Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023.

BACKGROUND: Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. METHODS: We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. RESULTS: Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae-positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. CONCLUSIONS: Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.

Retrospective Study of Infections with Corynebacterium diphtheriae Species Complex, French Guiana, 2016-2021.

Human infections with Corynebacterium diphtheriae species complex (CdSC) bacteria were rare in French Guiana until 2016, when the number of cases diagnosed increased. We conducted an epidemiologic, multicenter, retrospective study of all human CdSC infections diagnosed in French Guiana during January 1, 2016-December 31, 2021. A total of 64 infectious episodes were observed in 60 patients; 61 infections were caused by C. diphtheriae and 3 by C. ulcerans. Estimated incidence increased from 0.7 cases/100,000 population in 2016 to 7.7 cases/100,000 population in 2021. The mean patient age was 30.4 (+23.7) years, and male-to-female ratio was 1.7:1 (38/22). Of the 61 C. diphtheriae isolates, 5 tested positive for the diphtheria toxin gene, and all results were negative by Elek test; 95% (61/64) of cases were cutaneous, including the C. ulcerans cases. The increase in reported human infections underscores the need to raise awareness among frontline healthcare practitioners to improve prevention.

Seroprevalence of anti-diphtheria toxoid antibody and implications for vaccination policy in Vietnam's South-central coast: a cross-sectional study.

BACKGROUND: Diphtheria is a re-emerging infectious disease and public health concern worldwide and in Vietnam with increasing cases in recent years. This study aimed to assess the anti-diphtheria toxoid antibodies status in Khanh Hoa Province and identify factors contributing to the vaccination policy in the south-central coast of Vietnam. METHODS: This was a cross-sectional study to evaluate the seroprevalence of anti-diphtheria toxoid antibodies among 1,195 participants, aged 5 - 40 years in Khanh Hoa Province, Vietnam. Immunoglobulin G antibody levels against diphtheria were detected using a commercial anti-diphtheria toxoid enzyme-linked immunosorbent assay (SERION ELISA classic Diphtheria Immunoglobulin G) and were categorized following the World Health Organization guidelines. RESULTS: The mean anti-diphtheria toxoid antibody levels were 0.07 IU/ml (95% Confidence Interval: 0.07-0.08). Anti-diphtheria toxoid antibody levels were found to be associated with age and history of diphtheria vaccination. The 5-15 years age group had the highest levels (0.09 IU/ml), while the older age group had the lowest antibody level (p < 0.001). Individuals who received three doses (adjusted Odds ratio: 2.34, 95%CI: 1.35 - 4.07) or 4+ doses (adjusted Odds ratio: 2.45, 95%CI: 1.29 - 4.64) had a higher antibody level compared to those who received only one dose regardless of age. CONCLUSION: It is crucial to promote routine vaccination coverage to over 95% for children under one year of age with three primary doses of the diphtheria-containing vaccine, including additional doses at 18 months and 7 years of age. Booster doses should be promoted and administered to adolescents and adults every 10 years.

Diphtheria in a Swiss Asylum Seeker Reception Centre: Outbreak Investigation and Evaluation of Testing and Vaccination Strategies.

Objectives: To describe a suspected diphtheria outbreak in a Swiss asylum seeker reception centre, and to analyse its management response regarding testing and vaccination. Methods: We retrospectively analysed clinical, microbiology, and case management data of all asylum seekers tested for C. diphtheriae between 28th August and 31st December 2022 while residing at the centre. Results are reported descriptively. Results: Among 265 individuals tested, ten cases of cutaneous diphtheria, one simultaneous respiratory and cutaneous case, and nine respiratory carriers were identified. Mass throat screening, targeted throat testing and targeted wound testing yielded 4.8%, 4.3%, and 17.4% positive results, respectively. No respiratory carrier was identified among cutaneous cases undergoing a throat swab, and no symptomatic case was identified among individuals with unspecific throat symptoms. Rates of vaccination implementation of newly arriving asylum seekers before and after the outbreak were low (17.5% and 15.5%, respectively), as were rates of targeted vaccination among cases and close contacts. Conclusion: We provide evidence for transmission both prior to arrival and within the setting, suboptimal practices and timeliness of testing, and implementation gaps in vaccination.

Respiratory diphtheria in the time of Omicron.

