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The Iditarod today is now a famous dog sled race. Racers start at Anchorage and finish in Nome. It also isn't strictly a 9 day race. It can take from nine to twelve days. The race starts at 10:00 am and even if you don't win you get a sum of money.
http://iditarod.com/about/iditarod-today/

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The Iditarod could not be done with out these dogs. They are highly trained and very very conditioned. These dogs are insane and I don't know how they do it. Some have died along the way but many have become champions. Many racers say its about the dogs. They are the ones that win the race.
http://iditarod.com/edu/it-is-about-the-dogs-iditarod-sled-dogs-ready-to-run/

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This trail is the hardest in the world and it takes to get from point A to point B. Dogs do stop and eat, but they still have to run for days. Some dogs have died. This articles talks about one of 152 dogs who have died. It shows the hardship of this trail.
http://helpsleddogs.org/iditarod-questions-answers/

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This website was very interesting, and it shows a ton of cool articles. It had a video of Mitch crossing the finish line. It had photos and interesting facts about the race.
https://www.adn.com/section/outdoors-adventure/iditarod/

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This video is important because it shows what it would be like to travel on the trail.

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Hold tight! Take a wild sled dog ride with 4-time Iditarod champ Jeff King

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The 2014 Iditarod trail includes some of the toughest mushing in the history of the race, veterans said. Especially early along the trail, mushers were battered and bruised on snowless ground. Four-time winner Jeff King shot this footage using a helmet cam between Rainy Pass, in the Alaska Range, and the Rohn checkpoint on Monday, March 3.

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Winners             Year

Rick Swenson  1977-79-81-82-91
Susan Butcher 1986-87-88-90
Martin Buser    1992-94-97-2002
Lance Mackey  2007-08-09-10
Doug Swingley 1995-99-2000-01
Jeff King           1993-96-98-2006
Robert Sorlie    2003-05
Mitch Seavey   2004-13
Dallas Seavey  2012-14-15-16

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Back when the Iditarod wasn't a race, and the trail was traveled for work, mushing wasn't just a sport. Mushing was required to get from point A to point B in Alaska. Mushing then took a back seat to driving and flying places. This article explains the importance that mushing used to have.

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Al Grillo / AP

It's an epic challenge for man and man's best friend: the Iditarod Trail Sled Dog Race, which begins Saturday, is a grueling 1,150-mile trek in which a human captain (or musher) and an average of 16 dogs brave Alaska's frozen tundra and icy forests to compete for $69,000, a new truck, and the honor of conquering one of the country's last frontiers.

The modern Iditarod, which for more than a week winds from Anchorage to the isolated town of Nome, began in 1973. When settlers rushed to Alaska in search of gold around the turn of the 20th century, the Iditarod Trail — for which the race was christened — served as the primary artery for ferrying mail and supplies. Given the frigid conditions, the route was often impassable except by dog sleds. ( See pictures of the Iditarod.)

Given its centrality to Alaskan life, mushing emerged early on as both a popular sport and a vital necessity. In the winter of 1925, an epidemic of diphtheria ravaged Nome, which lacked the medicine to combat it. The nearest supply of antitoxin serum was in Anchorage—nearly 700 frozen miles away. In what has become known as the "Great Race of Mercy," 20 mushers and some 150 dogs teamed up to deliver the drugs in under six days, quelling an epidemic that threatened to decimate the town. Balto, the lead dog on the final stretch of the relay, earned national acclaim — and a statue that still stands in New York City's Central Park — for the feat, though many cite musher Leonhard Seppala and his lead dog, Togo, as the the effort's unsung champions.

The emergence of air travel blunted the Trail's importance in subsequent decades. But in the 1960s, a Wasilla resident named Dorothy Page moved to memorialize its importance by staging a race during Alaska's centennial celebrations in 1967. The inaugural title was won by Isaac Okleasik, who pocketed $25,000 for speeding through the abbreviated 27-mile jaunt. After a one-year hiatus due to lack of snow, the modest second running in 1969 drew just 12 mushers and paid out a mere $1,000. ( See TIME's Top 10 Endurance Competitions.)

That lackluster turnout failed to dissuade Page and venerable musher Joe Redington Sr., who mortgaged his home and sold a piece of land to help finance the event's start-up costs. Their efforts helped persuade officials to stage the first full-length Iditarod in March, 1973, in which Dick Wilmarth and his lead dog, Hotfoot, triumphed by covering the inhospitable terrain in 20 days. Since 1983, the Iditarod — the word is said to mean "distant place" in indigenous Alaskan dialects — has steadily grown in popularity, becoming both the most popular sporting event in the state and an international touchstone renowned for both the stamina it requires and the desolate beauty of the unforgiving terrain it covers.

Success in the race has minted heroes out of many ordinary Alaskans. Among the giants of the Iditarod are five-time champion Rick Swenson; families like the Redington, Seavey and Mackey clans, who have captured multiple championships and together have placed an entrant in every race since the event's inception; and four-time winners Susan Butcher and Martin Buser, who owns the record for the event's fastest recorded time (8 days, 22 hrs. and 46 mins). To prepare for the rigors of the journey, mushers spend months prepping their dogs, who are subject to drug screenings and tracked using collar tags and microchips implanted under the skin. And while the competition is intense, participation counts: organizers present the last-place musher with the "Red Lantern" award as a tribute to his persistence. (The slowest Red Lantern winner, John Schultz, took more than 32 days to reach the finish line.) Each finisher also receives more than $1,000 to defray travel expenses. ( See pictures of the science of snowflakes.)

The race has predictably drawn fire from animal rights groups like PETA and the ASPCA, attention that only worsened after veteran musher Ramy Brooks was given a two-year ban in 2007 for abusing his dogs. But most Alaskans steadfastly defend the event as a celebration of the state's heritage. This year, the greatest threats posed to the race come from other directions. A heavy snow recently blanketed parts of the Alaska, burying the trail in deep drifts and forcing mushers to break out their snowshoes. And just as it has in the Lower 48 states, the economy has cast a pall over the Land of the Midnight Sun. Due to higher operating costs, entrance fees have spiked 33% to $4,000 despite a shrinking prize pool; between food, supplies and preparation, the cost of running the race can reach $30,000. Meanwhile, mushers have griped about the salaries doled out to event executives, which dwarf their own comparatively meager paychecks. "We are the most underpaid professional athletes in the world to do what we do," two-time defending champion Lance Mackey told the Associated Press. "Most people wouldn't even consider it. We are literally working for welfare checks."
See the top 10 Alaskans of all time.
Read TIME's profile of Sarah Palin, a 2008 Person of the Year Runner-Up

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Breaking News, Analysis, Politics, Blogs, News Photos, Video, Tech Reviews - TIME.com

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It's an epic challenge for man and man's best friend: the Iditarod Trail Sled Dog Race, which begins Saturday, is a grueling 1,150-mile trek in which a human captain (or musher) and an average of 16 dogs brave Alaska's frozen tundra and icy forests to compete for $69,000, a new truck, and the honor of conquering one of the country's last frontiers.

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This is a picture of the checkpoint at Safety. The Safety checkpoint is the last checkpoint in the Iditarod race. It is very important because once the racers reach the checkpoint at safety, they know they are very close to finishing the whole race. The Safety checkpoint is approximately 22 miles away from the final destination of Nome.

