On February 25th, two little girls were seen in Hôpital Sacré Coeur’s Emergency Department complaining of upper respiratory tract symptoms, including severe sore throat and swelling of the neck. On examination, the attending physician observed in each patient’s throat the asymmetric grayish, white membrane that is the mark of diphtheria. The next day, two more children from the same family were admitted to Hôpital Sacré Coeur with similar symptoms.
Diphtheria is a deadly respiratory illness caused by the C. diphtheriae bacterium. The case fatality rate for diphtheria can be 10 percent—perhaps higher in young children and middle-aged or older adults. While diphtheria has been nearly eradicated in the US and other developing countries as a result of comprehensive childhood immunization, the disease remains a sad fact of life in developing countries like Haiti.
Since diphtheria is highly contagious, the four children were immediately isolated at Hôpital Sacré Coeur and strict infection control practices were instituted, including the barrier nursing (i.e., use of N-95 face masks, gowns and gloves, etc.) and HEPA filtration of the air in the isolation room. Aggressive antibiotic therapy was begun on all four patients.
Thanks to the efficient work of the Haitian Ministry of Public Health and Population (MSPP), a request for diphtheria antitoxin was made to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, which swiftly shipped this rare countermeasure to Milot But for one patient, the disease had progressed too far and she died just prior to surgery. The other three are well on the road to a complete recovery and have been discharged. Importantly, no secondary cases occurred at the hospital or in the community where the family lives, a tribute to the quick and competent response of Hôpital Sacré Coeur staff and the MSPP.
