Abstract
Diphtheria is a contagious upper respiratory illness that was a major cause of childhood mortality in the prevaccine era. In the early twentieth century, an effective toxoid vaccine was developed. Implementation of childhood vaccination virtually eliminated diphtheria from developed countries after the Second World War and implementation of the Expanded Program on Immunization in developing countries led to rapid declines in diphtheria globally in the 1980s. However, in the 1990s, a massive epidemic of diphtheria spread throughout the countries of the former Soviet Union. Unlike the prevaccine era, most cases of severe disease and deaths were reported among adults. Multiple factors contributed to the epidemic, including increased susceptibility among both adults and children; suboptimal socioeconomic conditions; high population movement; and delay in implementing appropriate control measures. Mass immunization was the key element in the epidemic control strategy developed and implemented in a well-coordinated response by an international public health coalition. This strategy focused on rapidly raising population immunity of both adults and children; the immunization of more than 140,000,000 adults and adolescents and millions of children successfully controlled the epidemic. While improved coverage of children in developing countries with diphtheria toxoid has led to progressive decreases in diphtheria; eradication is unlikely in the foreseeable future and gaps in immunity among adult population exist or are developing in many other countries. Routine childhood immunization with diphtheria toxoid is the key to controlling diphtheria while the role of routine adult reimmunization is less established; mass immunization will remain an important control measure for widespread diphtheria outbreaks.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Anonymous (1997) Diphtheria cases notified in the European Union. Eurosurveillance 2:63–64
Anonymous (2003) Diphtheria, Afghanistan. Weekly Epidemiological Record 78:314.
Centers for Disease Control and Prevention (2004) Fatal respiratory diphtheria in a U.S. traveler to Haiti-Pennsylvania, 2003. Morbid Mortal Weekly Rep 52:1285–1286
Cerdeñ-Tárraga AM, Efstratiou A, Dover LG, Holden MTG, Pallen M, et al. (2003) The complete genome sequence and analysis of Corynebacterium diphtheriae NCTC13129. Nucl Acids Res 31:6515–6523
Christenson B, Hellström U, Sylvan SPE, Henriksson L, Granström M (2001) Impact of a vaccination campaign on adult immunity to diphtheria. Vaccine 19:1133–114
Collier RJ (2001) Understanding the mode of action of diphtheria toxin: a perspective on progress during the 20th century. Toxicon 39:1793–1803
Coyle MD, Groman NB, Russell JQ, Harnisch JP, Rabin M, et al. (1989) The molecular epidemiology of three biotypes of Corynebacterium diphtheriae in the Seattle outbreak, 1972–1982. J Infect Dis 159:670–679
Craster CV (1941) The mass immunization of pre-school children. J Med Soc New Jersey 38:39–41
Department of Vaccines and Biologicals (2004) WHO Vaccine-Preventable Diseases: Monitoring System. 2004 Global Summary. World Health Organization, Geneva
Dittmann S, Wharton M, Vitek, C, Ciotti M, Galazka A, et al. (2000) Successful control of epidemic diphtheria in the states of the former Soviet Union of Soviet Socialist Republics: lessons learned. J Infect Dis 181(Suppl. 1): S10–S22
Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ, et al. (1993) Fatal respiratory disease due to Corynebacterium diphtheriae: case report and review of guidelines for management, investigation, and control. Clin Infect Dis 16:59–68
Galazka AM, Robertson SE (1995) Diphtheria: Changing patterns in the developing world and the industrialized world. Eur J Epidemiol 11:107–117
Galazka A, Tomaszunas-Blszczyk J (1997) Why do adults contract diphtheria? Eurosurveillance 2:60–63
Golaz A, Hardy IR, Glushkevich TG, Areytchiuk EK, Deforest A, et al. (2000) Evaluation of a single dose of diphtheria-tetanus toxoids among adults in Odessa, Ukraine, 1995:immunogenicity and adverse reactions. J Infect Dis 181(Suppl. 1):S203–S207
Griffith AH (1979) The role of immunization in the control of diphtheria. Developments in Biological Standardization 43:3–13
Hróbjartsson A, Gøzche PC, Gluud C (1998) The controlled clinical trial turns 100 years: Fibiger’s trial of serum treatment of diphtheria. Br Med J 317:1243–1245
Holmes RK (2000) Biology and molecular epidemiology of diphtheria toxin and the tox gene. J Infect Dis 181(Suppl. 1):S156–S167
