Diphtheria outbreak in Norway: Lessons learned

Rasmussen, Ingvill; Wallace, Sean; Mengshoel, Anne Torunn; Høiby, E. Arne; Brandtzæg, Petter

doi:10.3109/00365548.2011.600326

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…There was no dissemination outside of a close family contact whose household the index case stayed at overnight; this echoes the experience of investigators of a household outbreak of toxigenic diphtheria in Norway in 2008 where there were three cases in unimmunised individuals within the same family [ 20 ]. These cases developed a confluent, thick yellow membrane across their tonsils and peritonsillar tissue.…”

Section: Discussionsupporting

confidence: 66%

Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017

et al. 2018

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In early 2017, a United Kingdom (UK)-born person in their 20s presented with a skin ulcer on the foot 3 weeks after returning from Ghana. The patient had last received a diphtheria-containing vaccine in 2013, completing the recommended course. MALDI-TOF of a cutaneous swab identified Corynebacterium diphtheriae. Real-time PCR ascertained the species and presence of the diphtheria toxin gene. An Elek test confirmed toxigenicity. The isolate was macrolide sensitive and penicillin resistant. The local Public Health England (PHE) Health Protection Team obtained the patient’s clinical history and traced contacts to inform appropriate public health action. One close contact (in their early 80s with uncertain immunisation status who had not recently travelled) had a positive throat swab for toxigenic C. diphtheriae and reported a history of mild coryzal symptoms. Multilocus sequence typing revealed that strains from the index case and contact had Sequence Type 463. Diphtheria is extremely rare in the UK due to high vaccine coverage and this is the first documented transmission in 30 years. Clinicians and laboratory staff should remain highly suspicious of lesions in overseas travellers, even when patients are fully vaccinated. Older individuals who might not have completed a full immunisation course may have higher diphtheria susceptibility.

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Section: Discussionsupporting

confidence: 66%

Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017

et al. 2018

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“…As with cases in other industrialized countries, investigations could not identify a source of infection ( 4 , 7 ). Asymptomatic carriers remained a possibility because studies have reported bacterial carriage in vaccinated persons and nontoxigenic strains that underwent phage conversion ( 5 , 6 , 12 – 15 ). Because the patient had an unknown vaccination history, missing childhood vaccinations might have put him at risk for infection.…”

Section: Discussionmentioning

confidence: 99%

Fatal Case of Diphtheria and Risk for Reemergence, Singapore

Lai¹,

Parthasarathy²,

Ho³

et al. 2018

Emerg. Infect. Dis.

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“…In this outbreak, a high proportion of adults were affected, potentially due to disruption of health services resulting in poor vaccine coverage (114, 115) and reduced “natural” exposure over the preceding decades, resulting in antibody titers below protective levels (116–118). In recent years, multiple outbreaks, or potential transmission clusters have been reported in: Bangladesh (119, 120), Brazil (121), Colombia (122), Germany (30, 35), India (123–125), Indonesia (126), Laos (127), Norway (128), Nigeria (129), Poland (130), Spain (38), South Africa (36, 131), Syria (132), Switzerland (31), Thailand (114), the United Kingdom (37), Venezuela (133, 134), and Yemen (135). The global list of affected countries indicates that (i) the disease is remains poorly controlled, (ii) the main burden lies in low-income countries, and (iii) local and global surveillance should be intensified in order to better control the disease.…”

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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Diphtheria outbreak in Norway: Lessons learned

Cited by 8 publications

References 13 publications

Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017

Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017

Fatal Case of Diphtheria and Risk for Reemergence, Singapore

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

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