Volume: 24S3 - July 1998

Guidelines for the Control of Diphtheria in Canada

APPENDIX A

Recommendations for the Management of Diphtheria Cases and Contacts*

a. Strict isolation includes basic requirements for all potentially infectious cases, as well as a private room and the use of masks, gowns, and gloves for all persons entering the room. Special ventilation requirements with the room at negative pressure to surrounding areas are also desired. Maintain isolation until elimination of the organism is demonstrated by negative cultures of two samples obtained at least 24 hours apart after completion of antimicrobial therapy.

b. Both nasal and pharyngeal swabs should be obtained for culture.

c. The recommended dosage and route of administration depend on the extent and duration of disease. Refer to Table 1, page 11, for detailed dosage recommendations for equine diphtheria antitoxin.

d. Refer to page 11 for detailed dosage recommendations for treatment of cases. Antibiotic therapy is not a substitute for antitoxin treatment. Elimination of C. diphtheriae should be confirmed by two negative cultures of throat and nasopharyngeal swabs taken at least 24 hours apart, a minimum of 2 weeks after antibiotics are completed. Persistent carriage of the organism should be treated with an additional 10-day oral course of erythromycin with follow-up cultures.

e. Vaccination is required because clinical diphtheria does not necessarily confer immunity.

f. Close contacts include household members and other persons with a history of direct contact with a case (e.g. caretakers, relatives, or friends who regularly visit the home) as well as health-care personnel exposed to oral or respiratory secretions of a case.

g. Both nasal and pharyngeal swabs should be obtained for culture. Swabs should also be taken from any wounds or skin lesions.

h. Refer to pages 12 and 13 for detailed dosage recommendations for prophylaxis of contacts. Antibiotic therapy is not a substitute for antitoxin treatment.

i. Control measures for contacts of a case should be given a higher priority than control measures for contacts of a carrier.

j. Refer to page 13 for detailed dosage recommendations for treatment of carriers. Elimination of C. diphtheriae should be confirmed by two negative cultures of throat and nasopharyngeal swabs taken at least 24 hours apart, a minimum of 2 weeks after antibiotics are completed. Persistent carriage of the organism should be treated with an additional 10-day oral course of erythromycin with follow-up cultures.

k. Refer to published NACI recommendations for schedule of vaccination.

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