Implications of the Diphtheria Epidemic in the Former Soviet Union for Immunization Programs

Abstract

The massive diphtheria epidemic in the former Soviet Union provides important lessons for all diphtheria immunization programs: It is important to achieve a high level of childhood immunization, maintain immunity against diphtheria in older age groups, and use anti-epidemic measures, including immunization, to control epidemics in the early phase. The immunization coverage among children should be at least 90%. Further studies are needed to elaborate the most effective strategy to maintain immunity against diphtheria in adults (periodic booster doses, immunization of selected age groups in health care settings, use of Td [tetanus-diphtheria toxoids with reduced diphtheria toxoid content] vaccine instead of monovalent tetanus toxoid whenever tetanus toxoid is indicated [e.g., in treatment of wounds or in school-based immunization programs]). Efforts should be undertaken to monitor diphtheria immunity in different groups by conducting age-specific serologic studies.

Diphtheria toxin conformational switching at acidic pH

“…Diphtheria toxin (DT) is a protein toxin that causes the homonymous disease, which is currently re-emerging in those areas of the world where vaccination programs are not fully enforced [1]. DT has also been used to prepare immune-conjugates aimed at deleting selective populations of pathogenic cells [2].…”

Transcutaneous Immunization with Cross-Reacting Material CRM 197 of Diphtheria Toxin Boosts Functional Antibody Levels in Mice Primed Parenterally with Adsorbed Diphtheria Toxoid Vaccine

“…However, antidiphtheria antibody levels decrease with increasing age, and frequent booster vaccinations are required to maintain herd immunity in the adult population (5,14,18). The importance of maintaining high levels of seroprotection against diphtheria has been highlighted following the resurgence of disease in several European countries where a high proportion of the adult population were found to have antidiphtheria antibody titers below the putative protective levels of 0.01 IU/ml (4,16).…”

Effect of a Diphtheria Booster Vaccination in Adults with a Documented History of an Incomplete Primary Series Vaccination

“…Special attention should be paid to risk groups such as health care personnel and travelers to endemic regions [1,4]. WHO recommends regular diphtheria booster vaccinations for adults every 10 years, but this has not been effectively implemented in any country [6].…”