Khetsuriani N, Music S, Deforest A, Sutter RW (2000) Evaluation of a single dose of diphtheria toxoid among adults in the Republic of Georgia, 1995: immunogenicity and adverse reactions. J Infect Dis 181(Suppl. 1):S208–S212
Lee HF, Tseng LR, Yueh YY, Wu UC (1999) Immunity against diphtheria in Taiwan (Chinese). J Microbiol, Immunol, Infect 32:206–212
Magdei M, Melnic A, Benes O, Bukova V, Chicu V, et al. Epidemiology and control of diphtheria in the Republic of Moldova, 1946–1996. J Infect Dis 181(Suppl. 1):S47–S54
Markina SS, Maksimova NM, Vitek CR, Bogatyreva EY, Monisov AA (2000) Diphtheria in the Russian Federation in the 1990s. J Infect Dis 181(Suppl. 1):S27–S34
Marston CK, Jamieson F, Cahoon F, Lesiak G, Golaz A. et al. (2001) Persistence of a distinct Corynebacterium diphtheriae clonal group within two communities in the United States and Canada where diphtheria is endemic. J Clin Microbiol 39:1586–1590
McCloskey RV, Saragea A, Maximescu P (1972) Phage typing in diphtheria outbreaks in the southwestern United States, 1968–1971. J Infect Dis 126:196–199
McKinnon NE, Ross MA, Defries RD (1931) Reduction in diphtheria in 36,000 Toronto school children as a result of an immunization campaign. Can Public Health J 22:217–223
McKinnon NE (1942) Diphtheria prevented. In Cruickshank R (ed). Control of the Common Fevers. The Lancet Ltd, London, 1942, pp 41–56
Pappenheimer AM Jr. (1980) Diphtheria: studies on the biology of an infectious disease. Harvey Lectures 1980-81 76:45–73
Patel M, Morey F, Butcher A, Moore C, Brennan R, Mollison L (1994) The frequent isolation of toxigenic and non-toxigenic C. diphtheriae at Alice Springs Hospital. Commun Dis Intel 18:310–311
Ramon G (1923) Sur le pouvoir floculant et sur les proprietes immunisantes d’une toxin diphterique rendue anatoxique (anatoxine). C. R Acad Sci 177:1338–1440.
Ronne T, Valentelis R, Tarum S, Griskevica A, Wachmann CH, et al. (2000) Immune response to diphtheria booster vaccine in the Baltic States. J Infect Dis 181(Suppl. 1):S213–S219
Stowman K (1945) The epidemic outlook in Europe. Br Med J 1:72–74
Sutter RW, Hardy IR, Kozlova IA, et al. (2000) Immunogenicity of tetanus-diphtheria toxoids (Td) among Ukrainian adults: implications for diphtheria control in the Newly Independent States of the former Soviet Union. J Infect Dis 181(Suppl. 1):S197–S203
Tharmaphornpilas P, Yoocharoan P, Prempree P, Youngpairoj S, Sriprasert P, et al. (2001) Diphtheria in Thailand in the 1990s. J Infect Dis 184:1035–1040
US Bureau of the Census (1975) Historical Statistics of the United States, Colonial Times to 1970, Bicentennial Edition, Part 1. US Department of Congress, Washington, DC, pp 58, 63
Vitek CR, Brisgalov SP, Bragina VY, Zhilyakov AM, Bisgard KM, et al. (1999) Epidemiology of epidemic diphtheria in three regions, Russia, 1994–1996. Eur J Epidemiol 15:75–83
Vitek CR, Velibekov AS (2000) Epidemic diphtheria in the 1990s: Azerbaijan. J Infect Dis 181(Suppl. 1):S73–S79
Wharton M, Dittmann S, Strebel PM, Mortimer EA (eds) (2000) Control of epidemic diphtheria in the Newly Independent States of the former Soviet Union. J Infect Dis 181(Suppl. 1):S1–S248
WHO (1995) WHO/UNICEF strategy for diphtheria control in the Newly Independent States. World Health Organization, Regional Office for Europe, Copenhagen
WHO Vaccine Preventable Diseases Monitoring System. Antigen schedule selection centre: accessed on January 30, 2005 at http://www.who.int/vaccines/globalsummary/immunization/scheduleselect.cfm
WHO (1997) Expanded programme on immunization (EPI): Diphtheria control. Weekly Epidemiological Record 72:128–130
WHO (1998) The Children’s Vaccine Initiative (CVI) and WHO’s global programme for vaccines and immunization (GPV)-Recommendations from the Strategic Advisory Group of Experts (SAGE). Weekly Epidemiol Rec 73:281–284
WHO (2004) Recommendations from the Strategic Advisory Group of Experts to the Department of Immunization, Vaccines, and Biologicals. Weekly Epidemiol Rec 79:43–52
Zingher A (1921) Diphtheria preventive work in the public schools of New York City. Arch Pediatr 38:336–359
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Vitek, C.R. (2006). Diphtheria. In: Plotkin, S.A. (eds) Mass Vaccination: Global Aspects — Progress and Obstacles. Current Topics in Microbiology and Immunology, vol 304. Springer, Berlin, Heidelberg . https://doi.org/10.1007/3-540-36583-4_5
Download citation
DOI: https://doi.org/10.1007/3-540-36583-4_5
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-29382-8
Online ISBN: 978-3-540-36583-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)