Abstract: Diphtheria is a potentially fatal bacterial infection caused by toxin-producing strains of corynebacteria, most often Corynebacterium diphtheriae and less commonly Corynebacterium ulcerans. Incidence of the disease has fallen significantly since the introduction of vaccination programs; it is now rare in countries with high vaccination coverage such as Australia. This article presents the most recent respiratory cases of diphtheria in two children in New South Wales-the first locally acquired childhood cases in Australia in 30 years-and discusses potential contributing factors. These encompass the lack of clinical awareness and the delays in laboratory diagnosis in regional laboratories. The cases also highlight the problem of vaccine hesitancy and the role that primary carers play in addressing these anxieties. While clinical management of the cases progressed well, factors in the public health responses were complicated by access to appropriate care and by delays in antibiotic sensitivity profiles. The public health response to these cases raises important considerations for clinicians and public health practitioners, including preparedness for rare and re-emerging diseases, the need for culturally safe environments and the importance of addressing vaccine hesitancy. Preparedness requires consideration of the capacity of regional health systems with fewer resources and of how public health departments can support response to multiple crises. Preparedness also relies on access to necessary diagnostic laboratory resources, on up-to-date guidelines, and on maintaining awareness among clinicians for these rare infections.

The Burden and Risk Factors Associated with Infectious Diseases among Refugees in a Camp for Migrants in Porto Alegre: A Cross-Sectional Survey.

Refugees usually face a disproportionate burden of infectious diseases. Recently, Brazil has experienced an influx of refugees which demands the need for scaling up public health efforts to address the challenges. The research sought to study the burden and risk factors associated with infectious diseases among refugees received in the city of Porto Alegre. This was a cross-sectional study of 261 newly arrived refugees. The study sample was predominantly composed of Venezuelans (50.6%) and Haitians (44%), male (146: 56.7%), single (30.7%), with an average age of 33.38 (± 7.30) years. The average schooling was 10.42 (± 2.09) years. Diseases with the highest prevalence were influenza, whooping cough, diphtheria, and tuberculosis. There was significant association between the country of origin and presence of symptoms for infectious and contagious diseases, which warrants targeted interventions for reducing the incidence of these diseases among refugees in Brazil.

A Review of Traditional Vaccine-Preventable Diseases and the Potential Impact on the Otolaryngologist

Abstract Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines. Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases. Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States. Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.

Diphtheria in the Dominican Republic: reduction of cases following a large outbreak / Difteria en la República Dominicana: reducción de casos tras un extenso brote epidémico

OBJECTIVE: To describe the most recent outbreak of diphtheria in the Dominican Republic and the disease's occurrence and vaccination coverage in 2004-2013. METHODS: Clinical data of diphtheria cases that occurred in 2004 and that met the study's case definition were reviewed along with socioeconomic and epidemiological information from the cases' families. Univariate and multivariate analyses were performed to assess risk factors for fatal diphtheria. Routine surveillance and vaccination coverage data are presented. RESULTS: From January 2004-April 2005, a total of 145 diphtheria cases were reported; 80 (66%) of the 122 cases reported in 2004 met the case definition; 26 were fatal (case-fatality rate: 32.5%). Incidence was highest in the group 1-4 years of age at 5.3 per 100 000; 62.5% were male. Of the 80 cases, 61 (76%) where hospitalized in Hospital A, 17 in Hospital B, and 2 in two other hospitals. Earlier onset (first half of 2004), birth order, and tracheotomy were associated with fatal diphtheria (P < 0.05); cases in Hospital A were also more likely to be fatal (P = 0.066). The average annual diphtheria incidence was 4.91 cases/1 million people in 2000-2003, climbed to 8.8 cases per million in 2004-2005, and dropped to 0.38 in 2006-2014; no diphtheria cases have been reported since 2011. DTP3 vaccination coverage ranged from 72%-81% in 2000-2004 and from 81%-89% in 2005-2013. CONCLUSIONS: The 2004-2005 diphtheria outbreak in the Dominican Republic resulted in important and avoidable morbidity and mortality. Annual cases declined and no cases have been reported in recent years. Maintaining high vaccination coverage and diligent surveillance are crucial to preventing diphtheria outbreaks and controlling the disease.

