Diphtheria Infection: Learn the Basics

By Dr. Kyle Smart, DO, Chief Medical Officer

Cucamonga Valley Medical Group


In 1925 several children in Nome, Alaska became infected with what the local physician believed at first to be tonsillitis.

The illness spread, patients were getting worse, and several of the children died. The gray pseudomembrane soon revealed itself and the doctor diagnosed diphtheria.

At this time, the physician was out of the antitoxin as his requested shipment from the prior year had never arrived.

He immediately telegrammed Anchorage, where a local hospital had an ample supply.

By train, the antitoxin was sent as far north as possible, to Nenana. The rest of the journey to save the children of Nome was undertaken by mushers and sled dogs.

The trek totaled a whopping 674 miles!

The journey was treacherous and the whole nation was transfixed by the story. Some of the mushers got frostbite and several of the sled dogs were pushed beyond their limits and died.

The lead sled dogs, Togo and Balto, became national heroes. Balto’s statue remains in New York City’s Central Park to this day.
Though five children died by the time the antitoxin vaccine arrived, thankfully many more were saved.


As diseases, like measles, that are preventable by vaccines continue to make a resurgence, I wanted to touch on the topic of diphtheria, a disease that’s commonly forgotten because of the effectiveness of its vaccine.

Remembering stories, like the one above, help us understand the history of diseases and vaccinations so that today, we can make more informed decisions about our healthcare.

Diphtheria Early History

Could you imagine living during a time when a terrifying disease that mainly affects children is sweeping across the nation and spreading rapidly?

As panic starts to set in, so too does the realization that this disease is killing 20 percent of the children who contract it.

Sounds scary, right?

Unfortunately, that was the harsh reality for families in the 1930s who were living in fear of diphtheria, a highly-contagious bacterial disease that causes inflammation of the mucous membranes.

Diphtheria was feared and rightly so as the associated deaths were caused by suffocation on the pseudomembrane, a coating that was created in the throat by the disease.

Since this time in American history, we’ve grown to know that diphtheria is caused by the bacteria Corynebacterium diphtheriae which creates a toxin.

The toxin can then travel through the bloodstream from the upper respiratory tract to other parts of the body and is especially damaging to the heart, kidneys, and nerves.

In the mid-20th century, the toxin would poison and kill the skin cells in the nose, throat, tonsils, and voice box.

The dead skin cells formed a thick, gray coating which in and of itself made it difficult to breath.

The pseudomembrane would then detach after two to three days and obstruct the airway, suffocating the patient.

For quite some time, the only way to keep the patient breathing around the pseudomembrane would be to cut a hole in the trachea in the neck below the chin.

Although traumatic, performing a tracheostomy was a life-saving measure at the time.

From these efforts, a new medical procedure called “intubation” was developed in the late 1800s as an alternative to tracheostomy.

Through the late 1800s and early 1900s doctors and scientists learned that antibiotics alone were not enough to treat patients.

The early framework of today’s diphtheria vaccine was set into motion as an antitoxin was developed to neutralize the deadly diphtheria toxin.

Shibasburo Kitasato and Emil Von Behring studied diphtheria in guinea pigs in the 1890s.

They injected guinea pigs with a heat-treated diphtheria toxin and found that something in the blood or serum from those animals protected them from future infections with diphtheria.

Further, they found that they could transfer that protection from one animal to another.  They called their treatment serum therapy and they called the substance in the blood, which they could not see or identify, antitoxin. Now we know that what they had discovered were antibodies.

The guinea pigs were creating antibodies to the neutralized diphtheria toxin which not only protected them from future infections, but could be used to protect other, unimmunized guinea pigs.

Von Behring won the first medical Nobel Prize for his work on diphtheria in 1901.

Shortly thereafter, it was realized that if humans were going to gain protection from the diphtheria toxin using serum therapy, that scientists were going to have to find larger animals to test their theories.

Ultimately, horses were chosen and used to create and harvest the diphtheria antitoxin.

Using horse antibodies in humans was not without its own risks and problems.

Clemens Priquet and Bella Schick identified serum sickness in 1905 after studying the side effects some people developed after receiving the diphtheria antitoxin.

The side effects were:

  • Fever
  • Rash
  • Swelling and joint pain

The symptoms were temporary and came as a result of the recipient’s antibodies attacking the horse antibodies.

In 1902 the Biologics Control Act was passed in the United States.

The act allowed for the creation of the Hygienic Laboratory of the US Public Health Service (which would later become the National Institute of Health) to oversee quality of vaccine production and minimize adverse effects.

Diphtheria Symptoms

The signs and symptoms of diphtheria typically present themselves within two to five days after a person has been infected.

Symptoms include:

  • Fever
  • Difficulty breathing or rapid breathing
  • Nasal discharge
  • Sore throat
  • Swollen lymph nodes in the neck
  • Weakness

The most prominent symptom of diphtheria is the thick, gray material that covers the back of the throat which can block the airway, making it hard to breath.

Diphtheria Vaccine

Think about this for a moment. In 1921, before the diphtheria vaccine was developed, there were 206,000 recorded cases that resulted in 15,520 deaths.

Since then, that number has dropped by 99.9 percent.

Today, we use the diphtheria toxoid to vaccinate people rather than the diphtheria antitoxin.

A toxoid is the inactive toxin of a bacterium. Diphtheria toxoid is commonly combined with tetanus and pertussis vaccines so that patients get three vaccines in one injection or shot.

The best way to prevent diphtheria is to get vaccinated. There are currently four vaccines that protect against this disease:

  • DTAP vaccine: Protects young children from diphtheria, tetanus, and whooping cough.
  • DT vaccine: Protects young children from diphtheria and tetanus.
  • Tdap vaccine: Protects pre-teens, teens, and adults from tetanus, diphtheria, and whooping cough.
  • Td vaccine: Protects pre-teens, teens, and adults from diphtheria and tetanus.

Like with any medication or vaccine, there’s a slim chance that diphtheria vaccines could cause a serious reaction.

Why is the diphtheria vaccine important?

By receiving the diphtheria vaccine, you protect yourself from the bacteria Corynebacterium diphtheria, which causes diphtheria, and the associated risks that this disease brings.

The diphtheria vaccine is commonly given with tetanus and pertussis (whooping cough).

By getting the DTaP vaccine you are protecting yourself from all three of these diseases by priming your immune system to fight them without getting the disease.

Retelling stories such as the children of Nome, Alaska and the people and sled dogs who banded together to save them can help today’s culture understand that we are standing on the foundation laid by past generations, who suffered through rampant disease and happily embraced the inception of vaccinations.

CVMG supports the use of vaccines as recommended by the American Academy of Family Practice, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention.

If you have any questions about vaccinations or why CVMG has chosen a pro-vaccine stance, please do not hesitate to schedule an appointment with one of our providers.