Diphtheria in North America

Abstract

SummaryThe incidence of diphtheria has declined in North America during the last fifty years until it is now an uncommon disease. This general pattern is similar to that seen in other developed countries with well-organized immunization programmes, but certain noteworthy characteristics have been observed in recent years: foci of infection lingered in two population groups of low socio-economic status, in both of which the skin has been an important reservoir. In central areas of certain cities, endemic diphtheria, chiefly cutaneous, has occurred amongst indigent adult males living in unhygienic conditions; and in the native Indian population of Northern Canada diphtheria infection has been endemic in infants and children, many of the infections being of the skin or ear and toxic disease being uncommon. During the last few years, diphtheria outbreaks have not been reported in urban areas and possibly endemicity is now restricted to northern native populations. The number of infections detected in these northern endemic areas is steadily decreasing.

Detection Methods for Laboratory Diagnosis of Diphtheria

“…Antimicrobial resistance against either penicillin or erythromycin, the two antibiotics of choice in eliminating diphtheria-causing corynebacteria, has been described both in C. diphtheriae-albeit very rarely (Coyle et al 1979;Dixon 1984;Engler et al 2001b;Kneen et al 1998;Mina et al 2011;Pereira et al 2008;von Hunolstein et al 2002) and C. ulcerans (Schuhegger et al 2009;Tiwari et al 2008). Therefore, antibiotic sensitivity testing is highly recommended.…”

Human Clinical Isolates of Corynebacterium diphtheriae and Corynebacterium ulcerans Collected in Canada from 1999 to 2003 but Not Fitting Reporting Criteria for Cases of Diphtheria

“…Due to ongoing universal diphtheria vaccination programs in Canada, there have been no or a few cases of diphtheria meeting the criteria for notification per year since 1986 (4,14). Notifiable cases of diphtheria in Canada include those from which Corynebacterium diphtheriae is isolated from an appropriate clinical specimen and those with a histopathological diagnosis of diphtheria (1,12,15).…”

Persistence of a Distinct Corynebacterium diphtheriae Clonal Group within Two Communities in the United States and Canada Where Diphtheria Is Endemic

“…In the 1970s, nearly 1,300 cases of diphtheria in the United States (5) and 444 in Canada (3,6,9,19) were reported. Since the mid-1980s, the number of cases in both countries has declined to fewer than 50 (2,4,11,20).…”