Global Epidemiology of Diphtheria, 2000–20171

Clarke, Kristie E N; MacNeil, Adam; Hadler, Stephen C.; Scott, Colleen; Tiwari, Tejpratap; Cherian, Thomas

doi:10.3201/eid2510.190271

Cited by 120 publications

(129 citation statements)

References 11 publications

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“…years of age. It has been predicted that age of diphtheria case-patients could increase after introduction of DTP because a high proportion of older persons will be susceptible to the disease due to reduced circulation of bacteria, especially when no booster dose is provided (8). The 4 MLST types identified in this study (ST67, ST209, ST243, and ST244) were also identified in Thailand, Cambodia, the Philippines, and Binh Phuoc Province in Vietnam in the 2010s (4,9,10).…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

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

Kitamura¹,

Le²,

Le³

et al. 2020

Emerg. Infect. Dis.

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“…Therefore, molecular tests detecting rpoB and tox gene should be considered for implementation in endemic/high-risk areas to decrease response time for DAT administration. [ 9 ] RpoB primer pairs: forward 5'-CGT TCG CAA AGA TTA CGG AAC CA-3’ and reverse 5'-CAC TCA GGC GTA CCA ATC AAC-3'; with 105bp product and tox gene - primer pairs: forward 5'-CTT TTC TTC GTA CCA CGG GAC TAA-3’ and reverse 5'-CTA TAA AAC CCT TTC CAA TCA TCG TC-3'; with 226bp product. [ 10 ] Briefly the PCR protocol includes, initial denaturation at 95°C for 10 min, followed by 45 cycles of 95°C for 15 s, and 60°C for 30 s for combined annealing and extension.…”

Section: Discussionmentioning

confidence: 99%

Diphtheria resurgence in India: A case study from south Karnataka

Gupta

Gujral

Singh

et al. 2020

J Family Med Prim Care

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Corynebacterium diphtheriae is a gram-positive bacillus with characteristic polar metachromatic granules. It was a significant public health problem, infecting the throat and upper airways and producing a highly potent exotoxin but with the advent of diphtheria vaccine, cases have rapidly decreased. Now over the last decade, the reemergence of this infection has been noted and case reports from India have been documented. India represents 78% of globally reported cases with significant mortality despite national immunization programs in place. This case study indicates the severity of an improperly managed case, the importance of microbiological diagnosis with a special interest in molecular detection, and reinforces a resurgence of diphtheria infection.

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“…Globally, there are regions of endemicity for both diphtheria and pertussis, and factors such as age and vaccination status influence prevalence. Currently, in industrialized countries with high vaccination coverage, the incidence of these infections is relatively low, though it appears to be increasing [ 37 , 38 ]. In the case of diphtheria, DT is responsible for the clinical manifestations of disease, though several additional toxins, including adenylate cyclase and tracheal cytotoxin, are also involved in diphtheria disease.…”

Section: Toxin Detection In Infrequently Isolated Bacteriamentioning

confidence: 99%

Clinically Important Toxins in Bacterial Infection: Utility of Laboratory Detection

Forbes

2020

Clinical Microbiology Newsletter

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The elaboration of proteins that damage host cells is fundamental to the pathogenesis of many bacterial pathogens. The clinical significance of many bacterial toxins is well recognized, and routine detection is necessary to confirm definitive diagnosis for some types of infectious diseases. Determining the clinical significance of a toxin involves many factors, including the toxin's prevalence, virulence, and role in disease pathogenesis. While essential from a diagnostic perspective, toxin detection has the potential to be important for patient management decision making, as well as infection prevention and control measures. This review focuses on the history, epidemiology, pathogenesis, clinical presentation, and management of infections associated with well-defined, clinically important toxins (such as Shiga toxin-producing Escherichia coli ), as well as those that are less well defined (such as Staphylococcus aureus' Panton-Valentine leukocidin) where detection may yield clinically important information.

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Global Epidemiology of Diphtheria, 2000–20171

Cited by 120 publications

References 11 publications

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

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

Diphtheria resurgence in India: A case study from south Karnataka

Clinically Important Toxins in Bacterial Infection: Utility of Laboratory Detection

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