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One of the hardest parts of the Iditarod Trail is one of the final stretches from White Mountain to Safety. This portion of trail is relatively easy if the weather is good, but rarely is the weather good. This is one part of the trail towards the end that racers definitely need to watch out for. It can be very dangerous. Here is a link to the article.

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by Donald Bowers, Jr.
Quick Overview

This can be one of the most dangerous stretches on the race when the wind blows or a storm hits. It can make or break champions, not to mention back- of-the-packers. Mushers have nearly died within what would normally be a few hours' easy running to Nome. In reasonable weather, this is a pleasant five- to eight-hour run; in the worst conditions, it can be impassable.

The race uses the main snowmachine trail to Nome. It is well marked at the beginning of the race, but inevitably many markers are knocked over or blown down. Some parts have been permanently marked. Markers are absolutely critical for this leg because visibility can be near zero in storms and ground blizzards.

The trail leaves White Mountain on the Fish River for about three miles, and then leaves the river to cut overland to the southwest, crossing low, rolling tundra and several streams before reaching the Klokerblok River. It runs up the river and across some low ridges, and then crosses into the drainage of the Topkok River.

The trail then turns west and climbs over a series of barren ridges to a 400-foot saddle just northwest of Topkok Head, overlooking the coast. It then descends sharply to the beach, reaching the Nome Kennel Club shelter cabin at the foot of the hill, 30 miles from White Mountain.

For the next 12 miles the trail runs along or just behind the dune line and the "driftwood line" on the shore. This stretch is wide open and is subject to winds of more than 80 miles an hour from the north, as well as blinding whiteouts. The trail will join the Nome-to-Council road (not plowed in the winter) at the Bonanza Ferry bridge and then follow it for the last 12 miles to Safety.

Trail conditions on this leg can range from excellent to abysmal, and usually include glare ice, overflow, drifted snow, bare tundra, sand, and exposed gravel on the road. You MUST check the weather carefully before leaving White Mountain; you may want to wait it out, stop at a shelter cabin, or at least convoy with another musher (preferably someone who has run this stretch before).

One consideration is that the wind will most likely die down right after sunrise (if it's going to die down at all), but will probably come back up by noon and continue to blow through the afternoon and evening. In such situations, it is best to ask the locals at White Mountain or call race headquarters in Nome. All other things being equal, try to leave White Mountain about three hours before sunrise, so as to be heading up Topkok to catch any lull in the wind plus have daylight for the worst part of the run.

Detailed Description

You'll head out of White Mountain to the northwest, up the Fish River. If the wind is blowing from the north, you'll hit it as soon as you round the bend and leave the shelter of the hill behind the town. Watch the markers carefully so you don't miss the turn off the river to the left (southwest). If you keep going straight, you'll be on a trail to Council, 20 miles upstream.

Once on the overland trail and away from river, you'll be running mainly in the open, with just an occasional clump of willow bushes. The trail may be drifted if the wind is blowing, but it should be well marked. One problem you will probably encounter is that the trail is often marked on the downhill or downwind side; this means many trail markers are inadvertently knocked over by teams in front of you that slide or are blown into them. The markers are not put back up for following teams. It is entirely possible to go for a mile or more without seeing a marker on some stretches of trail because the markers have been knocked down.

About five miles after leaving the river you'll cross Cumberland Creek, which has a substantial treeline; this is locally called Timber and offers some shelter from the wind if things get too bad. More importantly, you must ensure you are on the trail at this point because there is only one place to cross the creek for several miles in either direction. There may be some light overflow crossing the creek itself.

A few miles past Timber you'll enter the valley of the Klokerblok River (one local pronunciation is "kootch-i-block"), which is usually somewhat out of the wind. Depending on overflow and ice conditions on the river, the trail may run up the river or above it on the slope to the right. After a few miles you will cut up the left bank and climb up a short, steep slope run southwest along the sidehill a hundred feet above the river for several miles, dropping down to cross side creeks (any of which may have overflow and glare ice).

Finally the Klokerblok will swing to the west and you will continue southwest, dropping back down into the valley of Topkok River. In the valley you'll see an abandoned A-frame shelter cabin that has been partly submerged in icy overflow. Watch for glare ice and light overflow here. In recent years this cabin has not been usable; do not count on being able to stop here. If you must have shelter in this area, continue down the Topkok River to the coast (about four miles), where there is an easily located cabin.

There are no trees past the A-frame all the way to Nome (and none at Nome, either). Everything from here on is barren, with only the occasional clump of scrub bushes. At the A-frame, the trail will swing up the hill to the right, off the Topkok River. You will quickly begin to pick up the wind if it is blowing. You will be heading southwest; a north or northwest wind (the usual) will be blowing from your right. The trail will climb a couple of 400-foot ridges and run generally sidehill, roughly paralleling and slowly separating from the Topkok River in the valley to the left.

After each ridge you will drop down to quickly cross a creek with some scrub willows before climbing sharply up again; there is some shelter in the creek bottoms from the wind if you want to take a break. Finally you will begin to climb the highest ridge-this is Topkok. The summit is about 500 feet above sea level, followed by a moderately steep one-mile descent to the beach; the down-trail can be icy.

From the A-frame to the summit is not quite five miles, almost all of it totally exposed to the wind and subject to ground blizzards. It is very important to stay on the trail because you can easily turn south in reduced visibility conditions and come out atop the high cliffs of Topkok Head. (The trail used to run along the cliffs but was considered too dangerous; the current trail is intended to keep dog teams and snowmachiners away from the rocks.) This is another reason to try to do this stretch in daylight-you may not have many trail markers to navigate by and you'll need all the extra visual cues you can get.

A major factor to consider in this area is that the wind can be extremely localized-and quite violent. You are moving through a series of natural wind tunnels, called "blow holes", any of which (or all of which, or none of which) may be blowing at any given time. You can easily move through a hurricane-force gale with blowing snow and come suddenly into a calm area-or vice versa. Moreover, the wind can start up within minutes and reach hurricane force within an hour, or quit just as quickly.

At the eastern end of the area, the wind will be in your face as it comes across the inland mountains and fans out; as you move further west, it will swing to become more of a direct cross wind and then finally to be more at your back. The wind may or may not be accompanied by blowing snow; there is usually more blowing snow later in the day after the sun has had a chance to hit the snowpack and loosen up the surface layer. There is ALWAYS blowing snow if the winds kick up after a fresh snowfall.

From the summit of Topkok you should carefully look ahead along the beach line to the west. If you can see the beach clearly all the way to the old buildings of Solomon (about 15 miles on), you should be able to cross. If you see blowing snow, or if you can see Cape Nome and the hills clearly but there seems to be a haze obscuring the beach area, you will have problems-your visibility at ground level might be zero once you're on the beach. At night there are no lights on this section, so you will have no indication of what lies ahead. It is entirely possible for the wind to be blowing on Topkok and not down below, or the other way around-or both.

At the west foot of Topkok, you are about 25 miles from Safety. The Nome Kennel Club maintains a snug shelter cabin here that has saved many a musher and snowmachiner. Again, if you see blowing snow ahead, you might be advised to hole up here for awhile if you're not familiar with the area. There is another shelter cabin 6 miles farther on, called Tommy Johnson's cabin. The six miles between these cabins is traditionally the worst blow hole in the area, although the wind can blow just as hard until well past the Bonanza Ferry bridge, 12 miles from the cabin. In most years the trail from the Kennel Club cabin heads west across Taylor Lagoon, a two-mile-long lake just behind the dune line. This is often blown clear of snow and is usually a skating rink. If the wind is blowing, you will probably not be able to control your team on the ice and will be forced to work over to the dune line, making your way along it through the scrub bushes and driftwood until you pick up the trail again past the lake.

