TWO cases of diphtheria have been confirmed in the Lothian area, the Herald can reveal.

Both individuals, who are believed to be receiving treatment for the disease in an Edinburgh hospital, had recently returned to Scotland after travelling abroad.

Diphtheria is an extremely contagious and potentially deadly bacterial infection.

It can be spread by coughs and sneezes, or by sharing items, such as cups, cutlery, clothing or bedding with an infected person.

It was once a major cause of death in the UK, but is now extremely rare due to high uptake rates for the childhood vaccine.

READ MORE: Chief of Royal College of Surgeons Edinburgh ousted in shock no confidence vote 

One of the last major outbreaks in Scotland was in 1968, when six members of the same household in Motherwell, Lanarkshire, fell ill. Two died.

A spokeswoman for Health Protection Scotland confirmed they were aware of two cases of diphtheria, but said NHS Lothian were "dealing with this at a local board level".

NHS Lothian stressed that the likelihood of any additional cases was "very small" due to high immunisation rates. 

Since 2015, there have only been five other cases reported in Scotland.

Alison McCallum, director of public health at NHS Lothian said: “Two related cases of diphtheria have been confirmed in the Lothian area, with both patients having recently returned from abroad.

"All close contacts of these patients have been identified, contacted and followed up in line with nationally agreed guidelines.

"The likelihood of any additional cases is very small, as most people are protected by immunisation given in childhood.

"In Lothian 98% of children are vaccinated against diphtheria by the age of 24 months.

"We encourage people travelling abroad to visit [NHS website] Fit for Travel where they can access information on how to stay safe and healthy abroad, as well as destination specific health advice.”

READ MORE: NHS is too important not be a political football 

Symptoms of diphtheria typically develop within two to five days of infection.

Some strains of diphtheria cause only mild disease, such as a sore throat.

However, the most dangerous forms can kill up to 10 per cent of people who fall ill, even with full medical treatment.

These are caused by types of bacteria which infect the respiratory tract and release toxins, killing off cells in the mouth, nose and throat.

Initial symptoms include fever, lethargy, difficulty swallowing and breathing, headaches, nausea and a thick grey-white coating at the back of the throat.

The disease was once dubbed the "strangling angel of children" because, as it advances, the glands in a victim's neck become enlarged and their airways obstructed with a film of dead cells that form a 'pseudomembrane'.

Eventually this led to suffocation and death.

READ MORE: Global warming 'will trigger surge in hospitalisations for poor nutrition' 

Before mass immunisation was introduced in 1942, there were more than 60,000 cases of diphtheria a year in Britain and over 4000 deaths annually.

Diphtheria can also attack the heart, causing fatal heart failure, or the nerves, leading to neurological damage.

In the UK, infants and children are routinely offered the six-in-one vaccine to protect against diphtheria as well as hepatitis B, whooping cough, polio, tetanus and haemophilus influenzae type b (Hib).

Uptake by age five averages 98.2% in Scotland, according to the latest figures.

However, the disease remains common in some parts of the world including Asia, the South Pacific, the Middle East, eastern Europe and the Caribbean.

Anyone travelling to areas with high rates of diphtheria is advised to have a booster jag if they have not been vaccinated in more than 10 years.