Diphtheria is a highly contagious infection that affects the nose and throat, and sometimes the skin. It’s rare in the UK, but there’s a small risk of catching it if you travel to some parts of the world.

It is spread via water droplets which can be transmitted through coughing, sneezing, sharing cups/cutlery, and close contact with someone who is infected. You can also become infected by sharing bedding or clothing with an infected person.

Diphtheria can be a serious illness and sometimes fatal, especially in children, if it’s not treated quickly. Vaccination can prevent it.

If you’re travelling to a part of the world where there may be a risk of diphtheria, you may need a booster vaccination if you were last vaccinated against it more than 10 years ago.

Since 2018, the World Health Organization has reported a rise in cases in places including:

• Indonesia
• India
• South America
• Africa

Places that have higher cases of diphtheria often change over time. For up-to-date information about the area you’re visiting, check the TravelHealthPro country guides.

Symptoms usually start 2 to 5 days after becoming infected.

Symptoms of diphtheria include:

• a thick grey-white coating that may cover the back of your throat, nose and tongue
• a high temperature (fever)
• sore throat
• swollen glands in your neck
• difficulty breathing and swallowing

In countries with poor hygiene, infection of the skin (cutaneous diphtheria) is more common.

If it’s cutaneous diphtheria, it can cause:

• pus-filled blisters on your legs, feet and hands
• large ulcers surrounded by red, sore-looking skin

Diphtheria is a highly contagious infection that affects the nose and throat, and sometimes the skin. It’s rare in the UK, but there’s a small risk of catching it if you travel to some parts of the world.

Diphtheria can be a serious illness and sometimes fatal, especially in children, if it’s not treated quickly. Vaccination can prevent it.

Diphtheria is common in many countries in Asia, the Middle East, eastern Europe, the Caribbean and the South Pacific (see map), while outbreaks have also been reported in other countries. The disease is more common in countries which do not offer routine vaccination.

Map adapted from the World Health Organization. Immunization Monitoring. Diphtheria Reported Cases. October 2020.

Tetanus is a serious infection caused by bacteria getting into a wound.

The bacteria can enter the body through cuts and grazes, body piercings, tattoos and injections, burns, animals etc. Tetanus is fatal in around 1 in 10 cases.

Most people who get tetanus have either not been vaccinated against it or did not complete the entire vaccination schedule.

Tetanus bacteria can survive for a long time outside the body and are commonly found in soil and the manure of animals such as horses and cows.

If the bacteria enter the body through a wound they can quickly multiply and release a toxin that affects the nerves, causing symptoms such as muscle stiffness and spasms.

The bacteria can get into your body through:

• cuts and grazes
• tears or splits in the skin
• burns
• animal bites
• body piercings, tattoos and injections
• eye injuries
• injecting contaminated drugs

Tetanus cannot be spread from person to person.

The symptoms of tetanus usually start around 4 to 21 days after infection. On average, they start after around 10 days.

The main symptoms of tetanus include:

• stiffness in your jaw muscles (lockjaw), which can make it difficult to open your mouth
• painful muscle spasms, which can make it difficult to breathe and swallow
• a high temperature
• sweating
• a rapid heartbeat

If it’s not treated, the symptoms can get worse over the following hours and days.

Fast treatment is necessary to prevent symptoms from worsening and anyone developing symptoms of tetanus will usually need to be admitted to hospital.

Tetanus is a serious but rare condition caused by bacteria getting into a wound. If you have signs or symptoms of tetanus, seek emergency care. If you have a simple, clean wound — and you’ve had a tetanus shot within 10 years — you can care for your wound at home.

Most people who get tetanus have either not been vaccinated against it or did not complete the entire vaccination schedule.

Tetanus is occasionally reported in England and Wales. Since 1991, there has been an average of seven cases reported each year; there have been no cases of neonatal tetanus in England and Wales for over 40 years. The majority of cases reported between 1984 and 2014 occurred in those over 45 years of age, many will have been born before routine vaccination schedules for tetanus were implemented in the UK in 1961.

