Metro diphtheria case prompts renewed vaccine push

A case of severe respiratory diphtheria was reported in a child in the Perth metropolitan area in August. Now, a second case of diphtheria has been reported in early September.

WA Health has issued a reminder of free booster vaccinations for all Aboriginal people across the state made available as part of its response to an ongoing outbreak.

So far WA has recorded 240 cases of diphtheria, predominantly affecting Aboriginal communities in regional WA in the Kimberley, Pilbara and Goldfields regions.

The outbreak has also spread across the Northern Territory as the country battles the largest outbreak since records began.

WA Health said the recent cases in the metropolitan area highlight the importance of vaccination for all eligible people.

GPs and health providers working in outbreak affected areas should consider and test for diphtheria in patients presenting with suspicious skin lesions or wounds, or pharyngitis/tonsillitis, particularly those with epidemiological risk factors or clinical features raising greater suspicion.

Vaccinations should be raised and spoken about with appropriate patients.

Key actions for health practitioners

If you suspect a case of diphtheria, you should:

Infection prevention and control: Isolate suspected or confirmed cases and use appropriate IPC measures, including when performing swabs

Test: Collect appropriate specimens (throat and/or skin lesion/wound swabs) using semi-solid (Amies) transport medium swab with or without charcoal for culture, and a paired dry swab for diphtheria toxin PCR, and clearly mark “culture and PCR for diphtheria” on the request form

Notification: Notify public health of suspected cases

Treat: Consider differentials; if cutaneous or respiratory diphtheria is confirmed or strongly suspected, commence appropriate antibiotics as per the outbreak guidance or Diphtheria – Therapeutic Guidelines

Advise: Provide the patient with the diphtheria factsheet. Exclude from work, school or childcare settings and provide additional advice as per the outbreak guidance.

Most cases in WA have been cutaneous diphtheria, a form of the disease that causes skin infections that present as slow-healing sores, wounds or ulcers.

There have also been cases of respiratory diphtheria, which can cause more severe illness, and can present with a thick greyish-white coating in the back of the nose or throat, and swollen, painful glands in the neck. It can make breathing difficult and become life-threatening.

Chief Health Officer Dr Clare Huppatz there was currently no evidence of wider community transmission in metropolitan Perth, but vaccination remained the best protection against serious illness.

“I strongly encourage Aboriginal people in Perth to check their vaccination history and have a booster if they are eligible, particularly given the ongoing outbreak in regional WA and the recent cases identified in Perth,” she said.

“People who are unsure whether they or their children are up to date with their vaccinations should check their immunisation history or speak with their healthcare provider.”

Earlier this year WA’s free vaccination program was expanded as case numbers continued to grow.

All Aboriginal people in WA, and people living in the Kimberley, Pilbara, Goldfields and Midwest regions, who have not received a diphtheria-containing vaccine in the past five years are eligible for a free booster through participating immunisation providers, including Aboriginal Medical Services and GPs.

Those who want to get a booster vaccination should call ahead and check that their healthcare provider has the vaccine available.

Diphtheria-containing vaccines are also provided free under the National Immunisation Program during infancy and early childhood, adolescence and pregnancy, and are available through immunisation providers including GPs, community immunisation services and participating pharmacies across WA.