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Home Eurosurveillance Monthly Release  1997: Volume 2/ Issue 8 Article 1
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Eurosurveillance, Volume 2, Issue 8, 01 August 1997
Research Articles
Diphtheria in the 1990s - do we have all the answers?

Citation style for this article: Editorial Committee. Diphtheria in the 1990s - do we have all the answers?. Euro Surveill. 1997;2(8):pii=202. Available online:

The recent epidemic of diphtheria in the former Soviet Union has been a major threat to countries in western Europe, where levels of diphtheria anti-toxin in adults are less than optimal. The total number of cases in western Europe linked to countries further east have been smaller than might have been expected (see Editorial note page 63). The discussion paper by Galazka and Thomaszunas - Blaszczyk on the reasons why adults contract diphtheria (pages 60) reminds modern readers that much can be learned about current diphtheria problems through a detailed analysis of past epidemics.

The contrast in diphtheria incidence between western and eastern Europe raises many questions. Why has the resurgence in cases in the Newly Independent States been predominantly in adults if the profound decrease in immunisation levels mainly affected children? What special conditions contributed to the increased vulnerability of the adult population in Russia? Does prevention depend upon frequent boosting immunisations for adults? If the answer is yes, then why hasn't an epidemic occurred in western Europe? Are the results of contemporary serological surveys comparable internationally? Opportunities for diphtheria transmission must have increased in the east due to declining social conditions and population migration, but why this should have exploited waning adult immunity so rapidly is unclear. Has a change in antibiotic usage as a secondary effect of economic transition allowed diphtheria to flourish?

This issue of Eurosurveillance does not provide the answers but it does illustrate the marked geographic and historical differences in diphtheria incidence which exist within Europe. Further comparative studies may reveal more satisfactory answers which could ultimately lead to more effective prevention.

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