Once past the lagoon, the trail will run along or just behind the beach and dune line. It will have bare spots and you will often be crossing exposed grass clumps and beach sand and skirting driftwood snags. The trail will be marked with 8-foot-high posts every few hundred yards, interspersed with wooden tripods and hundreds of Iditarod trail stakes. Everything is hung with reflectors. This is probably the best marked stretch of trail in the world, and it's sometimes still not marked well enough. It is critically important that you stay on the markers across this stretch if the weather is bad.

In strong winds, your leaders will tend to turn downwind if visibility is bad or they don't have a distinct trail to follow. You can very easily get turned out onto the beach and onto the shore ice. If the blow hole is roaring and you can't see where you're going, and you notice the wind is at your back before you reach the Nome-to-Council road, something is very wrong and you may be in serious trouble.

Usually your last warning will be the driftwood line on the beach. You must NEVER cross the driftwood line in poor visibility. There is one place, however, where the line is broken, about 11 miles past the Kennel Club cabin where the Solomon River breaches the spit and dune line to empty into the Bering Sea. To repeat, you MUST go marker to marker when visibility is bad.

If you find yourself out on the ice, or even think you may be out on the ice, STOP!!!! There is often open water as close as a quarter-mile offshore in this area. If you must move in such a situation, head directly into the wind until you come back to the beach.

The winds along this stretch are not an empty threat to make the race look more dangerous for publicity purposes. In 1994 back-of-the-packer Beth Baker got separated from her trail-sweep snowmachine escort and inadvertently headed out onto the ice. She finally got her team stopped only a few hundred yards from open water. The winds and blowing snow were so bad searchers could not find her until the next morning, and by then she had badly frostbitten her hands in the minus-130-degree wind chill; she had to scratch.

In 1992 Bob Ernisse and the group he was with became stalled in a whiteout in the middle of the blowhole, couldn't get back to the shelter cabin, and tried to camp out. Ernisse's sled bag and sleeping bag were partly open and he became hypothermic as the wind packed snow into every open space; his friend Bob Hickel found him in the morning and saved his life. He got to Nome in a medivac helicopter. (Ernisse came back and finished the race in 1994.)

If you are at the back of the pack, the trail sweeps will probably be able to escort you across the blowhole and it wouldn't be a bad idea to wait for them. Otherwise, your best bet may be to go with someone who is experienced. Once again: The winds in this area are nothing to trifle with. They have killed people in the past (fortunately no Iditarod mushers) and will undoubtedly do so in the future. In many cases the winds can be safely navigated, but it is not something to try if you don't know what you're doing.

Of course, this stretch can also be a pleasant stroll along the beach-you'll just have to pay your money and take your chances. The author has seen it both ways: In 1996 it was calm and clear, and in 1997, with rookies Sonny King and Suzan Amundsen in close formation, it was 75-mile-an-hour gusts strong enough to literally knock over the sleds and dogs all the way from the east foot of Topkok to Tommy Johnson's (fortunately without too much blowing snow).

Remember that the wind can take heat away from your dogs at astonishing rates, even if the temperatures are relatively mild and the dogs have thick coats. Consider putting dog blankets at least on your upwind dogs (in this case, the dogs on the right side of the gangline) before you head through an operating blow hole. If you must stop for any length of time in the wind, try to get the dogs behind some kind of shelter. And don't forget that the wind also tremendously accelerates dehydration, so your dogs will be working up a powerful thirst (and so will you).

After you pass Tommy Johnson's, you will be running along a narrow spit between the ocean on your left and a narrow lagoon on your right. Five miles past Tommy Johnson's you'll cross the main breach in the dune- and driftwood line where the Solomon River flows from the lagoon to the sea. The wind can still be blowing strongly enough here to create whiteout conditions. You MUST stay on the marked trail, especially crossing the Solomon River outlet.

As you approach the Nome-to-Council road you'll see the Bonanza Ferry bridge, where the road crosses from the mainland to the spit. Just north of the bridge you'll also see the Last Train to Nowhere, the skeletons of three old steam locomotives next to an old water tank. These were the pride and joy of the railroad from Solomon to Council, which was never finished and operated only for a few years in the early 1900s.

Once past the bridge you'll climb immediately up onto the road. The road isn't plowed during the winter, but more than likely the gravel roadway will be blown clear of snow and you'll have to run on the shoulders or even in the ditch. You will have mile markers from here to Nome. Safety Roadhouse is at Mile 22, about 12 miles ahead be running along a narrow spit between the Bering Sea on the left and Safety Sound on the right. Once you're on the road, it's hard to get lost, and in any case the wind is usually less intense and more at your back.

You'll see some old cabins and ruins along the road all the way into Nome. Some are still used as recreational cabins by Nomeites. In 1898 and 1899 the beach you're running along was almost shoulder-to-shoulder with thousands of people trying to make their fortunes from the gold-rich beach sand. There's still pay dirt there if you want to come back in the summer and give it a try, and lots of people do. There have never been any permanent claims allowed on the beach, which is public property. As long as you're actively working a spot, it's yours.

At the end of the spit you'll see the Safety bridge ahead; the trail will bypass the bridge to the left. The lone warehouse-looking building ahead on the far side of the bridge is Safety Roadhouse, the last checkpoint on the trail before Nome.

Most drivers don't stop very long at Safety, just long enough to pick up their bibs for the last 22 miles to Front Street. You were able to ship something here if you wanted; the dogs would probably appreciate a snack. If you're not in a major hurry, you can step inside the roadhouse for a bowl of soup or a beverage (and to use the facilities). Note: If there is a storm in progress, you might consider waiting here for awhile because you have almost no shelter between here and Nome.

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by Donald Bowers, Jr. This can be one of the most dangerous stretches on the race when the wind blows or a storm hits. It can make or break champions, not to mention back- of-the-packers. Mushers have nearly died within what would normally be a few hours' easy running to Nome.

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Here is a video that follows someone named Aliy as she runs the Iditarod. The video shows that some stretches of the trail can be very difficult to maneuver. I also found out that there are a lot of dogs on these sleds. Which would only make it more difficult to navigate the trails.

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Iditarod 2012- "Aliy Cam" Mushing thru Dalzell Gorge

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Skunk's Place (SP) Kennel is a premier sled dog racing kennel in Two Rivers, Alaska. We are dedicated to the individual dog through excellent health, nutrition, training and specialized care. We strive to make this Dog Log the most educational and entertaining internet source on sled dog sports.

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Going into the race, it is very important for racers to know what they are up against. The main opponent in the race is not other competitors, but the weather. Racers must know the weather, and how it will affect different stretches of the trail.  This article provides a detailed description of many different parts of the trail.

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Above is a map of the route sled-dog teams will follow for the Iditarod, which starts March 2. It is the official map put out by the Iditarod Trail Committee. Iditarod veteran and bush pilot Don Bowers (now deceased) wrote some wonderfully detailed descriptions of what sled-dog teams face on each leg of the race. They can be found here (scroll down to the table links) along with a printable version of the map.

I'll mention only a few of the trail's more salient features.