OBJETIVO: Describir el brote epidémico más reciente de difteria en la República Dominicana, la incidencia de la enfermedad y la cobertura de la vacunación del 2004 al 2013. MÉTODOS: Se analizaron los datos clínicos de los casos de difteria acaecidos en el 2004 y que cumplieron con la definición de caso del estudio, junto con la información socioeconómica y epidemiológica de las familias en las que aparecieron los casos. Se llevaron a cabo análisis de una sola variable y de múltiples variables para evaluar los factores de riesgo de difteria mortal. Se presentan los datos de vigilancia ordinaria y cobertura vacunal. RESULTADOS: De enero del 2004 a abril del 2005, se notificaron un total de 145 casos de difteria; 80 (66%) de los 122 casos notificados en el 2004 cumplieron con la definición de caso; 26 fueron mortales (tasa de letalidad por caso: 32,5%). La incidencia más alta (5,3 por 100 000) se produjo en el grupo de 1 a 4 años de edad; 62,5% fueron varones. De los 80 casos, 61 (76%) se hospitalizaron en el Hospital A, 17 en el Hospital B, y 2 en otros dos hospitales. La aparición más temprana (primera mitad del 2004), el orden de nacimiento y la traqueotomía se asociaron con difteria mortal (P < 0 ,05); la probabilidad de evolución mortal fue mayor en los casos ingresados en el Hospital A (P = 0,066). La incidencia promedio anual de difteria fue de 4,91 casos por millón de personas del 2000 al 2003, ascendió a 8,8 casos por millón durante los años 2004 y 2005, y descendió a 0,38 del 2006 al 2014; no se han notificado casos de difteria desde el 2011. La cobertura de la vacunación con DTP3 varió de 72 a 81% del 2000 al 2004 y de 81 a 89% del 2005 al 2013. CONCLUSIONES: El brote epidémico de difteria de los años 2004 y 2005 en la República Dominicana ocasionó una importante morbimortalidad prevenible. Se produjo un descenso en la incidencia de casos y no se han notificado nuevos casos en los últimos años. El mantenimiento de una alta cobertura vacunal y de una vigilancia eficiente es crucial para la prevención de los brotes epidémicos de difteria y el control de la enfermedad.

Comunicação de risco: caso suspeito de difteria / Risk communication: suspected case of diphtheria

A comunicação de risco tem como objetivo apoiar na divulgação rápida e eficaz de conhecimento às populações, parceiros e partes intervenientes possibilitando o acesso às informações fidedignas que possam apoiar nos diálogos para tomada de medidas de proteção e controle em situações de emergência em saúde pública. Em Goiás na SE 16/2022, foi notificado 01 caso suspeito de difteria, sexo feminino, 16 anos, do município de Santa Helena de Goiás, com histórico de 03 doses da vacina DTP+HIB (08/2010), não foi identificada doses de reforço, conforme preconizados pelo PNI

Risk communication aims to support the rapid and effective dissemination of knowledge to populations, partners and stakeholders, enabling access to reliable information that can support dialogues for taking protection and control measures in emergency situations in public health. In Goiás on SE 16/2022, 01 suspected case of diphtheria was reported, female, 16 years old, from the municipality of Santa Helena de Goiás, with a history of 03 doses of the DTP+HIB vaccine (08/2010), no doses were identified reinforcement, as recommended by the PNI

Difteria pelo Corynebacterium ulcerans: uma zoonose emergente no Brasil e no mundo / Corynebacterium ulcerans diphtheria: an emerging zoonosis in Brazil and worldwide / Difteria por Corynebacterium ulcerans: una zoonosis emergente en Brasil y en el mundo

O artigo revisa a literatura sobre a emergência de infecções humanas causadas por Corynebacterium ulcerans em diversos países, incluindo o Brasil. Foi realizada análise de artigos publicados entre 1926 e 2011 nas bases Medline/PubMed e SciELO, bem como artigos e informes do Ministério da Saúde. Apresenta-se um esquema de triagem, rápido, econômico e de fácil execução, capaz de permitir a realização do diagnóstico presuntivo de C. ulcerans e C. diphtheriae na maioria dos laboratórios brasileiros públicos e privados. A circulação de C. ulcerans em vários países, aliada aos recentes casos de isolamento do patógeno no Rio de Janeiro, é um alerta a clínicos, veterinários e microbiologistas sobre a ocorrência de difteria zoonótica e a circulação do C. ulcerans em regiões urbanas e rurais do território nacional e/ou da América Latina.

The article is a literature review on the emergence of human infections caused by Corynebacterium ulcerans in many countries including Brazil. Articles in Medline/PubMed and SciELO databases published between 1926 and 2011 were reviewed, as well as articles and reports of the Brazilian Ministry of Health. It is presented a fast, cost-effective and easy to perform screening test for the presumptive diagnosis of C. ulcerans and C. diphtheriae infections in most Brazilian public and private laboratories. C. ulcerans spread in many countries and recent isolation of this pathogen in Rio de Janeiro, southeastern Brazil, is a warning to clinicians, veterinarians, and microbiologists on the occurrence of zoonotic diphtheria and C. ulcerans dissemination in urban and rural areas of Brazil and/or Latin America.

