Immunity against diphtheria in adults in Poland

Gałazka, A; B, Kardymowicz

doi:10.1017/s0950268800030983

Cited by 24 publications

(10 citation statements)

References 11 publications

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“…There is need to improve the immunity status of persons above 40 years of age. Since diphtheria immunity is declining in adults aged 20 -60 years, it has been proposed that the adult-type diphtheriatetanus vaccine (Td) be used in adults, especially in professional and age groups vulnerable to reintroduction of virulent C. diphtheriae (20). A tetanus-toxoid vaccine should be actively offered to adult patients of both sexes seen in any health facility.…”

Section: Resultsmentioning

confidence: 99%

Tetanus incidence and immunity in Poland

Gałazka

1989

Eur J Epidemiol

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The level of tetanus antibody was determined with the passive hemagglutination method in 503 sera of 10 to 90-year-old persons. Immunity to tetanus was age-dependent: the percentage of immune persons amounted to 90%-100% in persons below 40 years and then declined to 70% and 60% in persons in the 40-50 and above 50 year-old groups, respectively. Males above 30 years are better immunized than females. The comparison of the results of the present study with results of several periodic surveys performed in the last 27 years showed gradually increasing immunity level in all age groups. The findings are in agreement with age-dependent incidence of tetanus, which has become now, in Poland, a disease primarily of older people.

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Section: Resultsmentioning

confidence: 99%

Tetanus incidence and immunity in Poland

Gałazka

1989

Eur J Epidemiol

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“…Over 94-100% children develop protective levels of antibodies following primary immunization but in the absence of boosters the titres drop and over 20–65% of adults may become susceptible [5,30,37,38]. Waning of antibodies with age has been documented through serological surveys in both developing and developed countries including India [6,39].…”

Section: Discussionmentioning

confidence: 99%

“…Cyclic epidemics of diphtheria have been documented since the 16th century in both developed and developing countries. The most striking resurgence was witnessed in the nineties in Eastern Europe [5]. The main reasons for the re-emergence of diphtheria in the post vaccine era are waning of immunity with age and improved immunization rates in children which reduces circulating wild organisms and hence the opportunities for natural boosting through subclinical infections [6].…”

Section: Introductionmentioning

confidence: 99%

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

et al. 2013

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BackgroundEpidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years.MethodsThis study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non- clinical variable using Microsoft™ Excel® 2010.ResultsOur findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district.ConclusionsThe outbreak raises several concerns regarding the epidemiology of diphtheria in Dhule. The reason for shift in the median age despite consistently poor immunization coverage (below 50%) remains unclear. Concomitant efforts should now focus on improving and monitoring primary immunization and booster coverages across all age groups. Gradually introducing adult immunization at ten year intervals may become necessary to prevent future vulnerabilities. Laboratory networks for genotyping and toxigenicity testing are urgently mandated at district level given the endemicity of the disease in the surrounding region and its recent introduction in remote Dhule. Contingency funds with pre- agreements to obtain ADS and DT/Td vaccines at short notice and developing standard case management protocols at district level are necessary. Monitoring the disease, emerging strains and mutations, alongside drug resistance through robust and effective surveillance is a pragmatic way forward.

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“…The infection also spread to Latvia, Lithuania, Belarus, Norway and Poland, where subjects in the 30-50 year age-group were mainly infected. In addition, other European countries such as Denmark, Sweden, Germany, Portugal, Turkey and England also reported sporadic cases of the disease [8,9]. With regard to Italy, where diphtheria vaccination with aluminium-containing toxoids has been mandatory since 1939, in the 1950s and 1960s, the number of reported cases came to several thousand/year, while between 1973 and 1982 the cumulative number of cases dropped to 1,427.…”

Section: Introductionmentioning

confidence: 99%

Low prevalence of diphtheria immunity in the population of Florence, Italy

et al. 1996

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A seroepidemiological study was conducted in 1994 on a representative sample of the population of Florence in order to verify the immunity coverage against diphtheria. Subjects were divided according to sex and age class. Sera from each selected class were at least 1.5/1000 of the residing population. Diphtheria antitoxin was titrated using a quantitative ELISA test. The results show an overall adjusted prevalence of diphtheria immunity (> or = 0.01 IU/ml) equal to 63.7%. Subjects of younger age classes have good protection levels (85.5% immune under 30 years), while only half individuals aged > or = 50 years have antibody titres > or = 0.01 IU/ml. Full protection (antibody titre > or = 0.1 IU/ml) was detected only in a very small proportion of those aged > or = 40 years. Our data show (1) how a recrudescence of diphtheria could theoretically take place in older subjects living in Italy, and (2) stress the importance of periodical re-vaccination of adults.

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Immunity against diphtheria in adults in Poland

Cited by 24 publications

References 11 publications

Tetanus incidence and immunity in Poland

Tetanus incidence and immunity in Poland

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

Low prevalence of diphtheria immunity in the population of Florence, Italy

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