OBJECTIVE: Diphtheria is a vaccine-preventable disease that can be fatal without proper management. We reported 5 diphteria cases in a family and the comprehensive management approach.
CASE: Five of seven siblings in a family living in Semarang aged 7-16 year-old were diagnosed as diphtheria over three succesive days (July 16th -18th, 2018) in Dr.Kariadi Hospital. A week before, a friend of them died from diphtheria. One sibling (16 year-old), developed neurological complication, one (12 year-old), developed cardiac and kidney complications, three siblings (7,10, and 11 year-old), developed mild diphtheria with no complication. They were cared in isolation room and treated with penicillin procain and antidiphtheria serum. The sibling with cardiac involvement also received corticosteroid and pace-maker insertion because of myocarditis and total AV block, however he finally was not survive due to cardiogenic shock. The other four siblings were survive and discharged home, All siblings had never received any immunization because of their parents rejection. When the health providers carried out contact-tracing, they found that two other siblings in this family had no diphtheria; then prophylaxis antibiotic was commenced. No more diphtheria case was found afterward in this family and surroundings. It can be summarized that the low of vaccination compliance in this family caused the diphteria out break. These situations finally changed the parents attitude  to  immunization. All six siblings later receiveddiphtheria vaccination. Now, six siblings are in a good condition.      
CONCLUSION: The best prevention for diphteria is vaccination, followed by contact-tracing and antibiotic prophylaxis for close contacts.