-
Current Opinion in Neurology Jun 2021The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the... (Review)
Review
PURPOSE OF REVIEW
The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management.
RECENT FINDINGS
Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers.
SUMMARY
Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient's history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.
Topics: Botulism; Communicable Diseases; Diphtheria; Humans; Tetanus; Vaccination
PubMed: 33840775
DOI: 10.1097/WCO.0000000000000933 -
Indian Pediatrics May 2017
Topics: Diphtheria; Diphtheria Toxin; Diphtheria Toxoid; Global Health; History, 20th Century; History, 21st Century; Humans; India
PubMed: 28601852
DOI: 10.1007/s13312-017-1115-1 -
Clinical Infectious Diseases : An... Feb 2021
Topics: Adult; Diphtheria; Humans; Incidence; Tetanus; Vaccination
PubMed: 33173936
DOI: 10.1093/cid/ciaa633 -
Journal of Medical Microbiology Oct 2019In Western Europe, the incidence of both respiratory and cutaneous diphtheria, caused by toxin-producing , or , has been low over the past few decades thanks to the use...
In Western Europe, the incidence of both respiratory and cutaneous diphtheria, caused by toxin-producing , or , has been low over the past few decades thanks to the use of an effective vaccine and a high level of vaccination coverage. However, the disease has still not been eradicated and continues to occur in all of Europe. In order to prevent sequelae or a fatal outcome, diphtheria antitoxin (DAT) should be administered to suspected diphtheria patients as soon as possible, but economic factors and issues concerning regulations have led to poor availability of DAT in many countries. The European Centre for Disease Prevention and Control and World Health Organization have called for European Union-wide solutions to this DAT-shortage. In order to illustrate the importance of these efforts and underline the need for continued diphtheria surveillance, we present data on all registered cases of toxigenic and non-toxigenic , and in Belgium during the past decade, up to and including 2017.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Belgium; Child, Preschool; Corynebacterium; Diphtheria; Diphtheria Toxin; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged
PubMed: 31418673
DOI: 10.1099/jmm.0.001039 -
The American Surgeon Dec 2023The foundation story of immunology is the Christmas miracle of Emil von Behring, whose diphtheria antitoxin was first used to save the life of a child on Christmas Day...
The foundation story of immunology is the Christmas miracle of Emil von Behring, whose diphtheria antitoxin was first used to save the life of a child on Christmas Day 1891. Modern scholarship has dismissed it as historically and scientifically implausible: Behring's lab did not have enough antitoxin serum for use in humans, and Ernst von Bergmann had prohibited its use at the Charité.But antitoxin was tried that December by their assistants, Erich Wernicke, who processed injected rams and horses and harvested the serum for Behring, and Heinrich Geissler, who was one of Bergmann's house physicians. Especially during the Christmas season, it is easy to imagine Wernicke and Geissler bypassing protocol and giving the serum a try as a last-ditch effort to save a dying child. Derek Linton, a Behring biographer, wrote:A harried nurse confronted by a dying infant belatedly remembers that a doctor with a promising remedy for diphtheria urged her to bring hopeless cases to his attention and has him roused from his slumber on the other side of Berlin in the middle of the night on December 20, 1891. The injection of his wonder serum then rapidly resuscitates the comatose infant. Five days later, the parents celebrate the most joyous Christmas of their lives with their fully recovered daughter.
Topics: Humans; Child; Male; Animals; Sheep; Horses; Diphtheria Antitoxin; Diphtheria; Mental Recall
PubMed: 36148687
DOI: 10.1177/00031348221129515 -
International Journal of Pediatric... Jul 2016Diphtheria is a respiratory infectious disease of childhood. It is a fatal disease and may cause complications if not recognized early and treated properly. Despite...
BACKGROUND
Diphtheria is a respiratory infectious disease of childhood. It is a fatal disease and may cause complications if not recognized early and treated properly. Despite availability of effective vaccination it continues to be reported from many parts of the world particularly developing countries.