In 2003, nine of the 12 reported cases occurred in people who inject drugs (PWID) aged between 20 and 47 years. Tetanus can be caused by contamination of drugs with spores during the production, distribution, storage, cutting, reconstitution and injection of drugs. Tetanus associated with foreign travel has only been reported twice in England and Wales since enhanced surveillance began in 1984.

The number is low because an effective tetanus vaccine is given as part of the NHS childhood vaccination programme.

Tetanus is found across the world, but some countries have higher incidences than others (see map).

Map adapted from the World Health Organization. Immunization Monitoring. Tetanus (total) reported cases. October 2020.

Polio is caused by a virus that spreads easily from person to person.

It usually spreads through contact with the poo of an infected person. For example, from not washing your hands properly and putting them in your mouth, or from contaminated food or water.

It can also spread through coughs or sneezes, but this is less common.

Your chance of getting polio in the UK is extremely low. This is because most people are fully vaccinated. Polio was eradicated in Europe in 2003.

There’s still an extremely small risk of catching it when travelling in a country where polio is still found, such as Afghanistan and Pakistan.

If you’re not vaccinated, there is also a very small risk of getting it through contact with a person bringing the polio virus from these countries when they return to the UK.

In severe cases of polio, the virus can attack the nerves in the spine and brain which can cause paralysis. In some cases, it can cause persistent or lifelong difficulties and even be life threatening.

Most people won’t develop any symptoms of polio or even realise they’re infected.

Some people get mild, flu-like symptoms, such as:

• a high temperature
• extreme tiredness (fatigue)
• headaches
• being sick (vomiting)
• a stiff neck
• muscle pain

These symptoms usually last up to 10 days.

Rarely, polio can lead to more serious symptoms that affect the brain and nerves, such as weakness in your muscles (paralysis), usually in the legs. This can happen over hours or days.

If the paralysis affects the muscles used for breathing, it can be life threatening.

Most people will recover, and movement will slowly come back over the next few weeks. Some people can be left with permanent disability.

Polio is a serious infection that’s now very rare because of the vaccination programme. It’s only found in a few countries and the chance of getting it in the UK is extremely low.

Rarely, polio can lead to more serious symptoms that affect the brain and nerves, such as weakness in your muscles (paralysis), usually in the legs. This can happen over hours or days. If the paralysis affects the muscles used for breathing, it can be life threatening.

Most people will recover, and movement will slowly come back over the next few weeks. Some people can be left with permanent disability.

Most countries are now free of polio (see map). The risk of polio is greatest in Afghanistan and Pakistan. Certain other countries are also affected.

Map adapted from the World Health Organization. Factsheet. Poliomyelitis. July 2019.

You’ll have some protection, but the diphtheria, tetanus & polio booster vaccination will strengthen this and help keep you protected for many more years.

In total, you need 5 doses of the tetanus, diphtheria and polio vaccines through your childhood. This will build up and maintain your body’s own immunity against these infections and protect you against the diseases.

You receive the first 3 doses as a baby in the 6-in-1 vaccine. The 4th dose is given around the age of 3 as a pre-school booster in the 4-in-1 vaccine, and the 5th and final dose is the diphtheria, tetanus & polio vaccine given at age 14 (school year 9).

You’ll usually only need an additional booster before travelling to some countries or if you have had a certain type of injury.

If you think you may have missed any of your doses, talk to a doctor, practice nurse or school nurse.

You’ll probably be offered the Meningitis ACWY  vaccine at the same time as your diphtheria, tetanus & polio vaccine.

It’s also a good opportunity to check with the doctor or nurse that all your other vaccinations are up-to-date, such as MMR. If not, you can have these other routine childhood vaccinations at the same time as the diphtheria, tetanus & polio vaccine.