Susceptibility to diphtheria in adults: prevalence and relationship to gender and social variables

Abstract

Recent outbreaks of diphtheria have drawn attention to the re-emergence of this disease. This study investigated susceptibility to diphtheria in north-east Germany and its relationship to gender and social factors. A study population of 4275 individuals recruited for the population-based Study of Health in Pomerania (SHIP) was available for analysis. IgG antibodies against diphtheria toxin were determined by ELISA and were used to define susceptibility to diphtheria (i.e., IgG titres < 0.1 IU/mL). The prevalence of susceptibility to diphtheria was 32.4%. Multivariate analysis revealed 45% increased odds of women being susceptible to diphtheria. Women who had not received diphtheria toxoid vaccination during the previous 10 years had four-fold increased odds of being susceptible to diphtheria toxin compared with unvaccinated men. None of the social factors investigated was associated with susceptibility status. It was concluded that a high proportion of middle-aged adults was susceptible to diphtheria. Women lacked seroprotection more often than men, which might be explained, in part, by gender-specific immune responses following vaccination. There is a need for information campaigns to improve public awareness of these problems.

Association of Socioeconomic Status with Iodine Supply and Thyroid Disorders in Northeast Germany

“…These activities may lead to a decreased iodine supply in better educated people. A similar phenomenon can also be observed for vaccination rates, which are lower among German individuals with a higher socioeconomic status than in those with a lower socioeconomic status (7).…”

Vaccination evokes gender-dependent protection against tularemia infection in C57BL/6Tac mice

“…Similarly, another study using PPV23 to prevent hospitalization due to S. pneumoniae demonstrated vaccine efficacy to be 68% in females and 34% in males [21]. However, in contrast to the above, vaccinated men are better protected against diphtheria and tetanus, which correlates with higher levels of toxin-specific Ab, which is required for protection in both cases [23,24]. The above differences in protection based on gender may reflect, in part, the type of immune response required for protection, suggesting that not just the individual's gender, but also the type of infectious agent involved are important factors in determining which gender is best protected against a given infection following vaccination.…”

“…In contrast to the above studies, men demonstrated superior Ab responses to diphtheria, measles, and smallpox vaccines when compared to women [19,22]. Men were also better protected against diphtheria and tetanus than their female counterparts [23,24]. …”

How sex and age affect immune responses, susceptibility to infections, and response to vaccination

“…This correlates with higher levels of seroprotection (Table2). In this context, military immunizations and higher rates of injury with consecutive immunization in men are considered decisive (Gergen et al ., 1995; Volzke et al ., 2006). Protective antitetanus titers were found in 60% of men aged 70+ with a history of military service compared to 20–30% of not serving men and < 20% in women (Gergen et al ., 1995).…”