What is the global incidence of diphtheria?

Updated: Jan 18, 2019
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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According to the World Health Organization (WHO), diphtheria epidemics remain a health threat in developing nations. [2] The largest epidemic recorded since widespread implementation of vaccine programs was in 1990-1995, when a diphtheria epidemic emerged in the Russian Federation, rapidly spreading to involve all Newly Independent States (NIS) and Baltic States. This epidemic caused more than 157,000 cases and 5000 deaths according to WHO reports. [11, 12] Disproportionately high rates of death were observed in individuals older than 40 years, and 5,000 deaths were reported. This epidemic accounted for 80% of cases reported worldwide during this time period. [13]

From 1993-2003, a decade long epidemic in Latvia resulted in 1359 reported cases of diphtheria with 101 deaths. The incidence fell from 3.9 cases per 100,000 cases in 2001 to 1.12 cases per 100,000 population in 2003. Most cases were registered in unvaccinated adults.

From 1995-2002, 17 cases of cutaneous diphtheria due to toxigenic strains were reported in the United Kingdom. [13]

Overall rates of infection have decreased in Europe from 2000 to 2009, according to the Diphtheria Surveillance Network. This has been attributed to improved vaccination rates creating herd immunity. However, issues with vaccinations still occur, especially in eastern European countries and Russia, and are thought to contribute to the ongoing outbreaks. [14]

Many case reports in the literature describe epidemics in sub-Saharan Africa, France, India, and the United States. [15, 16]

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