El articulo revisa la literatura sobre la emergencia de infecciones humanas causadas por Corynebacterium ulcerans en diversos países, incluyendo Brasil. Se realizó análisis de artículos publicados entre 1926 y 2011 en las bases Medline/Pubmed y SciELO, así como artículos e informes del Ministerio Brasileño de la Salud. Se presenta un esquema de selección, rápido, económico y de fácil ejecución, capaz de permitir la realización del diagnóstico presuntivo de C. ulcerans y C. diphtheriae en la mayoría de los laboratorios brasileños públicos y privados. La circulación de C. ulcerans en varios países, aliada a los recientes casos de aislamiento del patógeno en Rio de Janeiro (Sureste de Brasil), es un alerta a clínicos, veterinarios y microbiólogos sobre la ocurrencia de difteria zoológica y la circulación de C. ulcerans en regiones urbanas y rurales del territorio nacional y/o de América Latina.

Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil

Serologic data on diseases that are preventable by vaccines are necessary to evaluate the success of immunization programs and to identify susceptible subgroups. In the present study, we determined serum IgG levels against diphtheria toxin of military and civilian blood donors (N = 75; 69.3 percent males and 30.7 percent females) aged 18-64 years, from the Brazilian Army Biology Institute, Rio de Janeiro, using a commercial diphtheria kit (Diphtheria IgG ELISA; IBL, Germany). Most (63 percent) unprotected military donors were from the older age group of 41 to 64 years. In contrast, the majority (71 percent) of young military donors (18 to 30 years) were fully protected. About half of the military donors aged 31 to 40 years were protected against diphtheria. Among the civilians, about 50 percent of persons aged 18 to 30 years and 31 to 40 years had protective antibody levels against diphtheria as also did 64 percent of individuals aged 41 to 64 years. All civilians had a similar antibody response (geometric mean = 0.55 IU/mL) independent of age group. Military donors aged 18-30 years had higher IgG levels (geometric mean = 0.82 IU/mL) than military donors of 41-64 years (geometric mean = 0.51 IU/mL; P > 0.05). In conclusion, the existence of a considerable proportion of susceptible adults supports the position that reliable data on the immune status of the population should be maintained routinely and emphasizes the importance of adequate immunization during adulthood.

Informe especial: Actualización epidemiológica de difteria / Special report: Epidemiological update of diphtheria

La difteria es una enfermedad infecciosa grave, con potencial epidémico, para la que existe una vacuna eficaz. Es una infección bacteriana aguda causada por la liberación de una exotoxina específica, producida por el bacilo gram positivo, Corynebacterium diphtheriae. Sólo las cepas toxigénicas causan enfermedad. La enfermedad se presenta principalmente en menores de 15 años de edad sin vacunación o con vacunación incompleta; no obstante puede presentarse en adultos en áreas con baja cobertura de vacunación. En este informe se presentan distintos aspectos de la enfermedad y la situación epidemiológica en las Américas y en Argentina: definiciones de caso, medidas de prevención y de control

Diagnóstico laboratorial da difteria e a prática da coleta de material de comunicantes como estratégia da vigilância epidemiológica - Grande São Paulo, 1987 a 1996 / Laboratorial diagnosis of difhteria and the practice of material collection from contacts as a strategy of epidemiological surveillance - Metropolitan area of São Paulo, 1987 a 1996

Difteria é uma doença aguda causada pelo Corynebacterium diphtheriae. Apesar do conhecimento sobre sua etiopatogenia, seus aspectos clínico, terapêutico e profilático, a difteria permanece endêmica no Brasil. A ampla utilização da vacina tríplice bacteriana há mais de 25 anos, ao lado de melhorias nas condições sanitárias da população, é responsável pela mudança na situação epidemiológica da difteria, particularmente no Estado de São Paulo, promovendo uma drástica redução no númerode casos e óbitos pela doença. Embora possa prescindir da confirmação laboratorial valendo-se dos dados clínicos, cada vez mais, a investigação laboratorial é fundamental para o aumento da especificidade do diagnóstico clínico e para que se conheça a freqüência da infecção, a participação de cepas toxigênicas e demais aracterísticas do agente etiológico. Foram analisados os dados laboratoriais referentes ao período de 1987 a 1996, para a Grande São Paulo, de pacientes suspeitos de difteria e de seus comunicantes, com o objetivo de avaliar a prática da coleta de material como estratégia da vigilância epidemiológica para o controle da doença e diagnóstico dos casos. Na análise do número de casos suspeitos, observou-se, a partir de 1992, significativa diminuição do número de casos, seguida da sua estabilidade em níveis mais baixos a partir de 1994. A análise da toxigenicidademostrou que eram toxigênicas 91,2% das cepas isoladas dos casos suspeitos e 63,3% das cepas isoladas dos comunicantes. Os resultados apresentados reforçam a norma vigente de que a coleta de material de comunicantes e demais medidas de prevenção da doença não podem aguardar os resultados laboratoriais. Os resultados negativos não devem interferir na decisão do número de amostras a serem coletadas em comunicantes...