The boy with the first case of diphtheria in Spain for 28 years has died, Catalan regional health authorities have told The Spain Report. The boy had not been vaccinated against the disease, which his parents now attribute to being “tricked” by anti-vaccination groups.

And the bad news doesn't stop there. Already eight other Spanish children have been found to be carrying the Corynebacterium diptheriae bacteria that causes diphtheria. Fortunately, all these children had been vaccinated, and consequently have not developed the disease, but the danger of other unvaccinated children becoming exposed remains high.

As in most developed countries, Spain wiped diphtheria more than two decades ago with vaccination rates over 95%. The disease persists in Russia, India and Africa, where it was responsible for 3,300 deaths in 2013.

The six year old boy was admitted to Vall d'Hebron hospital on the 3^rd of June. As a result of the long period since there had been any cases of the disease, Spain had no stocks of the diptheria antitoxin and had to get some delivered from Russia. It is not known whether or not faster availability of the antitoxin would have saved the boy's life, now if the carrier who infected the boy has been identified.

While highly effective in children, the immunity conferred by the diphtheria vaccine wears off with age, and adults who have not had a booster shot are often vulnerable to the disease. Diphtheria is often less fatal in adults than children but it can kill at any age.

Prior to the introduction of vaccines, diphtheria was widespread in Spain with multiple epidemics over a period of centuries. The disease was so common and the symptoms so severe, that 1613 was known as “The Year of Strangulations”.

Besides lying about the risks of vaccination, the anti-vaccine movement has routinely diminished the seriousness of the diseases reduced or eliminated by injections. The symptoms of diphtheria - including heart and kidney damage and lymph glands so swollen they can prevent breathing and death rates above 10% - are so severe that the approach hadn't been taken in this case. Instead the effectiveness of the vaccines are questioned, and rare reactions to the injection hyped or simply invented.

However, as the World Health Organization makes clear, “diphtheroid toxoid is one of the safest vaccines available” and it is the high global rate of immunization that has led to the dramatic declines in deaths from this disease. If the anti-vaccination movement has its way, there will be many more cases occurring in places where the disease has not been seen for decades.