A diphtheria epidemic in a small central Texas community centered in the elementary school. Epidemiological investigation at the school included throat cultures and immunization histories of 306 of the 310 students and staff. Of these, 104 (34%) had culture-proven diphtheria infections; 15 were symptomatic cases and 89 were carriers.There was no statistical difference in the risk of diphtheria infection among those with full, lapsed, inadequate, or no previous diphtheria immunizations. However, the risk of symptomatic diphtheria was 30 times as great for those with none, and 11.5 times as great for those with inadequate immunizations as for those fully immunized. Diphtheria toxoid helps prevent symptomatic disease but does not prevent the carrier state nor stop the spread of infection. Identifying, isolating, and treating carriers are very important aspects in the control of diphtheria outbreaks. w ith the increase in the number of cases of diphtheria in the

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