Successful Control of Epidemic Diphtheria in the States of the Former Union of Soviet Socialist Republics: Lessons Learned

Abstract

Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.

Novel configurations of type I and II CRISPR–Cas systems in Corynebacterium diphtheriae

“…C. diphtheriae remains a significant cause of global morbidity and mortality, being present in every World Heath Organisation region globally, with new epidemics being regularly reported (www.WHO.int). Moreover, the eastern European outbreak of the 1990s resulted in 157 000 cases and 5000 deaths, indicating this pathogen is far from under control (Dittmann et al, 2000). Recently, there have been increasing numbers of cases being caused by non-toxigenic strains, suggesting a change to the life style of this pathogen (Edwards et al, 2011;Farfour et al, 2012;Romney et al, 2006).…”

Diphtheria in a Vaccinated Adult in Rio De Janeiro, Brazil

“…In 1990, diphtheria reemerged in the Russian Federation and spread to all Newly Independent States (NIS) with a high proportion of cases in adults, 64% to 82%, respectively. Severe disease and a high percentage (30%) of fatal cases were documented among vaccinated individuals (2,14).…”

“…The spread of epidemic seemed facilitated by large scale population movements; socioeconomic instability, partial deterioration of health infrastructure; delay in implementing measures to control epidemic; inadequate information for physicians and the public; lack of adequate supplies for prevention and treatment in most of the countries (2,8).The reasons for reemergence of epidemic diphtheria in countries where immunization programs had nearly eliminated diphtheria are not fully understood but are thought to include the introduction of toxigenic C. diphtheriae strains of a new biotype into the general population, besides low coverage with diphtheria vaccine among children and large gap of immunity among adults (4,22).…”

“…Despite the success of mass immunization in many countries diphtheria remains a serious health problem within many regions of the world (2,10,11,14,15,22,23). Diphtheria should be suspected in any patient who lives in an endemic area and that clinically significant outbreak of diphtheria could occur in the future.…”

Diphtheria Re-emergence: Problems Faced by Developing Countries

“…This higher case fatality was attributed to non availability of antitoxin in India [7,18,21,23]. This may also be due to delay in diagnosing the cases.…”