OBJECTIVE
To assess the demographic and clinical characteristics of diphtheria patients, and the predictors of outcomes of respiratory diphtheria.
METHODS
A prospective analysis of 180 patients with a clinical diagnosis of respiratory diphtheria admitted from 2011 to 2014 at a tertiary referral hospital. They were evaluated with respect to demographic details, immunization status, clinical features, complications and outcomes.
RESULTS
Most common age group affected was children less than 5 years of age (87 cases, 48.33%). The peak incidence of diphtheria was seen in the months of September and October (111 cases, 62%). Majority of the patients were unimmunized (54%), followed by partially immunized (21%). The most common complication was respiratory in 80 cases (44%), followed by cardiac complications in 54 cases (30%), and renal (16%) and neurological complications (10%). Cardiac complications were associated with the highest mortality rate (63%). The presence of bull neck and pseudomembrane score >2 was associated with a high mortality.
CONCLUSION
Diphtheria is still a preventable public health problem in many developing countries. Improved vaccination coverage, including booster dosage, coupled with early detection and effective treatment, may all reduce incidence and mortality.
Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Diphtheria; Diphtheria Toxoid; Female; Humans; Incidence; Infant; Male; Prevalence; Prospective Studies; Survival Rate; Tertiary Care Centers; Treatment Outcome; Young Adult
PubMed: 27260583
DOI: 10.1016/j.ijporl.2016.04.024 -
Clinical Infectious Diseases : An... Dec 2020
Topics: Adult; Diphtheria; Humans; Incidence; Rubella; Tetanus; Vaccination
PubMed: 32239130
DOI: 10.1093/cid/ciaa360 -
Clinical and Experimental Immunology Jan 2017Besides immunizations against influenza, Streptococcus pneumoniae and herpes zoster, which are recommended specifically for elderly people, regular booster vaccinations... (Review)
Review
Besides immunizations against influenza, Streptococcus pneumoniae and herpes zoster, which are recommended specifically for elderly people, regular booster vaccinations against tetanus, diphtheria and in some cases pertussis and polio are recommended in many European countries for adults, including elderly people. Vaccination recommendations for adults differ greatly between individual countries and coverage data is scarce. Tetanus-specific antibody concentrations are generally higher than diphtheria-specific antibodies, and a substantial proportion of adults, and particularly of elderly people, do not have protective antibody concentrations against diphtheria. Antibody levels increase upon booster vaccination in all age groups, but diphtheria-specific antibody concentrations remain below protective levels in some older individuals, even immediately after vaccination and long-term protection is frequently not achieved. Future vaccination strategies should therefore include regular and well-documented booster shots, e.g. against tetanus and diphtheria, throughout life.
Topics: Adult; Aged; Animals; Diphtheria; Europe; Humans; Immunity, Humoral; Immunization, Secondary; Immunosenescence; Tetanus; Tetanus Toxoid; Vaccination
PubMed: 27279025
DOI: 10.1111/cei.12822 -
Euro Surveillance : Bulletin Europeen... Feb 2022BackgroundDiphtheria is uncommon in the World Health Organization (WHO) European Region. Nevertheless, sporadic cases, sometimes fatal, continue to be reported.AimTo...
