Diphtheria vaccine: WHO position paper, August 2017 – Recommendations

Organization, World Health

doi:10.1016/j.vaccine.2017.08.024

Cited by 45 publications

(12 citation statements)

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“…Diphtheria and its causative pathogen, Corynebacterium diphtheriae , have been drifting out of focus in Western countries because of effective vaccination programs. In 1994, the World Health Organization aimed to eliminate these infections by the year 2000, but epidemics such as that in the former Soviet Union and outbreaks in other countries show that the goal of elimination by 2000 was not reached ( 1 ) and nationwide vaccination programs are still essential ( 2 ). Despite high vaccination coverage in most Western countries, cases of wound and bloodstream infections caused by C. diphtheriae are rising because vaccination with toxoid prevents only diphtheria toxin–associated symptoms.…”

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confidence: 99%

Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017

Dangel¹,

Berger²,

Konrad³

et al. 2018

Emerg. Infect. Dis.

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From 2016 through the middle of 2017, the German Consiliary Laboratory on Diphtheria noted an increase in nontoxigenic Corynebacterium diphtheriae isolates submitted from cities in northern Germany. Many patients for whom epidemiologic data were available were homeless, alcohol or drug abusers, or both. After performing routine diagnostics and multilocus sequence typing (MLST), we analyzed isolates of sequence type (ST) 8 and previously submitted isolates by whole-genome sequencing. Results were analyzed for phylogenetic relationship by core genome MLST (cg-MLST) and whole-genome single-nucleotide polymorphism profiles. Next-generation sequencing–based cg-MLST revealed several outbreak clusters caused by ST8; the geographic focus was in the metropolitan areas of Hamburg and Berlin. To achieve enhanced analytical depth, we used additional cg-MLST target genes and genome-wide single-nucleotide polymorphisms. We identified patient characteristics and detected transmission events, providing evidence that nontoxigenic C. diphtheriae infection is a potential public health threat in industrialized countries.

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confidence: 99%

Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017

Dangel¹,

Berger²,

Konrad³

et al. 2018

Emerg. Infect. Dis.

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“…According to the international criteria, diphtheria antibodies levels below 0.01 IU/ml were considered to be not protective, 0.01 to <0.1 IU/ml concentrations confer basic protection while 0.1 to <1 IU/ml levels confer full protection. Levels of 1 IU/ml or higher are associated with long-term protection [12] .…”

Section: Methodsmentioning

confidence: 99%

Immune responses to vaccine-preventable diseases among toddlers and preschool children after primary immunization and first booster in Northwestern Algiers, Algeria

Benamrouche

Maamar

Chemli

et al. 2018

Heliyon

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ObjectivesTo determine immune responses to selected vaccine-preventable communicable diseases: pertussis, diphtheria and Haemophilus influenzae type b (Hib1) in Algerian toddlers and preschool children after primary vaccination and first booster, recruited from three local healthcare facilities in Northwestern Algiers.MethodsThe information of demographic characteristics and vaccination status were collected for each subject by questionnaire. Specific antibody levels and Hib antibody avidity were determined using commercial ELISA kits.ResultsA total of eighty-one subjects aged between 19 and 55 months were studied. Almost all subjects were fully protected against diphtheria (76/81; 93.83%; 95% CI2: 86.35–97.33) and invasive Hib disease (29/30; 96.67%; 95% CI: 83.33–99.41), while only 20/78 (25.64%; 95% CI: 17.26–36.31) had anti-PT3 (pertussis toxin) antibody levels above 25 IU/ml. A significant decrease of anti-PT antibody levels was observed until the age of 36 months (p = 0.02). GMTs4 (geometric mean titers) of anti-PT antibodies were low, but remain significantly higher in children ≤36 months of age (p = 0.02). Both GMT and rates of ≥0.15 μg/ml, ≥1 μg/ml, and ≥5 μg/ml titers were significantly higher in Hib-vaccinated subjects (p < 0.01). Relative Hib-avidity index (≥50%) and GMAI5 (geometric mean avidity index) were high in both Hib-vaccinated and -unvaccinated groups.ConclusionsAs shown in the present study, young children were fully protected against diphtheria and Hib, but showed low immunity to pertussis. Further sero-epidemiological studies including a large number of subjects with a wider range of age are needed to explore the immunity level in older children, adolescents and adults.

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“…WHO has recommended to replace standalone TT vaccine with Td vaccine in older children, adolescents, and WRA since 1988 to decrease the outbreaks of diphtheria, as the schedule of diphtheria vaccine is similar to that of tetanus. 18 For MNTE to be achieved as well as sustained, at least 80% of pregnant women in every district should be completely protected against tetanus. All persons who have been immunized with 6 doses of TTCV, starting from infancy (or 5 doses if vaccinated after infancy), are considered fully protected against tetanus throughout their adulthood and beyond.…”

Section: Likely Strategies To Sustain Mntementioning

confidence: 99%