The first thing to note is that the map shows the trail splitting at Ophir, near the halfway point of the race, into a northern and southern route before meeting again at Kaltag. The northern route is used during even-numbered years (e.g., 2008, 2010, 2012), the southern-route during odd-numbered years (e.g., 2009, 2011, 2013). The southern route was added to the race in the late 1970s for several reasons:

1. To involve the southern villages in the race.

2. To include the historic gold rush town of Iditarod.

3. To give the northern villages a break by having the race run through them only every other year.

This year's mushers will, of course, follow the southern route.
CHECKPOINTS AND MANDATORY RESTS

Mushers must check in with a race official at each labeled checkpoint. The race official notes the musher's time in, number of dogs, and asks whether the musher will stay to rest or pass through the checkpoint. For most checkpoints, staying or going is up to the musher. However, there are three mandatory checkpoint rests each musher must take:

1. One 24-hour rest, to be taken at a checkpoint of the musher's choosing. Most mushers take this long rest at McGrath.

2. One 8-hour rest at one of the checkpoints on the Yukon river (for the 2013 route, this would include Anvik, Grayling, and Eagle Island).

3. One mandatory 8-hour rest at White Mountain.

Mushers may also rest anywhere along the trail between checkpoints provided they move off the trail to make way for other dog teams.

During checkpoints rests, mushers unharness their dogs and spread straw for them to rest or sleep on. (Before the race, mushers arrange with the ITC to have straw bales and dog food shipped to the various checkpoints.) Mushers remove their dogs' protective booties and apply ointment to the dogs' feet. They also feed the dogs before getting a hot meal and sleep themselves.Veterinarians at each checkpoint along the route examine the dogs for any health issues. If a dog is overly tired, sick, or injured, a musher can drop it from the team at a checkpoint. (Mushers start the race with a maximum of sixteen dogs and must have at least six on the towline when they finish.) Mushers are not allowed to leave sick or injured dogs on the trail between checkpoints. If a dog gets sick or injured or dies on the trail (which is rare), the musher must carry it in their sled basket to the next checkpoint.
THE ROUGH STRETCHES

The trail from Willow to Finger is a relatively trouble-free run, though during this early stretch of the race sled-dog teams still have to contend with fans, media, snowmobiles, etc. Once they clear the Alaska Range, after Rohn, they head into the Alaskan interior where they are pretty much on their own, at least between checkpoints. However, they do sometimes have to contend with wildlife on the trail. Moose can be a particular problem, especially when there is heavy snowfall. The moose sometimes use the trail to get better footing. This can lead to violent encounters between moose and dogs. During the 1985 Iditarod, veteran musher Susan Butcher had to withdraw from the race after two of her dogs were killed by a pregnant moose.

The difficulties with the trail itself start after Finger Lake, as sled-dog teams make the 3,000-foot ascent up the Alaska Range to the Rainy Pass checkpoint. On the way to Rainy Pass, sled-dog teams encounter the Happy River Steps, a series of three sharp, twisting descents. Sled brakes often get a good workout tackling this part of the trail, and it can be particularly treacherous during periods of high winds or blizzards.

After reaching the summit at Rainy Pass, sled-dog teams make the steep descent down the western side of the Alaska Range into Dalzell Gorge, a several-mile winding drop into a frozen river valley. It is quite a wild ride! Here is a video clip, shot by Aliy Zirkle, showing a musher's perspective of heading into the Gorge.

Veteran musher and four-time Iditarod champion, Martin Buser, says of crossing this part of the Alaska Range, "It takes two days to get up it and two hours to get down."

Once mushers reach the Rohn checkpoint, they've cleared the Alaska Range and the most difficult part of the trail. Still, there are some tricky stretches that await them, especially in bad weather.
The Farewell Burn
Between the 75-mile stretch between Rohn and Nikolai, mushers cross the Farewell Burn, the result of a 1977 forest fire that scorched over 300, 000 acres. When snowfall is light, mushers encounter a bumpy field of grass tussocks and deadfall poking through the snow. It can make for a bone-jarring ride that has been known to break both resolve and sleds.

Once mushers reach the ghost town of Iditarod, they're halfway to Nome.
The Yukon River
The southern route along the Yukon River, between Anvik and Kaltag, can be challenging as mushers sometimes face fierce 50 mile-per-hour headwinds across the desolate tundra. Windchill can bring the temperature down to 50 degrees below zero.
The Bering Sea
Mushers reach the Bering Sea Coast at Unalakleet. High winds and blizzards coming off Norton Sound are not uncommon. Between Shaktoolik and Koyuk is a 50-mile stretch across sea ice where it is easy to lose sight of the trail in a blizzard.

In addition to these highlights, sled-dog teams face slick glaciers where dogs find it hard to get their footing and mushers work to control their sleds; undulating hills and sharp hairpin turns; holes in the ice; narrow ice bridges spanning rapidly moving water; missing or misplaced trail markers; fighting dogs; dogs in heat; unfriendly wildlife; and trees, trees, trees. It's also easy for lead dogs to lose the scent of the trail, especially for teams who are out front. Front-runners have to break trail, which can slow them down considerably. Warmer winters raise temperatures on some parts of the trail to 30 - 40 degrees, which is hard on huskies used to running in -20-degree weather.

Other than that, it's a sled ride.

Not that you'll be seeing me try it anytime soon!

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Above is a map of the route sled-dog teams will follow for the Iditarod, which starts March 2. It is the official map put out by the Iditarod Trail Committee. Iditarod veteran and bush pilot Don Bowers (now deceased) wrote some wonderfully detailed descriptions of what sled-dog teams face on each leg of the race....

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Without checkpoints, the Iditarod would not be a race. Checkpoints are important for the dogs to rest and eat. I guess they are also important for the humans, but they aren't doing nearly as much work as the dogs are. This is a list of checkpoints on the Iditarod, with links to an article on each.

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This picture of a dog with raw paw shows how bad the conditions on the trail can be. Raw paw is something that can affect many dogs that run the race, as they are running almost nonstop. Raw paw occurs when a paw is constantly irritated, and can lead to rash-like skin on a dog's paw.

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Here is a map of the Iditarod Trail. It goes all the way from Anchorage to Nome, on opposite ends of Alaska. It spans almost the whole state and over 1000 miles.

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To understand why the Iditarod first started, it is important to understand what caused it. This article tells about the reason that people needed to use the Idiatrod trail. If not for this trail, then the disease of diphtheria would have been spread even further. We must also thank brave Balto and his team for pushing their sled as hard as they could, and saving the entire town of Nome. This is an important event in out nations history, and everyone should know how it began.
http://www.history.com/news/the-sled-dog-relay-that-inspired-the-iditarod

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In this article, they give more information about the history of the trail. They talk about the dogs, Balto and Togo, who helped greatly in delivering the serum. They also talk about the dog's sled drivers, Leonhard Seppala and Gunnar Kaason. In this article they also talk about the founder of what we now know the Iditarod for; the race. It also includes information about where a statue of Balto is located.
http://westfordk12.us/pages/Curric/links35/socialstudiesfolder/iditarod/iditarod_history.htm

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In this article they talk about the Alaskan gold rush. The Iditarod trail was used by miners when they were mining for gold. There was really no other way to get around other than by dog and sled. Trails such as the Iditarod trail, were very important in everyone's daily lives. In this article it also talks about where the trail goes and what towns it run through and to. A few of these towns are boom towns, which are towns that were 'booming' during the gold rush, but now are ghost tows, because there was no more gold left.
http://iditarod.com/about/booms-and-busts/

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This video is very useful because it gives lots of information about the Iditarod. It tells how the trail was used to bring the cure to Nome. The townspeople of Nome were not even allowed to leave their houses in fear of getting diphtheria. Instead of having one sled team go the entire 537 miles, the teams made a relay to carry the serum. The sled dogs traveled 125 miles a day, running five times faster than normal. Togo and Balto were one of the leaders of the dog teams that really pushed their teams, and made it possible for them to make it to Nome in the time that they did.

