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European Journal of Epidemiology Feb 1995In the past, diphtheria was considered one of the most serious childhood diseases because it took a heavy toll in health and life among preschool-aged children. Prior to... (Review)
Review
In the past, diphtheria was considered one of the most serious childhood diseases because it took a heavy toll in health and life among preschool-aged children. Prior to the widespread availability of diphtheria toxoid, nearly 70% of cases were in children younger than 15 years of age. In the industrialized countries, immunization against diphtheria became widespread in the 1940s and 1950s. This led to a marked decrease in the incidence of diphtheria. There was also a decrease in circulating toxigenic Corynebacterium diphtheriae organisms, resulting in less natural boosting of antibody levels. This had led to gaps in the immunity of the adult population. Since 1990, diphtheria has made a spectacular comeback in several European countries, with a high proportion of cases in adults. In developing countries, immunization of infants with diphtheria toxoid was introduced with the Expanded Programme on Immunization in the late 1970s. Coverage rose slowly to 46% in 1985 and 79% in 1992. Because the pool of immunized persons is not yet large, the process of maintaining immunity still operates through natural mechanisms, including frequent skin infections caused by C. diphtheriae. But recently, several developing countries where coverage has been high for 5-10 years have reported diphtheria outbreaks. These outbreaks have been characterized by high case fatality rates, a large proportion of patients with complications, and their occurrence in both young and older age groups. In all countries, priority should be given to efforts to reach at least 90% coverage with three doses of diphtheria toxoid in children below one year of age. In countries where diphtheria has been successfully controlled, immunity levels should be maintained by booster doses.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Developing Countries; Diphtheria; Diphtheria Toxoid; Disease Outbreaks; Global Health; Humans; Immunity; Incidence; Infant; Infant, Newborn; Middle Aged; Vaccination
PubMed: 7489768
DOI: 10.1007/BF01719955 -
Infectious Disorders Drug Targets 2024Diphtheria, a vaccine-preventable disease, has resurfaced in Nigeria, where many outbreaks have been reported in recent years. The outbreaks have occurred across the... (Review)
Review
Diphtheria, a vaccine-preventable disease, has resurfaced in Nigeria, where many outbreaks have been reported in recent years. The outbreaks have occurred across the country, including in areas with high vaccination coverage. Corynebacterium diphtheriae, the causal agent, is a highly contagious bacteria that can cause severe respiratory and systemic symptoms and can be fatal if not treated. The reemergence of diphtheria in Nigeria is most likely due to a combination of factors, including gaps in routine immunization regimens. The outbreak is further aggravated by multiple epidemics, which have diverted resources and attention away from the emergency of other infectious diseases. Furthermore, there is a lack of awareness of diphtheria in Nigeria. With a focus on the difficulties in controlling the disease, methods of diagnosis, available treatments, and preventive measures, this study provides a thorough analysis of diphtheria, covering its historical context, clinical presentation, associated complications, and current outbreaks. It emphasizes how important vaccination, early detection, and better access to healthcare are in reducing diphtheria outbreaks. The study highlights the serious effects of diphtheria on public health, particularly in regions with scarce resources and vaccine resistance, and offers a number of suggestions to overcome these challenges and prevent further outbreaks.
Topics: Nigeria; Humans; Diphtheria; Disease Outbreaks; Corynebacterium diphtheriae; Vaccination; Public Health; Communicable Diseases, Emerging; History, 21st Century
PubMed: 38018182
DOI: 10.2174/0118715265251299231117045940 -
The Lancet. Infectious Diseases Feb 2024
Topics: Humans; Diphtheria; Corynebacterium diphtheriae; Africa, Western; Disease Outbreaks
PubMed: 38280399
DOI: 10.1016/S1473-3099(24)00026-4 -
Journal of Tropical Pediatrics Apr 2019Infection with Corynebacterium diphtheriae persists in Haiti. Twenty-six children with clinically severe respiratory diphtheria presented to a hospital in northern Haiti...
