehrlich
Paul Ehrlich (; 14 March 1854 – 20 August 1915) was a Nobel Prize-winning German physician and scientist who worked in the fields of hematology, immunology, and antimicrobial chemotherapy. Among his foremost achievements were finding a cure ...
developed a standardized unit of measure for diphtheria antitoxin. This was the first ever standardization of a biological product, and played an important role in future developmental work on sera and vaccines.
In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of
tetanus. This incident, coupled with a tetanus outbreak in Camden, New Jersey, played an important part in initiating federal regulation of biologic products.
On 7 January 1904,
Ruth Cleveland died of diphtheria at the age of 12 years in
Princeton, New Jersey
Princeton is a municipality with a borough form of government in Mercer County, in the U.S. state of New Jersey. It was established on January 1, 2013, through the consolidation of the Borough of Princeton and Princeton Township, both of w ...
. Ruth was the eldest daughter of former
President
President most commonly refers to:
*President (corporate title)
* President (education), a leader of a college or university
* President (government title)
President may also refer to:
Automobiles
* Nissan President, a 1966–2010 Japanese ...
Grover Cleveland
Stephen Grover Cleveland (March 18, 1837June 24, 1908) was an American lawyer and politician who served as the 22nd and 24th president of the United States from 1885 to 1889 and from 1893 to 1897. Cleveland is the only president in American ...
and the former
first lady
First lady is an unofficial title usually used for the wife, and occasionally used for the daughter or other female relative, of a non- monarchical head of state or chief executive. The term is also used to describe a woman seen to be at the ...
Frances Folsom
Frances Clara Cleveland Preston (née Folsom born as Frank Clara; July 21, 1864 – October 29, 1947) was an American socialite, education activist, and the first lady of the United States from 1886 to 1889, and again from 1893 to 1897 as t ...
.
In 1905, Franklin Royer, from Philadelphia's Municipal Hospital, published a paper urging timely treatment for diphtheria and adequate doses of antitoxin. In 1906,
Clemens Pirquet
Clemens Peter Freiherr von Pirquet (12 May 187428 February 1929) was an Austrian scientist and pediatrician best known for his contributions to the fields of bacteriology and immunology.
Career
Born in Vienna, he studied theology at the Universit ...
and
Béla Schick
Béla Schick (16 July 1877 – 6 December 1967) was a Hungarian-born American pediatrician. He is the founder of the Schick test. Bela Schick was born in Balatonboglár, Hungary, and brought up in Graz, Austria, where he attended medical s ...
described
serum sickness in children receiving large quantities of horse-derived antitoxin.
Between 1910 and 1911,
Béla Schick
Béla Schick (16 July 1877 – 6 December 1967) was a Hungarian-born American pediatrician. He is the founder of the Schick test. Bela Schick was born in Balatonboglár, Hungary, and brought up in Graz, Austria, where he attended medical s ...
developed the
Schick test
The Schick test, developed in 1913, is a skin 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. Procedure
The test i ...
to detect pre-existing immunity to diphtheria in an exposed person. Only those who had not been exposed to diphtheria were vaccinated. 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
MetLife, Inc. is the holding corporation for the Metropolitan Life Insurance Company (MLIC), better known as MetLife, and its affiliates. MetLife is among the largest global providers of insurance, annuities, and employee benefit programs, wi ...
with an appeal to parents to "Save your child from diphtheria." A vaccine was developed in the next decade, and deaths began declining significantly in 1924.
In 1919, in Dallas, Texas, 10 children were killed and 60 others made seriously ill by toxic antitoxin which had passed the tests of the New York State Health Department.
Mulford Company of Philadelphia (manufacturers) paid damages in every case.
In the 1920s, each year an estimated 100,000 to 200,000 diphtheria cases and 13,000 to 15,000 deaths occurred in the United States.
Children represented a large majority of these cases and fatalities. One of the most infamous outbreaks of diphtheria occurred in 1925, in
Nome, Alaska
Nome (; ik, Sitŋasuaq, ) is a city in the Nome Census Area in the Unorganized Borough of Alaska, United States. The city is located on the southern Seward Peninsula coast on Norton Sound of the Bering Sea. It had a population of 3,699 record ...
; the
"Great Race of Mercy" to deliver diphtheria antitoxin is now celebrated by the
Iditarod Trail Sled Dog Race.
In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria
toxoid
A toxoid is an inactivated toxin (usually an exotoxin) whose toxicity has been suppressed either by chemical (formalin) or heat treatment, while other properties, typically immunogenicity, are maintained. Toxins are secreted by bacteria, whereas ...