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Four Legged Heroes: Togo & Balto - YouTube

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This is a picture of the trail that Balto's dog team traveled along this trail to bring the serum for the vaccination of diphtheria to the town of Nome. As you can see this is the route that the teams took to bring to the serum to the townspeople. The teams had to start all the way from Anchorage and go to Nome, which is 537 miles. This was a very long trail to travel for one dog team. Instead of having just one team make the whole trip, they had a relay of dog teams to make this journey. These dogs had to travel through the cold snow and had to do it faster than ever because the case was so urgent

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This is picture of Balto. This is important because this dog played a very important role in helping the people of Nome. Balto is one of the main reasons that the sled containing the diphtheria vaccination got to the town of Nome. Balto led the team through thick and thin and pushed them on wards toward the town. We can thank this brave dog for saving the town.

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It is important to also know what the Iditarod trail was also used for. Before being the famous trail for racing, it was just a normal trail. Back in the early 1700's there was only one way of transportation in Alaska, and that was by sled. This trial was used to carry supplies, go from town to town, and hunting. After being cleared by the government in 1908, it was rarely used, until in 1910 gold was found.
http://iditarod.com/edu/the-history-of-the-iditarod-trail-sled-dog-race/

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This picture of a sled and it's team of dogs pulling it, is an example of what would have been on the Iditarod trail. These dogs worked hard in cold weather, and had to pull a big sled through lots of snow, and rough weather. As you can see in this picture, big dogs with warm coats were perfect dogs to use to pull the sleds. These dogs delivered supplies, mail, and many more important items. Going by sled was one of the only way to get to places in Alaska, so this trail was used very frequently to get around.

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This picture is important because it shows that  Diphtheria can be spread throughout the body. The disease is usually located in the throat but if left untreated it can spread farther and become more serious. This sickness travels by using passages that connect glands to other major areas. This is why it is always important to treat Diptheria as early as possible,

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This article mainly gets into how you can detect Diphtheria. The main way to detect it is by checking glands and your respiratory system. It is important to do that since the disease mainly affects your throat and nose. It can take up to five days to find out that you have Diphtheria, but you can fight it. The main way to protect yourself is to stay clean and wash your hands.

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Overview

Diphtheria (dif-THEER-e-uh) is a serious bacterial infection usually affecting the mucous membranes of your nose and throat. Diphtheria typically causes a sore throat, fever, swollen glands and weakness. But the hallmark sign is a sheet of thick, gray material covering the back of your throat, which can block your airway, causing you to struggle for breath.

Diphtheria is extremely rare in the United States and other developed countries, thanks to widespread vaccination against the disease.

Medications are available to treat diphtheria. However, in advanced stages, diphtheria can damage your heart, kidneys and nervous system. Even with treatment, diphtheria can be deadly - up to 3 percent of people who get diphtheria die of it. The rate is higher for children under 15.

Symptoms

Diphtheria signs and symptoms usually begin two to five days after a person becomes infected and may include:

A thick, gray membrane covering your throat and tonsils

A sore throat and hoarseness

Swollen glands (enlarged lymph nodes) in your neck

Difficulty breathing or rapid breathing

Nasal discharge

Fever and chills

Malaise

In some people, infection with diphtheria-causing bacteria causes only a mild illness - or no obvious signs and symptoms at all. Infected people who remain unaware of their illness are known as carriers of diphtheria, because they can spread the infection without being sick themselves.

Skin (cutaneous) diphtheria

A second type of diphtheria can affect the skin, causing the typical pain, redness and swelling associated with other bacterial skin infections. Ulcers covered by a gray membrane also may develop in cutaneous diphtheria.

Although it's more common in tropical climates, cutaneous diphtheria also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions.

When to see a doctor

Call your family doctor immediately if you or your child has been exposed to someone with diphtheria. If you're not sure whether your child has been vaccinated against diphtheria, schedule an appointment. Make sure your own immunizations are current.

Causes

The bacterium Corynebacterium diphtheriae causes diphtheria. Usually C. diphtheriae multiplies on or near the surface of the mucous membranes of the throat. C. diphtheriae spreads via three routes:

Airborne droplets. When an infected person's sneeze or cough releases a mist of contaminated droplets, people nearby may inhale C. diphtheriae. Diphtheria spreads efficiently this way, particularly in crowded conditions.

Contaminated personal items. People occasionally catch diphtheria from handling an infected person's used tissues, drinking from the infected person's unwashed glass or coming into similarly close contact with other items on which bacteria-laden secretions may be deposited.

Contaminated household items. In rare cases, diphtheria spreads on shared household items, such as towels or toys.

You can also come in contact with diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmune people for up to six weeks - even if they don't show any symptoms.

Risk factors

People who are at increased risk of contracting diphtheria include:

Children and adults who don't have up-to-date immunizations

People living in crowded or unsanitary conditions

Anyone who travels to an area where diphtheria is endemic

Diphtheria rarely occurs in the United States and Western Europe, where health officials have been vaccinating children against the condition for decades. However, diphtheria is still common in developing countries where immunization rates are low.

In areas where diphtheria vaccination is standard, the disease is mainly a threat to unvaccinated or inadequately vaccinated people who travel internationally or have contact with people from less-developed countries.

Complications

Left untreated, diphtheria can lead to:

Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection - usually, the nose and throat. At that site, the infection produces a tough, gray-colored membrane composed of dead cells, bacteria and other substances. This membrane can obstruct breathing.

Heart damage. The diphtheria toxin may spread through your bloodstream and damage other tissues in your body, such as your heart muscle, causing such complications as inflammation of the heart muscle (myocarditis). Heart damage from myocarditis may be slight, showing up as minor abnormalities on an electrocardiogram, or severe, leading to congestive heart failure and sudden death.

Nerve damage. The toxin can also cause nerve damage. Typical targets are nerves to the throat, where poor nerve conduction may cause difficulty swallowing. Nerves to the arms and legs also may become inflamed, causing muscle weakness. If C. diphtheria toxin damages the nerves that help control muscles used in breathing, these muscles may become paralyzed. Respiration may then become impossible without a respirator or another device to assist with breathing.

With treatment, most people with diphtheria survive these complications, but recovery is often slow. Diphtheria is fatal in as many as 3 percent of those who get the disease.

Prevention

Before antibiotics were available, diphtheria was a common illness in young children. Today, the disease is not only treatable but is also preventable with a vaccine.

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). The three-in-one vaccine is known as the diphtheria, tetanus and pertussis vaccine. The latest version of this vaccine is known as the DTaP vaccine for children and the Tdap vaccine for adolescents and adults.

The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend during infancy. Vaccination consists of a series of five shots, typically administered in the arm or thigh, given to children at these ages:

The diphtheria vaccine is effective at preventing diphtheria. But there may be some side effects. Some children may experience a mild fever, fussiness, drowsiness or tenderness at the injection site after a DTaP shot. Ask your doctor what you can do for your child to minimize or relieve these effects.

