Risk Factors for Diphtheria: A Prospective Case‐Control Study in the Republic of Georgia, 1995–1996

Abstract

The large-scale resurgence of diphtheria in the former Soviet Union offered a unique opportunity to evaluate risk factors for the transmission of respiratory diphtheria; therefore, a prospective case-control study was done in the republic of Georgia. In total, 218 diphtheria cases (hospitalized between October 1995 and March 1996) and 408 matched controls participated. One hundred cases (45%) were </=14 years of age, and 118 (55%) were >/=15 years of age (range: <1 to 75 years). In the multivariate analyses, the following risk factors were found to be significant: lack of vaccination (matched odds ratio [mOR]=19.2), household exposure to diphtheria (mOR=7.4), exposure to skin lesions (mOR=5.8), history of eczema (mOR=3.4), fever with myalgia prior to illness (mOR=2.6), having tonsils (mOR=4.4), sharing a bed (mOR=1.9), sharing cups and glasses (mOR=2.7), and taking a bath less than once a week (mOR=2.6). These findings emphasize primary prevention through immunizations, secondary prevention following exposure to diphtheria (and to suspicious skin lesions), and adherence to strict standards of personal hygiene.

Epidemiology of Three Cases of Severe Diphtheria in Finnish Patients with Low Antitoxin Antibody Levels

“…There are also reports of diphtheria being transmitted by milk [44]. In light of our report and the results of the Georgian case-control study [40], food and poorly washed dishes seem inefficient in transmitting diphtheria. As there have been very few cases among Finnish travellers, aerosol or droplet spread also seems improbable.…”

“…In a prospective survey conducted in a boarding school where throat cultures were taken every 2-4 days, of those sharing a room in a dormitory with an infected student, 9.6% tested positive for Corynebacterium diphtheriae as compared to 5% of those attending the same class and 1.3% of those sharing only the same table at meals [39]. In a prospective case-control study in the Republic of Georgia, risk factors for acquiring diphtheria were found to be household exposure to diphtheria, sharing a bed, sharing cups and glasses, and taking a bath less than once a week [40]. Kissing was not found to be a risk factor, but this kind of information may not have been shared completely with the investigators.…”

“…As there have been very few cases among Finnish travellers, aerosol or droplet spread also seems improbable. If direct contact with saliva is the main mode of transmission of diphtheria, hand washing may be important in the protection of both healthcare workers and travellers to endemic areas [40].…”

Diphtheria in a Vaccinated Adult in Rio De Janeiro, Brazil

“…The spread of epidemic seemed facilitated by large scale population movements; socioeconomic instability, partial deterioration of health infrastructure; delay in implementing measures to control epidemic; inadequate information for physicians and the public; lack of adequate supplies for prevention and treatment in most of the countries (2,8).The reasons for reemergence of epidemic diphtheria in countries where immunization programs had nearly eliminated diphtheria are not fully understood but are thought to include the introduction of toxigenic C. diphtheriae strains of a new biotype into the general population, besides low coverage with diphtheria vaccine among children and large gap of immunity among adults (4,22).…”

“…Despite the success of mass immunization in many countries diphtheria remains a serious health problem within many regions of the world (2,10,11,14,15,22,23). Diphtheria should be suspected in any patient who lives in an endemic area and that clinically significant outbreak of diphtheria could occur in the future.…”