The Singapore Ministry of Health (MOH) reported a local, fatal case of diphtheria in a Bangladeshi worker.

This child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neck”. Image/CDC
This child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neck”. Image/CDC

The individual was a 21-year-old construction worker who developed fever and swelling of the neck on July 30.

He went to the hospital the next day and was immediately isolated and hospitalized on the same day. He subsequently passed away on August 4. His respiratory sample tested positive for toxigenic Corynebacterium diphtheriae.

As he had not travelled out of Singapore recently, he was likely to have been infected in Singapore. The last local case of diphtheria was reported in 1992 and the last imported case was in 1996.

MOH is screening the individual’s close contacts, including those who resided at the same dormitory and worked in the same workplace. A total of 48 contacts who worked or lived with the patient have been identified for further assessment. Among the 48 contacts identified, two close contacts had developed sore throat since Aug 3. They have been isolated at Khoo Teck Puat Hospital. All 48 contacts have been given preventive medication and a booster diphtheria vaccine, and their respiratory samples have been taken for testing.

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The risk of spread of diphtheria is assessed to be low. In Singapore, compulsory vaccination against diphtheria has been established as part of the National Childhood Immunization Programme since 1962. As diphtheria vaccination is compulsory by law for children, the vaccination coverage for diphtheria in children aged two in the Singaporean population remains high (at 96 to 98%).

Diphtheria is a vaccine-preventable disease caused by the Corynebacterium diphtheriae bacterium. It is transmitted from person to person via the respiratory route through close contact (e.g. through air droplets from coughing or sneezing) with an affected case. Symptoms include fever/ chills, sore throat, swelling of the neck and nasal discharge.

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Diphtheria can cause infection of the airway, which may lead to breathing difficulties and death. Diphtheria is fatal in five to ten percent of cases, with a higher fatality rate in young children. Treatment involves administering diphtheria antitoxin as well as antibiotics.

The best way to prevent diphtheria is to get vaccinated. Vaccination against diphtheria is effective in reducing the mortality and morbidity of diphtheria dramatically.

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