Rarely, the DTaP vaccine causes serious complications in a child, such as an allergic reaction (hives or a rash develops within minutes of the injection), seizures or shock - complications that are treatable.

Some children - such as those with epilepsy or another nervous system condition - may not be candidates for the DTaP vaccine.

Booster shots

After the initial series of immunizations in childhood, you need booster shots of the diphtheria vaccine to help you maintain immunity. That's because immunity to diphtheria fades with time.

Children who received all of the recommended immunizations before age 7 should receive their first booster shot at around age 11 or 12. The next booster shot is recommended 10 years later, then repeated at 10-year intervals. Booster shots are particularly important if you travel to an area where diphtheria is common.

The diphtheria booster is combined with the tetanus booster - the tetanus-diphtheria (Td) vaccine. This combination vaccine is given by injection, usually into the arm or thigh.

Tdap is a combined tetanus, diphtheria and acellular pertussis (whooping cough) vaccine. It's a one-time alternative vaccine for adolescents age 11 through 18 and adults who haven't previously had a Tdap booster. It's also recommended for anyone who's pregnant, regardless of previous vaccination status.

Talk to your doctor about vaccines and booster shots if you're unsure of your vaccination status. Tdap may also be recommended as part of the Td series for children ages 7 through 10 who aren't up to date with the vaccine schedule.

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Diphtheria (dif-THEER-e-uh) is a serious bacterial infection usually affecting the mucous membranes of your nose and throat. Diphtheria typically causes a sore throat, fever, swollen glands and weakness. But the hallmark sign is a sheet of thick, gray material covering the back of your throat, which can block your airway, causing you to struggle for breath.

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This video is important to people because it gives general information about Diphtheria. The video dives deeper into how the disease is formed. It also shows you diagrams and snapshots of bacteria. This video gives a good understanding of how Diphtheria can be formed and how to spot it. It also gives a little bit of a look at the effects.

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This bacteriology lecture will explain the general properties of corynebacterium diptheriae and it also explains the pathogenesis and infectivity of corynebacterium diptheriae. It also explains the treatment against diptheria. For more information, log on to- http://shomusbiology.weebly.com/ Download the study materials here- http://shomusbiology.weebly.com/bio-materials.html

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Here is a picture of a person that is infected with Diphtheria. On the roof of the mouth you can see yellowish rashes and the swollen lymph nodes. The person usually has difficulty or pain in swallowing. They would also usually experience coughing and runny noses.

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Works Cited

ADN Iditarod. www.adn.com/section/outdoors-adventure/iditarod/. Accessed 12 May 2017.

Allen, Nikki. “It’s about the Dogs.” Itidarod Edu, 5 Sept. 2012, iditarod.com/edu/it-is-about-the-dogs-iditarod-sled-dogs-ready-to-run/. Accessed 12 May 2017.

Altman, Alex. “The Iditarod.” Time, 6 Mar. 2009, content.time.com/time/nation/article/0,8599,1883457,00.html. Accessed 12 May 2017.

Balto Statue. Blogspot, nyclovesnyc.blogspot.com/2013/03/bronze-sculpture-of-balto-in-central.html. Accessed 12 May 2017.

Bowers, Don. “Booms and Busts.” Iditarod, Feb. 2012, iditarod.com/about/booms-and-busts/. Accessed 12 May 2017.

Bowers, Donald, Jr. “White Mountain to Safety.” Iditarod, iditarod.com/about/the-iditarod-trail/white-mountain-to-safety/. Accessed 12 May 2017.

“Checkpoints.” Iditarod, iditarod.com/race/checkpoints/. Accessed 12 May 2017.

“Corynebacterium Diptheriae Introduction and Infection.” Youtube, uploaded by Shomu’s Biology, 15 Feb. 2014, www.youtube.com/watch?v=wyRqDOHDIyo. Accessed 12 May 2017.

Diphtheria Hand. OMICS International, www.omicsonline.org/norway/diphtheria-peer-reviewed-pdf-ppt-articles/. Accessed 12 May 2017.

Diphtheria Throat. Emaze, www.emaze.com/@AOCTOCIC/Diphtheria. Accessed 12 May 2017.

Dobson, Martha. “The History of the Iditarod Trail Sled Dog Race.” Iditarod Edu, 24 Jan. 2017, iditarod.com/edu/the-history-of-the-iditarod-trail-sled-dog-race/. Accessed 12 May 2017.

Dog with Raw Paw. Boxer Forums, www.boxerforums.com/general-boxer-forum/60997-shes-still-licking-chewing-her-paws.html. Accessed 12 May 2017.

“Four Legged Heroes: Togo & Balto - YouTube.” Youtube, uploaded by Cheryl Campbell, 24 Feb. 2013, www.youtube.com/watch?v=IQipgKqm7a4. Accessed 12 May 2017.

“Hold Tight! Take a Wild Sled Dog Ride with 4-time Iditarod Champ Jeff King.” Youtube, uploaded by Alaska Dispatch News, 7 Mar. 2014, www.youtube.com/watch?v=dAHa-6VkUQY. Accessed 12 May 2017.

Iditarod History. westfordk12.us/pages/Curric/links35/socialstudiesfolder/iditarod/iditarod_history.htm. Accessed 12 May 2017.

Iditarod Today. iditarod.com/about/iditarod-today/. Accessed 12 May 2017.

“Iditarod 2012- ‘Aliy Cam’ Mushing Thru Dalzell Gorge.” Youtube, uploaded by SPKDogLog, 12 Apr. 2012, www.youtube.com/watch?v=jjyItL68iqU&feature=youtu.be. Accessed 12 May 2017.

Klein, Christopher. “The Sled Dog Relay That Inspired the Iditarod.” History, 10 Mar. 2014, www.history.com/news/the-sled-dog-relay-that-inspired-the-iditarod. Accessed 12 May 2017.

MacGill, Markus. “What Is Diphtheria? What Causes Diphtheria?” Medical News Today, 18 Sept. 2015, www.medicalnewstoday.com/articles/159534.php. Accessed 12 May 2017.

Man Sled Racing. Rondy, www.furrondy.net/events/world-championship-sled-dog-races. Accessed 12 May 2017.

Map. Blogspot, lifewiththeluikens.blogspot.com/2012/03/iditarod-2012-last-great-race-on-earth.html. Accessed 12 May 2017.

March, Sebastian. “The Iditarod Trail.” Iditarod Trail, 8 Feb. 2013, iditarodoutsider.wordpress.com/2013/02/08/the-iditarod-trail/. Accessed 12 May 2017.

Mayo Clinic Staff. “Diphtheria.” Mayo Clinic, 8 Dec. 2016, www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/dxc-20300514. Accessed 12 May 2017.

Old Iditarod Map. Wordpress, aramink.wordpress.com/2007/07/28/the-nome-serum-run-true-heroes-in-a-legendary-race-against-time-and-tragedy. Accessed 12 May 2017.

Old Sled Dog Image. Animation Source, www.animationsource.org/balto/en/articles/Sled-Dog-Teams-and-the-U.S.-Mail/84936.html&id_film=12. Accessed 12 May 2017.

Pack. Sled Dog Action Coalition, helpsleddogs.org/iditarod-questions-answers/. Accessed 12 May 2017.

