Diphtheria Immunization

Miller, Louis W.; Older, Jules; Drake, James; Zimmerman, S. M.

doi:10.1001/archpedi.1972.02110090067004

Cited by 48 publications

(3 citation statements)

References 4 publications

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“…Erythromycin tablets were distributed to all contacts of diphtheria patients. However, only 2 asymptomatic carriers were identified among 49 contacts, lower than expected considering that 97% of case-patients could be asymptomatic in a vaccinated population (12). However, the sensitivity of laboratory testing might have been low because of the length of time required to collect and transport samples or because of prior antimicrobial drug use, so some carriers likely were not identified.…”

Section: Discussionmentioning

confidence: 85%

Diphtheria Outbreaks in Schools in Central Highland Districts, Vietnam, 2015–2018

Kitamura¹,

Le²,

Le³

et al. 2020

Emerg. Infect. Dis.

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D iphtheria is a serious childhood disease with a high mortality rate (1). After a diphtheria-tetanus-pertussis vaccine (DTP) was introduced in the early 20th century, the number of cases dramatically decreased. Incidence reached a low of 4,333 cases in 2006, but more recently, the number of reported cases has increased, with incidence reaching 16,648 cases in 2018 (2). In 1981, Vietnam introduced a vaccination program in which participants received 3 primary doses of DTP (DTP3) vaccine; in 2011, a booster shot (DTP4) to be given 18 months after the initial doses was added (3). Although diphtheria cases had become sporadic by 2010, beginning in 2013, outbreaks occurred in the western and central highland areas of Vietnam, which prompted our study (4). The Study During June 2015-April 2018, the Pasteur Institute in Nha Trang, Vietnam, and the provincial health authority investigated 46 cases involving patients with suspected diphtheria, 8 of whom died, and 49 asymptomatic contacts in the provinces of Quang Nam and Quang Ngai in the central highlands region of Vietnam (Figure 1). We used standard case investigation forms to collect demographic and clinical information. We collected throat swab specimens from 93 patients and contacts but were unable to collect samples from 2 patients who had died. No cutaneous diphtheria was reported. We used sheep blood agar and tellurite medium cultures to identify Corynebacterium diphtheriae and extracted DNA with a QIAGEN DNA Mini Kit (QIA-GEN, https://www.qiagen.com), following a standard protocol. We used 2 sets of primers, Tox1/Tox2 and Dipht6F/Dipht6R, for PCR testing (5). The Elek test for diphtheria is not available in Vietnam. Laboratory testing confirmed diphtheria in 22 of 46 suspected cases: 17 patients, including 4 who died, tested positive in both culture and PCR tests, whereas 5 patients, including 1 who died, tested positive only

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Section: Discussionmentioning

confidence: 85%

Diphtheria Outbreaks in Schools in Central Highland Districts, Vietnam, 2015–2018

Kitamura¹,

Le²,

Le³

et al. 2020

Emerg. Infect. Dis.

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“…Prior to the availability of toxoid-vaccines, nearly 70% of the cases were in children younger than 15 years of age (89). With the introduction of vaccines in the 1940s and 1950s, a significant decrease in incidence was observed (87, 88, 90–93), although no controlled clinical trial to evaluate the efficacy of the toxoid-vaccines in preventing diphtheria has ever been performed.…”

Section: The Return Of An Old Foementioning

confidence: 99%

“…It has been found that the diphtheria vaccination only prevents symptomatic infection, and does not inhibit carriage or transmission of the pathogen. Miller and colleagues have shown that a high percentage of C. diphtheriae carriers were fully vaccinated, suggesting that antibodies against the toxin does not inhibit nasopharyngeal colonization (93). Based on this data, we may conclude that adults and the elderly are at higher risk of C. diphtheriae infection.…”

Section: The Return Of An Old Foementioning

confidence: 99%

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Seth-Smith

Egli

2019

Front. Public Health

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Corynebacterium diphtheriae ( C. diphtheriae ) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis . Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.

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Epidemiology of Diphtheria in San Antonio, Tex, 1970

Marcuse

Grand

1973

JAMA

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Diphtheria Immunization

Cited by 48 publications

References 4 publications

Diphtheria Outbreaks in Schools in Central Highland Districts, Vietnam, 2015–2018

Diphtheria Outbreaks in Schools in Central Highland Districts, Vietnam, 2015–2018

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Epidemiology of Diphtheria in San Antonio, Tex, 1970

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