(a modified version of the toxin used for vaccination) by treating it with aluminum salts. Vaccination with toxoid was not widely used until the early 1930s. In 1939, Dr.
Nora Wattie
Nora Wattie (1900–1994) MBChB (Aberdeen), DPH (Cambridge) was a pioneer of social medicine, setting up Glasgow’s internationally renowned ante-natal care service (both before and after the creation of the National Health Service).
Througho ...
Principal Medical Officer (Maternity and Child Welfare) introduced immunisation clinics across
Glasgow
Glasgow ( ; sco, Glesca or ; gd, Glaschu ) is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated popu ...
, and promoted mother and child health education, resulting in virtual eradication of the infection in the city.
Widespread vaccination pushed cases in the United States down from 4.4 per 100,000 inhabitants in 1932 to 2.0 in 1937. In
Nazi Germany
Nazi Germany (lit. "National Socialist State"), ' (lit. "Nazi State") for short; also ' (lit. "National Socialist Germany") (officially known as the German Reich from 1933 until 1943, and the Greater German Reich from 1943 to 1945) was ...
, where authorities preferred treatment and isolation over vaccination (until about 1939–41), cases rose over the same period from 6.1 to 9.6 per 100,000 inhabitants.
Between June 1942 and February 1943, 714 cases of diphtheria were recorded at
Sham Shui Po Barracks
Sham Shui Po Barracks was a British Army facility built in the 1920s in the Sham Shui Po area of Kowloon, Hong Kong. The base was bounded by Fuk Wa Street to the east by Yen Chow Street and to the west by Tonkin Street and Camp Street.
The bu ...
resulting in 112 deaths because the
Imperial Japanese Army
The was the official ground-based armed force of the Empire of Japan from 1868 to 1945. It was controlled by the Imperial Japanese Army General Staff Office and the Ministry of the Army, both of which were nominally subordinate to the Emper ...
did not release supplies of anti-diphtheria serum.
In 1943, diphtheria outbreaks accompanied war and disruption in Europe. The 1 million cases in Europe resulted in 50,000 deaths.
In Kyoto during 1948, 68 of 606 children died after diphtheria immunization due to improper manufacture of aluminum phosphate toxoid.
In 1974, the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
included
DPT vaccine in their
Expanded Programme on Immunization The Expanded Program on Immunization is a World Health Organization program with the goal to make vaccines available to all children.
History
The World Health Organization (WHO) initiated the Expanded Program on Immunization (EPI) in May 1974 wi ...
for
developing countries
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
.
In 1975, an outbreak of cutaneous diphtheria in Seattle, Washington, was reported .
After the breakup of the former Soviet Union in 1991, vaccination rates in its constituent countries fell so low that an explosion of diphtheria cases occurred. In 1991, 2,000 cases of diphtheria occurred in the USSR. Between 1991 and 1998 as many as 200,000 cases in the
Commonwealth of Independent States
The Commonwealth of Independent States (CIS) is a regional intergovernmental organization in Eurasia. It was formed following the dissolution of the Soviet Union in 1991. It covers an area of and has an estimated population of 239,796,010 ...
were reported, with 5,000 deaths.
In 1994, the Russian Federation had 39,703 diphtheria cases. By contrast, in 1990, only 1,211 cases were reported.
In early May 2010, a case of diphtheria was diagnosed in
Port-au-Prince
Port-au-Prince ( , ; ht, Pòtoprens ) is the capital and most populous city of Haiti. The city's population was estimated at 987,311 in 2015 with the metropolitan area estimated at a population of 2,618,894. The metropolitan area is define ...
,
Haiti
Haiti (; ht, Ayiti ; French: ), officially the Republic of Haiti (); ) and formerly known as Hayti, is a country located on the island of Hispaniola in the Greater Antilles archipelago of the Caribbean Sea, east of Cuba and Jamaica, and s ...
, after the devastating
2010 Haiti earthquake
A catastrophic magnitude 7.0 Mw earthquake struck Haiti at 16:53 local time (21:53 UTC) on Tuesday, 12 January 2010. The epicenter was near the town of Léogâne, Ouest department, approximately west of Port-au-Prince, Haiti's ca ...
. The 15-year-old male patient died while workers searched for antitoxin.
In 2013, three children died of diphtheria in
Hyderabad, India
Hyderabad ( ; , ) is the capital and largest city of the Indian state of Telangana and the '' de jure'' capital of Andhra Pradesh. It occupies on the Deccan Plateau along the banks of the Musi River, in the northern part of Southern Ind ...