Racer Winning. Pinterest, www.pinterest.com/pin/108227197266977092/. Accessed 12 May 2017.

Safety Checkpoint. Iditarod, iditarod.com/race/2017/checkpoints/18-Safety/. Accessed 12 May 2017.

Sled Dog Action Coalition. 2017, helpsleddogs.org/iditarod-questions-answers/. Accessed 12 May 2017.

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This article is important to people because it explains what can cause Diphtheria. Almost anyone can get this disease so everyone should know how to protect yourself from it.

If you know how to stop this virus from spreading, then it won't be as common in people.

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Thanks to routine immunization, diphtheria is a disease of the past in most parts of the world. Since the 1980s only a handful of cases of the bacterial infection have been reported in the US, with just one case since 2004.

In countries where there is a lower uptake of booster vaccines, however, such as in India, there remain thousands of cases each year. In 2014, there were 6,094 cases of diphtheria reported in India, 1,079 in Nepal and 35 in Bangladesh. ¹¹

Use this page to learn more about this contagious disease, which usually infects the nose and throat or the skin - and find details about the childhood vaccinations that prevent it.

Fast facts on diphtheria

Here are some key points about diphtheria. More detail and supporting information is in the body of this article.

Diphtheria is now rare in the US because the disease, caused by bacteria, can be prevented by routine childhood vaccination.

Before the development of treatments and vaccines, diphtheria was widespread and mostly affected children under the age of 15.

Most cases are caused by Corynebacterium diphtheriae, and the infection is usually spread by contact with people breathing out droplets, but also by skin contact, and rarely via shared objects.

Certain strains of the bacterium produce a toxin that causes the serious complications of diphtheria.

Some of the symptoms of diphtheria are similar to those of the common cold, but the telltale sign, which the disease was named after, is the formation of a thick gray membrane over the back of the throat.

In the unusual cases where infection occurs in the skin, rather than the respiratory system, the disease is usually less serious and produces different symptoms.

In all infections that release the toxin, this can lead to complications of nerve damage, heart failure and, in around 5-10% of cases, death.

Diagnosis is suspected on the basis of symptoms and the patient's history, and confirmed with identification of the bacteria from swab specimens and laboratory testing of their toxicity.

Treatment, which is not always successful, is with antitoxin and antibiotics while the patient is isolated and monitored in intensive care. The best outcomes occur when diagnosis is swift and treatment prompt.

Immunization against diphtheria prevents the disease and is incorporated into vaccines for other infectious diseases, administered in children's early years.

What is diphtheria?

Diphtheria is now a rare bacterial infection in the US and most other countries thanks to the success of universal coverage with routine childhood vaccinations. Since the 1980s there have been no more than five cases of the infection in any one year in the US, and just one report of diphtheria in the last two decades.1,2

Diphtheria's historical timeline:3,4

5th century BCE: Hippocrates is first to describe the disease. It can cause the formation of a new layer to mucous membranes - a 'pseudomembrane' - which is where the modern name for the disease, diphtheria, arises; diphthera is the Greek term for leather hide

6th century: First observations of diphtheria epidemics

Late 19th century: Bacteria responsible for diphtheria are identified by the German scientists Edwin Klebs and Friedrich Löffler (Klebs observed it in the diphtheritic membranes created by the disease, while Löffler then cultivated the microbe)

1892: Antitoxin treatment, derived from horses, first used in the US

1920s: Development of the toxoid used in vaccines.

In countries that have a lower uptake of booster vaccines, there are still thousands of annual cases of the disease. ¹

India, for example, achieves around three-quarters coverage of the third and final childhood immunization dose, compared with full coverage in most countries. ² There have been between 3,000 and 8,000 reports of diphtheria in India every year since the decade starting in 2004. ¹

In people who are not vaccinated against the bacteria that cause diphtheria, infection can cause serious complications such as nerve problems, heart failure, and even death. ⁴

Overall, between 5-10% of people who get infected with diphtheria will die, and this level has remained consistent for the past half century. Some people are more vulnerable than others, with a mortality rate of up to 20% in infected people under 5 or older than 40 years of age. ⁴

The primary effect of the bacterium is to cause an infection of, in most cases, the nose and throat or the skin, although other parts of the body can also be affected. 4,5

The following section explores in more depth how the bacteria cause the initial infection and the potentially serious complications of diphtheria.

What causes diphtheria?

Diphtheria is an infectious disease caused by bacterial microorganisms known as Corynebacterium diphtheriae.⁴ Other Corynebacterium species can be responsible, but this is rare.⁵

Some strains of this bacterium produce a toxin. Infection with these toxigenic diphtheria bacteria is what leads to the most serious complications of diphtheria. The bacteria are toxigenic because they themselves are infected by a certain type of virus. 4,5

Diphtheria is prevented by early-years vaccination.
The toxin that is released: ⁴

Inhibits the production of proteins by cells

Destroys the tissue at the site of the infection

Leads to membrane formation - which leads to the telltale sign at the back of the throat

Gets taken up into the bloodstream and distributed around the body's tissues

Causes myocarditis (inflammation of the heart) and neuritis (nerve damage)

Can cause low platelet counts (thrombocytopenia) and produce protein in the urine (proteinuria).

Diphtheria is an infection spread only among humans - people are the only known reservoir for it. It is contagious via direct physical contact with: ⁴⁻⁶

Droplets breathed out into the air (as an aerosol, in the same way as the spread of flu)

Secretions from the nose and throat (again, similar to other upper respiratory infections)

Infected skin lesions

Intermediary objects such as bedding or clothes (rarely).

The spread from an infected patient to a susceptible new person can be to any mucous membrane, but the toxic infection typically attacks the nasopharynx (the lining of the nose and throat). 4,5

Signs and symptoms of diphtheria

Specific signs and symptoms of diphtheria depend on the particular strain of bacteria involved, and the site of the body affected.

One type of diphtheria, more common in the tropics, causes skin ulcers rather than respiratory infection. These atypical cases are usually less serious than the classic cases, first described by Hippocrates, that lead to severe illness and sometimes death.

The classic case of diphtheria is an upper respiratory infection caused by toxin-producing bacteria that leads to the creation of a gray pseudomembrane over the lining of the nose/throat, around the area of the tonsils. This pseudomembrane may also be greenish or blueish, and even black if there has been bleeding. 4,5,7,8

Early features of the infection, occurring prior to the appearance of the nasopharyngeal pseudomembrane, include: 4,5,7,8

Fever (though not usually a very high temperature), malaise and weakness

Enlarged lymph nodes at the front of the neck (popularly referred to 'swollen glands')

Swelling of soft tissue in the neck (giving a 'bull neck' appearance)

High heart rate (tachycardia, disproportionately high for the level of fever).

Children with a pharyngeal diphtheria infection are more likely to have the following early features: ⁵

After a person is first infected with the bacteria there is an average incubation period of 5 days before early signs and symptoms appear.

This 'prodromal period' lasts between 12 and 24 hours and, if the bacteria colonizing the nasopharynx are toxic, a pseudomembrane forms over the following 2-3 days, leading to: ⁴⁻⁸

Sore throat

Difficulty swallowing (dysphagia)

Possible obstruction that causes difficulty breathing (shortness of breath - dyspnea).

