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State of Alaska Epidemiology Bulletin

Bulletin No. 20
October 31, 1975
Diphtheria Outbreak in Gakona

To date, 12 patients in Gakona have been discovered to have throat cultures positive for toxigenic diphtheria. The first case came to attention when an alert physician became suspicious while examining a school cook who complained of pharyngitis. He cultured her throat for diphtheria and the organism was subsequently recovered by the State Laboratory on October 16. An investigation was undertaken.

All of the children in the Gakona school, the teachers, other kitchen workers, and the patient's family were cultured. While none of the children in the school exhibited any symptoms, 11 children were found to have throat cultures positive for diphtheria. All of the school children and all of the families of the 11 children with positive cultures are being treated with antibiotics to eradicate the organism. In addition, we are trying to determine if there has been spread of diphtheria outside of the school.

Immunization clinics have been held in Gakona, Gulkana and Glennallen. It must be emphasized that the only effective control of diphtheria is through active immunization with the diphtheria toxoid, including an adequate program to maintain immunity. Adequate immunization is the single most effective measure to control a diphtheria outbreak. Immunization against diphtheria only protects against the diphtheria toxin and is effective in preventing the neurologic and cardiac complications of diphtheria. A person can be fully immunized and still carry the organisms or have a severe pharyngitis. Asymptomatic patients with positive throat cultures should be treated with Bicillin or Erythromycin to eradicate the carrier state. Diphtheria antitoxin, which should only be used for patients having clinical (symptomatic) diphtheria, is available from the State's Regional Laboratories in Juneau, Fairbanks and Anchorage.

All health workers should make special efforts to update all diphtheria immunizations and to maintain a high index of suspicion for diphtheria in patients with pharyngitis. Request for assistance or vaccine can be made through the State Laboratories, local public health nurses, or the Director of the Section of Communicable Disease Control in Anchorage, Alaska at 279-9417.

(Reported by James Pinneo, M.D., Douglas Brown, PHN, Rose Tanaka, SCRO Laboratory, and Hal Margolis, M.D. from the Center for Disease Control, Anchorage.)

Influenza - A Shifty Virus

The Center for Disease Control has informed State Health Departments that an influenza virus has been isolated at Christmas Island which shows a major antigenic shift away from the viruses contained in the new influenza vaccine. The significance of this shift is unknown at the present time. However, the CDC has requested that active surveillance be undertaken to determine whether or not this new virus will reach the United States. In past years, it has been noted that many of the first cases from a new antigenic variant of Influenza A have been introduced through either Hawaii or Alaska. For this reason, we would be most interested in obtaining viral cultures from any patient suspected of having the clinical diagnosis of influenza. Please notify John Middaugh, M.D., Medical Epidemiologist at 272-7534 or Tom Bender, M.D., Alaska Activities, 279-9511 and we will make arrangements for obtaining viral cultures and for their processing.

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