Infection with Corynebacterium diphtheriae persists in Haiti. Twenty-six children with clinically severe respiratory diphtheria presented to a hospital in northern Haiti during a 3-year period beginning in early 2015. The mortality rate was 50%. Partial or absent vaccinations as well as delayed and limited care contributed to mortality. This cohort offer insights into the multiple challenges involved in preventing and caring for children with diphtheria in resource-limited settings.
Topics: Child; Cohort Studies; Corynebacterium diphtheriae; Delayed Diagnosis; Diphtheria; Diphtheria Antitoxin; Female; Haiti; Health Services Accessibility; Humans; Immunization; Respiratory Tract Infections; Vaccination
PubMed: 29688558
DOI: 10.1093/tropej/fmy021 -
Journal of Forensic and Legal Medicine Feb 2013Diphtheria, an acute infectious condition caused by Corynebacterium diphtheriae, was once a major killer of children. Although the mortality rates dropped dramatically... (Review)
Review
Diphtheria, an acute infectious condition caused by Corynebacterium diphtheriae, was once a major killer of children. Although the mortality rates dropped dramatically in the mid-twentieth century, due to a combination of improved standards of living and immunization programs, outbreaks are still occurring. Two children, aged four and five years respectively, are reported to demonstrate characteristic features of lethal cases. Death in case 1 was due to an extensive upper airway pseudomembrane causing acute respiratory failure. The diagnosis of diphtheria was only made at postmortem. Death in case 2 was due to acute cardiac failure with heart block complicating diphtheria. Other mechanisms in fatal cases involve disseminated intravascular coagulation, renal and endocrine failure. Declining levels of immunity among adults has resulted in a change in the epidemiological pattern of the disease with an older age of victims in recent outbreaks. As a result of population shifts and failure to immunize children it is likely that forensic pathologists may see more cases of diphtheria in the future. Due to the rarity of cases in Western communities and atypical presentations, the diagnosis may only be established at autopsy.
Topics: Acute Kidney Injury; Bundle-Branch Block; Child, Preschool; Diphtheria; Diphtheria Toxoid; Disseminated Intravascular Coagulation; Female; Forensic Pathology; Heart Block; History, 16th Century; History, 17th Century; History, 19th Century; History, 20th Century; Humans; Pleural Effusion; Respiratory Insufficiency; Respiratory System; Risk Factors
PubMed: 23357389
DOI: 10.1016/j.jflm.2012.04.006 -
Tropical Doctor Jul 1974
Topics: Anti-Bacterial Agents; Child; Conjunctiva; Corynebacterium diphtheriae; Diagnosis, Differential; Diphtheria; Diphtheria Antitoxin; Humans; Immunity; Immunity, Maternally-Acquired; Larynx; Mumps; Myocarditis; Paralysis; Skin; Time Factors; Tropical Climate; Ulcer
PubMed: 4211927
DOI: 10.1177/004947557400400305 -
Toxins May 2024Diphtheria toxin (DT) is the main virulence factor of and Moreover, new species with the potential to produce diphtheria toxin have also been described. Therefore,... (Review)
Review
Diphtheria toxin (DT) is the main virulence factor of and Moreover, new species with the potential to produce diphtheria toxin have also been described. Therefore, the detection of the toxin is the most important test in the microbiological diagnosis of diphtheria and other corynebacteria infections. Since the first demonstration in 1888 that DT is a major virulence factor of , responsible for the systemic manifestation of the disease, various methods for DT detection have been developed, but the diagnostic usefulness of most of them has not been confirmed on a sufficiently large group of samples. Despite substantial progress in the science and diagnostics of infectious diseases, the Elek test is still the basic recommended diagnostic test for DT detection. The challenge here is the poor availability of an antitoxin and declining experience even in reference laboratories due to the low prevalence of diphtheria in developed countries. However, recent and very promising assays have been developed with the potential for use as rapid point-of-care testing (POCT), such as ICS and LFIA for toxin detection, LAMP for gene detection, and biosensors for both.
