On top of everything else, Diphteria

What do you get if you add a completely controllable and vaccinable disease plus Venezuela’s health system? Chaos, wild tropical chaos, Guayana style.

Diphtheria is the mysterious “new” disease that has taken the life of 23 kids this year and everyone, at least in Bolívar State, is freaking out. For a moment, before the vaccines ran out, the lines to get them were longer than those for food (which is a lot to say) and the public healthcare system remained completely collapsed during that time.

You’d probably never heard of this disease until some tía told you to go make a kilometric line in an ambulatorio to get vaccinated. Most of the western hemisphere has kept it under control for the last 30 years, so it has become rather obscure to the general public.

So what’s happening in Bolívar State?

The return of the diphteria caught everyone off guard, and the outbreak is being handled in probably the worst way possible. Instead of rushing to roll out the overdue vaccines, the government decided to hide the problem, and now that it has gotten big, they are only acknowledging 2 out of the 23 fatal cases reported in the press. They even went as far as shifting the blame onto the mother of one of the deceased kids for not vaccinating him.

People started getting concerned and lines started to grow where the vaccine was being administered. Guaiparo, one of the main hospitals of Ciudad Guayana, was so overcrowded that nurses had difficulty attending their regular patients, and people did day-long lines to get vaccinated after signing up in the waiting list two days in advance.

Hospitals weren’t properly equipped to attend the sick either. In one case, one 3-year old kid infected with diphtheria supposedly died just because they didn’t have any oxygen masks.

Now, what exactly is diphtheria? One of us (J.C.) is a medical student, so we can geek out a bit here. 

The real bad guy in this story is not the bacteria itself, but the toxin it produces.

Diphtheria means “leather” in greek; it’s caused by bacteria Corynebacterium diphteriae. The bacteria spreads the way a cold spreads: air droplets from coughing or sneezing, shared household items, etc.  

But the real bad guy in this story is not the bacteria itself, but the toxin it produces. Diphtheric toxin is a necrotizing one, which means it destroys tissues wherever the bacteria reproduces. 

Sounds ugly right? In fact in most cases all diphteria means is a really badass sore throat, characterized by the presence of a gray leather-ish membrane in the tonsils or the back of the mouth. Probably not  as horrific as you’d think based on some info recently gone viral, but still ugly. These membranes may also appear on the skin, although this is rarer.

So can it kill you?

In some cases, yes. It’s not particularly common, but up to a 50% of unvaccinated patients can present potentially life-threatening complications. Kids, especially those under seven, are the most at risk. The main problem with diphtheria is that the membrane can stick to the throat and occasionally bleed and grow to the point it blocks the airway. Since kids’ throats are thinner, they get blocked more easily.

Diphtheria is a perfectly preventable disease and it’s actually really simple, all you have to do is get a vaccine.

Remember we said toxin is the real baddie? That’s because in an even smaller group of people, it can travel through the bloodstream and mess with different organs, including the kidneys and the heart. That’s bad.

Is there a cure?

Yes there is, and it’s the best one: prevention. Diphtheria is a perfectly preventable disease and it’s actually really simple, all you have to do is get a vaccine. Complications only develop in unvaccinated people. This doesn’t mean you have to run to your nearest ambulatorio and get vaccinated right now. Take it easy and keep reading.

Whether chavistas want to admit it or or not, Venezuela is part of the West, and for at least 40 years, Venezuelan children have been responsibly vaccinated at 2, 4, 6 and 18 months, with an extra dose at 5 years old, and a booster shot every 10 years, commonly associated with the tetanic toxoid (the injection you are supposed to get after you cut yourself with a dirty piece of metal).

Vaccination is extremely effective, and it’s the main reason people don’t know much about the disease. Cases have been reduced to almost zero in most of the western hemisphere since vaccination policies hardened.

You can be protected against all the ugly effects of diphteria, but still have (and transmit) the bacteria to other people.

There is a ‘but’ however. The diphteria vaccine is actually a toxoid — a “weakened” toxin that is hard enough to stimulate your immune system to create protection but not strong enough to make you sick. This means that your body is trained to recognize and neutralize the toxin, but not the bacteria itself. So you can be protected against all the ugly effects of diphteria, but still have (and transmit) the bacteria to other people. That’s why it is so important that small kids get their vaccines right.

So is the situation in Guayana improving?

Some vaccines were delivered a while ago. After a month, vaccines ran out, and although the panic subsided a bit, a lot of people were left unprotected. Extra booster shots are expected to arrive in mid-November, but this time they will be for hospital staff only. One nurse we interviewed, accustomed to the economics of scarcity, already decided to bring her big purse to work that day, just in case.

A completely irrational behaviour, especially in a health worker. But again, scarcity has scarred us all one way or another.

So…should we freak out?

It’s hard to determine the exact magnitude of this outbreak. Not all cases are reported, and the fact that it’s been years since official bodies have published data really doesn’t help, either. The only official data we have are contradicting reports from the government.

And yet, it’s unlikely that diphtheria will become a nationwide health problem. Even given our current crisis, it’s just such an easy disease to prevent. If you have small children, you need to make sure they have all their vaccines. And If it has it been more than 10 years since your last booster, take a new one. That’s all.

It makes you wonder how  a disease like this one managed to do this much damage.