If the membrane extends to the larynx, the symptoms of hoarseness and a barking cough are more likely, as is the danger of complete obstruction of the airway. The membrane may also extend further down the respiratory system towards the lungs. ⁴

Complications of diphtheria

Further illness, and the most severe and potentially life-threatening stage of the disease, results from the absorption of the toxin into the bloodstream, which then goes on to damage other vital tissues, as follows.4,5

Myocarditis - heart damage

Myocarditis is a heart condition, involving inflammation of the heart muscle, in this case caused by the diphtheria toxin. This condition can lead to heart failure, and the greater the degree of bacterial infection, the higher the toxicity to the heart, producing effects that range from abnormalities that are only apparent on a heart monitor, to sudden death. ⁵

The heart problems usually appear 10-14 days after the start of the infection, although problems can take weeks to appear and vary in severity. Heart problems associated with diphtheria include: ⁵

Changes visible on an electrocardiograph (ECG) monitor

Atrioventricular dissociation (where the chambers of the heart lose their synchronicity, beating independently)

Complete heart block (where no electrical pulses travel between the atria and the ventricles)

Ventricular arrhythmias (where the beating of the lower chambers, the ventricles, is abnormal)

Heart failure (where the heart is unable to maintain sufficient blood pressure and circulation).

The abnormal heart rhythms and heart failure caused by diphtheria are accompanied by a high chance of death. ⁵

Neuritis - nerve damage

Neuritis is a less common effect of diphtheria and is inflammation of nerve tissue that results in damage to cranial and peripheral nerves. This complication of diphtheria occurs in about 5% of patients, usually after a severe respiratory infection with diphtheria. Typically, the condition develops as follows: ⁵

In the 3rd week of illness, there can be paralysis of the soft palate

After the 5th week, paralysis of eye muscles, limbs, and diaphragm can occur

Pneumonia and respiratory failure may occur secondarily to paralysis of the diaphragm.

Less severe disease from infection at other locations

If the bacterial infection is atypical and affects tissues other than the throat and respiratory system, the illness is generally milder. This is because the body absorbs lower amounts of the toxin, especially if the infection affects the skin only.⁵ Mild diphtheria can also be caused by strains of the bacteria that do not produce the toxin.⁴

If the skin is the site of the infection, any lesions that occur are usually at the extremities and these lesions normally vary in appearance. The infection can coexist with other infections and skin conditions, and may look no different from eczema, psoriasis, or impetigo. However, diphtheria in the skin can produce ulcers in which there is no skin at the centre and which have clear edges, and sometimes grayish membranes. 4,5

Other mucous membranes can become infected by diphtheria - including the conjunctiva at the eyes, women's vulvovaginal tissue, and the external ear canal. ⁴

Three general levels of bacterial toxicity and disease severity

The location of the infection is not the only factor in determining disease severity and effects. There are three key toxigenic bacterial strains responsible for diphtheria, each with a different degree of virulence and toxicity, resulting in one of three levels of disease severity.⁶

All three bacterial strains produce the same toxin, and disease severity relates to the rate and amount of toxin production. The three strains of Corynebacterium diphtheriae are: ⁶

Gravis. This strain grows quickly, creating the most severe disease by growing quickly - it has a 'generation time' in a laboratory dish of 60 minutes

Intermedius. This strain takes longer to colonize the throat, with an in vitro generation time of 100 minutes

Mitis. This one takes the longest, 180 minutes, and leads to the least severe disease.

Diagnosis and tests for diphtheria

There are definitive tests for diagnosing a case of diphtheria, so if symptoms and history cause a suspicion of the infection, it is relatively straightforward to confirm the diagnosis.

Classic cases of diphtheria cause sore throat and swollen lymph nodes in the neck, and the formation of a characteristic 'pseudomembrane' over the back of the throat.
Doctors should be suspicious when they see the characteristic membrane, or patients have unexplained pharyngitis, swollen lymph nodes in the neck, and low-grade fever. Hoarseness, paralysis of the palate, or stridor (high-pitched breathing sound) are also clues.

Tissue samples taken from a patient with suspected diphtheria can be used to isolate the bacteria, which are then cultured for identification and tested for toxicity:⁹

Clinical specimens are taken from the nose or nasopharynx, and throat

All suspected cases and their close contacts are tested

If possible, swabs are also taken from under the pseudomembrane, or removed from the membrane itself.

Once the diphtheria bacterium has been isolated, it is 'biotyped' to elucidate the particular strain, which will point to its toxicity, as outlined above.

Toxigenicity is further tested using the Elek test, which determines whether the organisms produce the diphtheria toxin; if positive, it triggers the diagnosis of diphtheria.

The tests may not be readily available, and so doctors may need to rely on a specialist laboratory.

Treatment of diphtheria

Treatment is most effective when instituted early, which makes a prompt diagnosis important.3,10 The antitoxin that is deployed does not work against the diphtheria toxin once it has bound with the tissues and caused the damage.³

Treatment aimed at countering the bacterial effects has two components: 4,5,10

Antitoxin - also known as anti-diphtheritic serum - to neutralize the toxin released by the bacteria

Antibiotics - erythromycin or penicillin to eradicate the bacteria and halt their spread.

Patients with respiratory diphtheria and symptoms would be treated in an intensive care unit in the hospital, and monitored for respiratory and cardiac complications. Health care staff would take isolation precautions to prevent the spread of the infection via respiratory droplets or physical contact. ⁵

Such treatment conditions are maintained until tests for bacteria repeatedly return negative results in the days following the completion of the course of antibiotics (or until the death of the patient). ⁵

Prevention of diphtheria through vaccination

Vaccines are routinely used to prevent diphtheria infection in almost all countries. The vaccines are derived from purified toxin that has been removed from a strain of the bacterium. The cell-free C. diphtheriae toxin is treated with formaldehyde before being absorbed onto an aluminium salt to help trigger an immune system response that leads to the creation of antibodies to the toxin. 4,7

Two strengths of diphtheria toxoid are used in routine diphtheria vaccines: 7

'D' - a higher-dosed primary vaccine (containing at least 30IU of toxoid) for children under 10 years of age. This is usually given in three doses - at two, three and four months of age

'd' - a lower-dosed version (with about 2IU of toxoid) for use as a primary vaccine in children over 10 years, and as a booster for reinforcing the usual immunization in babies, about three years after the primary vaccine, normally between 3.5 and 5 years of age.

In the 1940s in the US, diphtheria toxoid was routinely incorporated in the tetanus toxoid and pertussis vaccine. 4

Modern vaccination schedules continuing to this day include diphtheria toxoid in the childhood immunization known as DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine).4

This vaccine is the option of choice recommended by the US Centers for Disease Control and Prevention (and more information is provided by the CDC, including why some children should not get the DTaP vaccine or should wait). The doses are given as follows: 4

1. Age 2 months

2. Age 4 months and after an interval of 4 weeks

3. Age 6 months; interval 4 weeks

4. Age 15-18 months; interval 6 months

5. If the fourth dose is given before the fourth birthday, this fifth, booster, dose is recommended at 4 through 6 years of age (but is not needed if the fourth primary dose was given on or after the fourth birthday).

Booster doses of the adult form of the vaccine, tetanus-diphtheria toxoids vaccine (Td), may be needed every ten years to maintain immunity.

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What is diphtheria? What causes diphtheria?

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Thanks to routine immunization, diphtheria is a disease of the past in most parts of the world. Since the 1980s only a handful of cases of the bacterial infection have been reported in the US, with just one case since 2004.