By Pamela Hunter
Special to DG News
CHICAGO, IL -- December 19, 2001 -- Diphtheria used to be a widespread and serious disease with a significant rate of morbidity and mortality among both children and adults. It is caused by the bacterium Corynebacterium diphtheriae.
Vaccination has controlled the disease for many decades but it has re-emerged in a number of the countries in the former USSR.
Between 1994 and 1996 a diphtheria outbreak occurred in Latvia with nearly 800 cases and 55 deaths. A major immunisation campaign was instituted and cases were reduced quite dramatically. But in August 2000 an outbreak occurred in a military academy among trainees, many of whom were vaccinated.
This outbreak was investigated by the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia and reported today (Dec. 19) at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, in Chicago, Illinois, Dr. Chima Ohuabunwo from the CDC.
The immunization history, clinical and laboratory records of the trainees was recorded. Of the 207 trainees examined, 45 (22 percent) had symptoms indicative of diphtheria. These included membranous pharyngitis or linked epidemiologically to a positive culture of a toxigenic strain of C diphtheriae. All patients survived although one had severe myocarditis. A further 79 (38 percent) of the trainees were carrying the toxigenic strain of the bacterium.
Vaccination records were available for 192/207 trainees and 164 of these (85 percent) had received several doses of diphtheria toxoid, most of whom had received their last dose between three and five years prior to the outbreak.
A major risk factor for infection was found to be the sharing of drinking cups. Another risk factor appeared to be having received lower antigen toxoid as the last booster dose, in contrast to those who had received the higher antigen toxoid dose as booster.
The authors concluded that the system of booster doses should be reviewed, as the indications from the investigation of this outbreak were that higher antigen toxoid was more protective for adolescents living in close proximity with one another. Hygiene was also important as any sharing of respiratory secretions increased the chances of the infections being transmitted, Dr. Ohuabunwo said.
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