OSSSC Nursing Disease Guide

Communicable · High priority

Diphtheria, pertussis, and tetanus

Core disease facts with the linked government programme, prevention and treatment or cure reality.

TypeBacterial diseases — caused by Corynebacterium diphtheriae, Bordetella pertussis and Clostridium tetani respectively.

Image-based identification

Adherent gray pharyngeal pseudomembrane in diphtheria
What to identifyAn adherent gray pharyngeal pseudomembrane is a classic diphtheria clue and can threaten the airway; do not forcibly remove it.Image credit: CDC / Carl Flint — public domain
Patient with tetanus showing opisthotonus caused by severe muscle spasm
What to identifyOpisthotonus is severe arching from sustained neck and back muscle spasm—a classic sign of generalized tetanus.Image credit: CDC — public domain

Government programmes, schemes and services

  • Programme: Universal Immunisation Programme: Provides pentavalent, DPT and Td vaccines at scheduled ages to prevent diphtheria, pertussis and tetanus.
  • Mission: Mission Indradhanush: Finds and vaccinates children and pregnant women who missed routine vaccine doses, especially in low-coverage and hard-to-reach areas.
  • Surveillance: Vaccine-preventable-disease surveillance: Detects cases and clusters, confirms disease where possible and triggers vaccination or outbreak-control action.

Prevention

  • Prevent: Pentavalent/Diphtheria-Pertussis-Tetanus/Tetanus-diphtheria vaccination, clean delivery and wound care, isolation/contact measures for diphtheria/pertussis

Treatment and cure reality

  • Treat: Treatable: diphtheria needs antitoxin plus antibiotics; pertussis needs appropriate antibiotic/supportive care; tetanus needs immunoglobulin, wound care, spasm/airway support and vaccination.

Must remember

  • Diphtheria clue: grey adherent pseudomembrane, “bull neck,” myocarditis, and neuropathy.
  • Diphtheria treatment principle: Give diphtheria antitoxin promptly plus antibiotics and isolation; do not wait for laboratory confirmation when strongly suspected.
  • Pertussis clue: paroxysmal cough, inspiratory whoop, and post-tussive vomiting; infants may present with apnoea.
  • Tetanus clue: trismus, risus sardonicus, rigidity, and painful spasms.
  • Tetanus spread: Wound contamination; it does not spread person to person.
  • Tetanus disease does not provide reliable immunity: The patient still needs active immunisation.
  • Vaccine: Pentavalent vaccine contains diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type b antigens.
  • Name change: Tetanus-diphtheria vaccine has replaced tetanus toxoid for adolescents and pregnancy in the current national schedule.