.
In early June 2015, a case of diphtheria was diagnosed at
Vall d'Hebron University Hospital
The Vall d'Hebron University Hospital is a public and university affiliated hospital founded in 1955. It belongs to the Catalan Health Institute and is the hospital complex with the highest volume of interventions in Catalonia, Spain. It is located ...
in
Barcelona
Barcelona ( , , ) is a city on the coast of northeastern Spain. It is the capital and largest city of the autonomous community of Catalonia, as well as the second most populous municipality of Spain. With a population of 1.6 million within c ...
, Spain. The 6-year-old child who died of the illness had not been previously vaccinated due to parental
opposition to vaccination. It was the first case of diphtheria in the country since 1986 as reported by ''"El Mundo"'' or from 1998, as reported by WHO.
In March 2016, a 3-year-old girl died of diphtheria in the University Hospital of
Antwerp
Antwerp (; nl, Antwerpen ; french: Anvers ; es, Amberes) is the largest city in Belgium by area at and the capital of Antwerp Province in the Flemish Region. With a population of 520,504, ,
Belgium
Belgium, ; french: Belgique ; german: Belgien officially the Kingdom of Belgium, is a country in Northwestern Europe. The country is bordered by the Netherlands to the north, Germany to the east, Luxembourg to the southeast, France to ...
.
In June 2016, a 3-year-old, 5-year-old, and 7-year-old girl died of diphtheria in
Kedah
Kedah (), also known by its honorific Darul Aman and historically as Queda, is a state of Malaysia, located in the northwestern part of Peninsular Malaysia. The state covers a total area of over 9,000 km2, and it consists of the mainland ...
,
Malacca
Malacca ( ms, Melaka) is a States and federal territories of Malaysia, state in Malaysia located in the southern region of the Malay Peninsula, next to the Strait of Malacca. Its capital is Malacca City, dubbed the Historic City, which has bee ...
, and
Sabah
Sabah () is a state of Malaysia located in northern Borneo, in the region of East Malaysia. Sabah borders the Malaysian state of Sarawak to the southwest and the North Kalimantan province of Indonesia to the south. The Federal Territory ...
,
Malaysia
Malaysia ( ; ) is a country in Southeast Asia. The federal constitutional monarchy consists of thirteen states and three federal territories, separated by the South China Sea into two regions: Peninsular Malaysia and Borneo's East Mal ...
.
In January 2017, more than 300 cases were recorded in Venezuela.
In 2017, outbreaks occurred in a
Rohingya refugee camp in Bangladesh, and in children unvaccinated due to the
Yemeni Civil War.
In November and December 2017, an outbreak of diphtheria occurred in
Indonesia
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Gui ...
with more than 600 cases found and 38 fatalities.
In November 2019, two cases of diphtheria occurred in the
Lothian
Lothian (; sco, Lowden, Loudan, -en, -o(u)n; gd, Lodainn ) is a region of the Scottish Lowlands, lying between the southern shore of the Firth of Forth and the Lammermuir Hills and the Moorfoot Hills. The principal settlement is the Scott ...
area of
Scotland
Scotland (, ) is a country that is part of the United Kingdom. Covering the northern third of the island of Great Britain, mainland Scotland has a border with England to the southeast and is otherwise surrounded by the Atlantic Ocean to ...
. Additionally, in November 2019 an unvaccinated 8-year-old boy died of diphtheria in Athens, Greece.
In July 2022, two cases of diphtheria occurred in northern
New South Wales
)
, nickname =
, image_map = New South Wales in Australia.svg
, map_caption = Location of New South Wales in AustraliaCoordinates:
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, es ...
,
Australia
Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
.
In October 2022 there was an outbreak of diphtheria at the former
Manston airfield, a former MoD site in
Kent, England, which had been converted to an asylum seeker processing centre. The capacity of the processing centre was 1,000 people, though about 3,000 were living at the site with some accommodated in tents. The Home Office, the government department responsible for asylum seekers, refused to confirm the number of cases.
References
Further reading
*
* "Antitoxin dars 1735 and 1740." ''The William and Mary Quarterly'', 3rd Ser., Vol 6, No 2. p. 338.
*
External links
*
Mapping diphtheria-pertussis-tetanus vaccine coverage in Africa, 2000–2016: a spatial and temporal modelling study
{{Authority control
Bacterial diseases
Wikipedia medicine articles ready to translate
Wikipedia emergency medicine articles ready to translate
Vaccine-preventable diseases