Topics: Diphtheria Toxin; Humans; Diphtheria; Corynebacterium; Corynebacterium diphtheriae
PubMed: 38922140
DOI: 10.3390/toxins16060245 -
Klinicheskaia Laboratornaia Diagnostika Dec 2020The problem of diphtheria infection remains relevant, since the circulation of toxigenic strains of Corynebacterium diphtheriae persists in the body of bacterial...
The problem of diphtheria infection remains relevant, since the circulation of toxigenic strains of Corynebacterium diphtheriae persists in the body of bacterial carriers, despite ongoing vaccination. The lecture presents modern ideas about the properties of the pathogen, its pathogenicity factors (toxin, pili, surface proteins (67-72P (or DIP0733), DIP1281, etc.) and their role in the pathogenesis of the disease.. Information about the clinical and epidemiological characteristics and modern methods of laboratory diagnostics of diphtheria is presented. The algorithm of bacteriological research and methods for determining the toxigenic properties of the pathogen are described. The basics of diphtheria vaccination as the only effective means of preventing mass outbreaks of this disease are considered in the framework of the proposed lecture. Knowledge of the peculiarities of the circulation of strains of Corynebacterium diphtheria in modern conditions, pathogenetic and clinical-epidemiological features of diphtheria, as well as modern methods of laboratory diagnostics is important and necessary for students of medical schools and infectious diseases doctors, pediatricians, bacteriologists, therapists, pulmonologists, epidemiologists, etc.
Topics: Clinical Laboratory Techniques; Corynebacterium diphtheriae; Diphtheria; Diphtheria Toxin; Humans
PubMed: 33301660
DOI: 10.18821/0869-2084-2020-65-11-699-706 -
Clinical Microbiology and Infection :... Dec 2022
Topics: Humans; Diphtheria; Corynebacterium diphtheriae; Polynesia; Diphtheria Toxin
PubMed: 35182755
DOI: 10.1016/j.cmi.2022.01.018 -
Journal of Infection in Developing... Jul 2022Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Although the incidence of diphtheria worldwide has rapidly declined following the...
INTRODUCTION
Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Although the incidence of diphtheria worldwide has rapidly declined following the largely successful diphtheria toxoid-based vaccines, concerns persist for those who were unvaccinated or incompletely vaccinated. In this report, we describe a recent diphtheria outbreak in Malaysia involving four confirmed diphtheria cases.
METHODOLOGY
The outbreak investigation efforts and epidemiological characteristics of a diphtheria outbreak in Malaysia are described. For all suspected cases, swabs were taken and sent for isolation of Corynebacterium diphtheriae and confirmation of toxigenic strains.
RESULTS
The index case was a two-year-old child living with his family in a welfare home. Following contact tracing efforts and investigation for suspected cases, seven samples came back as culture positive for Corynebacterium diphtheriae. Confirmation of toxigenic strains was performed using PCR and Elek's test, which showed 100% correlation in positivity for four of the samples. All four confirmed cases were below 18 years of age, and three of them did not have complete vaccination history (two unvaccinated, one unknown). The index case eventually succumbed due to severe diphtheria with multiorgan failure while all the other cases were discharged healthy.
CONCLUSIONS
In Malaysia, despite good vaccination coverage, sporadic diphtheria outbreaks still occur. The rising trend of cases reported over the recent years underscores the need to remain vigilant. Addressing pockets of unvaccinated children and potential waning immunity levels in the population remains pivotal.
Topics: Child; Child, Preschool; Corynebacterium; Corynebacterium diphtheriae; Diphtheria; Disease Outbreaks; Humans; Malaysia; Public Health
PubMed: 35905020
DOI: 10.3855/jidc.16076