BackgroundDiphtheria is uncommon in the World Health Organization (WHO) European Region. Nevertheless, sporadic cases, sometimes fatal, continue to be reported.AimTo report on diphtheria cases and coverage with first and third doses of diphtheria, tetanus and pertussis vaccines (DTP1 and DTP3, respectively) for 2010-19 in the Region with a focus on 2019.MethodsData on diphtheria cases were obtained from WHO/United Nations International Children's Emergency Fund (UNICEF) Joint Reporting Forms submitted annually by the Region's Member States. WHO/UNICEF Estimates of National Immunization Coverage for DTP1 and DTP3 were summarised for 2010-19. For 2019, we analysed data on age, and vaccination status and present data by country on DTP1 and DTP3 coverage and the percentage of districts with ≥ 90% and < 80% DTP3 coverage.ResultsFor 2010-19, 451 diphtheria cases were reported in the Region. DTP1 and DTP3 coverage was 92-96% and 95-97%, respectively. For 2019, 52 cases were reported by 11 of 48 countries that submitted reports (including zero reporting). Thirty-nine countries submitted data on percentage of their districts with ≥ 90% and < 80% DTP3 coverage; 26 had ≥ 90% districts with ≥ 90% coverage while 11 had 1-40% districts with < 80% coverage.ConclusionLong-standing high DTP3 coverage at Regional level probably explains the relatively few diphtheria cases reported in the Region. Suboptimal surveillance systems and inadequate laboratory diagnostic capacity may also be contributing factors. Still, the observed cases are of concern. Attaining high DTP3 coverage in all districts and implementing recommended booster doses are necessary to control diphtheria and prevent outbreaks.
Topics: Child; Diphtheria; Diphtheria-Tetanus-Pertussis Vaccine; Global Health; Humans; Immunization Programs; Infant; Vaccination; Vaccination Coverage; World Health Organization
PubMed: 35209973
DOI: 10.2807/1560-7917.ES.2022.27.8.2100058 -
Vaccine Mar 2022The drastic decline of Ukraine's immunization coverage since 2009 led to concerns about potential resurgence diphtheria and tetanus, along with other vaccine-preventable...
BACKGROUND
The drastic decline of Ukraine's immunization coverage since 2009 led to concerns about potential resurgence diphtheria and tetanus, along with other vaccine-preventable diseases.
METHODS
To assess population immunity against diphtheria and tetanus, we tested specimens from the serosurvey conducted in 2017 among children born in 2006-2015, the birth cohorts targeted by the nationwide outbreak response immunization following a circulating vaccine-derived poliovirus type 1 outbreak in Zakarpattya province in 2015. We surveyed four regions of Ukraine, using cluster sampling in Zakarpattya, Sumy, and Odessa provinces and simple random sampling in Kyiv City. We tested serum specimens for IgG antibodies against diphtheria and tetanus, using microbead assays (MBA). We estimated seroprevalence and calculated 95% confidence intervals. We also obtained information on the immunization status of surveyed children.
RESULTS
Seroprevalence of ≥0.1 IU/mL diphtheria antibodies was <80% in all survey sites (50.0%-79.2%). Seroprevalence of ≥0.1 IU/mL tetanus antibodies was ≥80% in Sumy, Kyiv City, and Odessa (80.2%-89.1%) and 61.6% in Zakarpattya. Across the sites, the proportion of children vaccinated age-appropriately with diphtheria-tetanus-containing vaccines (DTCV) was 28.5%-57.4% among children born in 2006-2010 and 34.1%-54.3% among children born in 2011-2015. The proportion of recipients of <3 DTCV doses increased from 7.1%-16.7% among children born in 2006-2010 to 19.8%-38.6% among children born in 2011-2015, as did the proportion of recipients of zero DTCV doses (2.6%-8.8% versus 8.0%-14.0%, respectively).
CONCLUSIONS
Protection against diphtheria among children born in 2006-2015 was suboptimal (<80%), particularly in Zakarpattya. Protection against tetanus was adequate (≥80%) except in Zakarpattya. Diphtheria-tetanus immunization status was suboptimal across all sites. Catch-up vaccination of unvaccinated/under-vaccinated children and other efforts to increase immunization coverage would close these immunity gaps and prevent the resurgence of diphtheria and tetanus in Ukraine, particularly in Zakarpattya.
Topics: Adolescent; Antibodies, Bacterial; Child; Diphtheria; Diphtheria-Tetanus Vaccine; Humans; Seroepidemiologic Studies; Tetanus; Ukraine
PubMed: 35153095
DOI: 10.1016/j.vaccine.2022.02.006