In June 2015, Spanish media began reporting a severe case of diphtheria in a six year old boy. The child had not been vaccinated and was in intensive care. Spain, Europe and the world were shocked.
The boy spent twenty-five days in hospital receiving antibiotics and antitoxins in an attempt to slow the damage to his organs.
Historically, diphtheria has been called the ‘strangling angel’ because it destroys the lining of the airways as the disease advances. A thick film develops in the throat making it increasingly difficult to breath, causing death by ‘choking’.
Protection is possible: The disease, caused by bacteria that can be spread in coughs or sneezes, is preventable through vaccination. The vaccine is freely available in Spain and in most of the world.
While life-support machines kept the child alive, public health authorities began tracing people he had been in contact with. Ten more cases, including nine children and an adult close to one of those children, were detected.
But while these individuals had tested positive for the bug that causes diphtheria, authorities said they were unlikely to develop the disease because they had been protected through vaccination. They isolated at home as a precaution to protect others who may not have been vaccinated. The outbreak was contained.
Despite the best efforts of medical staff, the child died. His name was Pau.
It was the first registered case of diptheria in Spain in nearly three decades – the disease having been all-but wiped out thanks to vaccination programmes which began in the 1940s. The vaccine is one of the first vaccines given in the early months of life, often as part of a combined diphtheria-tetanus-pertussis (DTP) vaccine.
The child’s parents said, after the devastating loss of their son, that they had been misled by anti-vaccine groups.
‘The family is devastated and admit that they feel tricked, because they were not properly informed,’ according to Dr Antoni Mateu who was Catalan public health chief at the time of the case. ‘They have a deep sense of guilt, which we are trying to rid them of.’ (El Pais, June 2015).
For the public, and for health experts, the shocking return of a preventable disease was a wake-up call. Never again should a child die from an avoidable illness.
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Ten years on and the news is grim.
Europe is enduring its biggest diphtheria outbreak in 70 years. Data from the European Centre for Disease Prevention & Control (ECDC), published in the New England Journal of Medicine (NEJM), show that several countries have seen a spike in cases since 2022.
The bacteria responsible for a series of 2022 epidemics are genetically similar to those causing cases in 2025. In short, it may be that the 2022 outbreak is essentially bubbling away in the background, causing 320 cases in the first wave (2022) but also killing a child in Germany in 2025. The running total is now well above 500 cases in less than three years.
These outbreaks are mainly affecting migrants who have recently arrived in Europe, and are also hitting other vulnerable groups including people experiencing homelessness. Austria, Belgium, France, Germany, Italy, Norway, the Netherlands, Spain, Switzerland and the United Kingdom have reported cases.
Ten people have died of diphtheria in Europe since 2022. All were preventable.
Make diphtheria history again
Diphtheria belongs in the history books. The disease caused wave after wave of deaths over the centuries, until the development of an antitoxin in the late 19th century and vaccines in the 20th century.
In one celebrated episode in the fight against the disease, a 1925 outbreak in Alaska was prevented only by deploying a team of dogs to deliver antitoxin to the town of Nome. The 20-member dog relay won a race against time, after a three-year-old boy was admitted to hospitals with diphtheria symptoms.
Nome was snowed in and the route was treacherous, making other forms of transit impossible. The dogs covered a total of 674 miles (1,085 km), making headlines around the world. Their story earned them a place in the history books, a statue in New York’s Central Park, and a Disney movie named Togo.
Thankfully, diphtheria protection is far more easily available today. Ask your healthcare provider about free diphtheria vaccination near you.
Read more:
The Alaskan hero dogs who prevented a diphtheria epidemic in 1925 (Al Jazeera).
Diphtheria: a timeline (History of Vaccines)
Diphtheria – the first toxoid vaccines (Institut Pasteur)
How science conquered diphtheria, the plague among children (Smithsonian)
Europe’s diphtheria outbreaks: what the experts say
- Silvia Funke, ECDC expert on vaccine-preventable diseases: ‘The study shows how important it is to ensure that everyone’s vaccination status against diphtheria is up to date, including among vulnerable people such as migrants, people experiencing homelessness, people who inject drugs or unvaccinated people.’
- Prof Adrian Egli, University of Zurich, Switzerland: ‘Diphtheria can present with a broad range of clinical symptoms. Especially in infections with toxin-producing bacteria, respiratory complications are feared – as those can be life threatening.’
