5 Diphtheria

5.8 Public health measures

It is a legal requirement that all cases of diphtheria be notified immediately on suspicion to the local medical officer of health.

Alert the laboratory that the sample is from a suspected case of diphtheria. If C. diphtheriae or C. ulcerans is isolated, it should be sent to the Institute of Environmental Science and Research (ESR) reference laboratory to determine whether it is a toxigenic strain. All patients with C. diphtheriae or C. ulcerans isolated from a clinical specimen should be discussed with the medical officer of health urgently.

All contacts should have cultures taken, be given antimicrobial prophylaxis and have their immunisation status updated.

5.8.1 Antimicrobial prophylaxis

All close contacts, after cultures have been taken and regardless of immunisation status, should receive:

Benzathine penicillin is preferred for contacts who cannot be kept under surveillance.

5.8.2 VaccinationTop

All contacts should also be offered a complete course of vaccine or a booster according to the following schedule.

5.8.3 ExclusionTop

Child contacts should be excluded from school, early childhood services and community gatherings until they are known to be culture negative. Adult contacts who are food handlers or who work with children should be excluded from work until known to be culture negative. Cases should be excluded from school until recovery has taken place and two negative throat swabs have been collected one day apart and one day after cessation of antibiotics.

For more details on control measures, refer to the Communicable Disease Control Manual 201224 or the Control of Communicable Diseases Manual.25