July 2018 World Health Report

Published 30th July 2018

Venezuela

The harsh economic climate in Venezuela is casting its shadow upon all levels of society. Along with shortages of food, electricity and water, there are inevitable increases in crime as witnessed by the soaring rates of armed robbery, kidnapping and carjacking. Included in those currently fleeing the country’s projected million percent inflation rate are the medical professionals, worsening an already compromised healthcare system that is subject to shortages in both medicines and medical supplies. Infectious diseases are now rife. Over 2,000 cases of measles have been reported in nine states, resulting in 50 deaths. Malarial infections are also sky-rocketing: hundreds of thousands of malaria patients have now been identified, and more will follow. Added to these diseases is the increased rate of diphtheria.

Infants are usually vaccinated against diphtheria as part of the childhood vaccination programme. Routinely administered to babies with five other immunisations at eight weeks of age, diphtheria is now a rare disease in those countries with high uptake of the diphtheria vaccine. For those who are unprotected, however, diphtheria can pose a significant threat.

Possibly first described by Hippocrates in the 5th century BC as the ‘Cough of Perinthus’ in which several neurological features accompanied a chest infection, diphtheria has been a dreaded cause of infant mortality for many centuries. Its name was derived from the Greek word ‘dipthera’, meaning leather, which described the tough membrane that forms over the back of the throat during an infection with diphtheria. Comprised of dead cells and the causative bacteria Corynebacterium diphtheria, this coating is so tough that a frequent cause of death was the breathing-in of the membrane, causing a complete obstruction to breathing.

Following an incubation period of usually less than a week, patients experience a mild sore throat and fever that leads to symptoms of an upper chest infection. Most deaths occur very early on in the infection due to asphyxiation of the membrane in throat, but further complications can follow if this stage is survived. Inflammation of the heart can occur in up to 60% of infections leading to heart failure and circulatory collapse. Defects in the rhythm of the heart can also arise, sometimes leading to cardiac arrest. Neurological problems are also well described with infections of diphtheria: nerve palsies can occur, but so can inflammation of certain nerves causing paralysis, sometimes as late as three months after infection.

For most countries, the advent of the vaccination has made a spectre of the threat of Corynebacterium diphtheria. As Venezuela has so far reported more than 1,700 cases of diphtheria, resulting in the death of almost 15% of the patients, it is hoped that control will once again be achieved of this devastating infection. At present there is sadly little hope of this.

As the threat from many sides in Venezuela continues, we advise that all non-essential travel to the country is strongly reconsidered until the economic and social situation improves.

Written by Dr. Simon Worrell, Head of Medical Communications