01 August 1997
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: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=202
Date of submission:
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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