-
Outbreak of Corynebacterium diphtheriae among asylum seekers in Belgium in 2022: operational challenges and lessons learnt
- Stéphanie Jacquinet1 , Helena Martini2 , Jean-Paul Mangion3 , Sarah Neusy4 , Aurélie Detollenaere4 , Naïma Hammami5 , Lien Bruggeman6 , Bart Hoorelbeke7 , Denis Pierard2 , Laura Cornelissen1
-
View Affiliations Hide AffiliationsAffiliations: 1 Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium 2 Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium 3 Médecins Sans Frontières, Brussels, Belgium 4 Preventive Medecine, Commission Communautaire Commune, Brussels, Belgium 5 Agency for Care and Health, Team Infection control and prevention, Brussels, Belgium 6 National Medical Coordinator, Fedasil, Brussels, Belgium 7 Public Health Emergencies department, Federal Public Service – Health, Food Chain Safety and Environment, Brussels, BelgiumStéphanie Jacquinetstephanie.jacquinet sciensano.be
-
View Citation Hide Citation
Citation style for this article: Jacquinet Stéphanie, Martini Helena, Mangion Jean-Paul, Neusy Sarah, Detollenaere Aurélie, Hammami Naïma, Bruggeman Lien, Hoorelbeke Bart, Pierard Denis, Cornelissen Laura. Outbreak of Corynebacterium diphtheriae among asylum seekers in Belgium in 2022: operational challenges and lessons learnt. Euro Surveill. 2023;28(44):pii=2300130. https://doi.org/10.2807/1560-7917.ES.2023.28.44.2300130 Received: 20 Feb 2023; Accepted: 14 Sept 2023
Abstract
Since 2022, European countries have been facing an outbreak of mainly cutaneous diphtheria caused by toxigenic Corynebacterium diphtheriae among asylum seekers. In Belgium, between 1 March and 31 December 2022, 25 cases of toxigenic C. diphtheriae infection were confirmed among asylum seekers, mostly among young males from Afghanistan. Multi-locus sequence typing showed that most isolates belonged to sequence types 574 or 377, similar to the majority of cases in other European countries. The investigation and management of the outbreak, with many asylum seekers without shelter, required adjustments to case finding, contact tracing and treatment procedures. A test-and-treat centre was organised by non-governmental organisations, the duration of the antimicrobial treatment was shortened to increase compliance, and isolation and contact tracing of cases was not possible. A vaccination centre was opened, and mobile vaccination campaigns were organised to vaccinate a maximum of asylum seekers. No more cases were detected between end December 2022 and May 2023. Unfortunately, though, three cases of respiratory diphtheria, including one death, were reported at the end of June 2023. To prevent future outbreaks, specific attention and sufficient resources should be allocated to this vulnerable population, in Belgium and at international level.
Article metrics loading...
Full text loading...
References
-
Centers for Disease Control and Prevention (CDC). The Pink Book: Diphtheria. Atlanta: CDC; 2021. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html
-
Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed. Philadelphia: Elsevier Saunders; 2015.
-
European Centre for Disease Prevention and Control (ECDC). Increase of reported diphtheria cases among migrants in Europe due to Corynebacterium diphtheriae, 2022. Stockholm: ECDC; 6 Oct 2022. Available from: https://www. ecdc.europa.eu/sites/default/files/documents/diphtheriacases-migrants-europe-corynebacterium-diphtheriae-2022.pdf
-
European Centre for Disease Prevention and Control (ECDC). Gap analysis on securing diphtheria diagnostic capacity and diphtheria antitoxin availability in the EU/EEA. Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Diphtheria%20Gap%20Analysis%20final%20with%20cover%20for%20web.pdf
-
Truelove SA, Keegan LT, Moss WJ, Chaisson LH, Macher E, Azman AS, et al. Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis. Clin Infect Dis. 2020;71(1):89-97. https://doi.org/10.1093/cid/ciz808 PMID: 31425581
-
European Centre for Disease Prevention and Control (ECDC). Diphtheria - Annual Epidemiological Report for 2018. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/diphtheria-annual-epidemiological-report-2018.pdf
-
European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/surveillance-atlas-infectious-diseases
-
Wyndham-Thomas C, Martini H, Pierard D. Surveillance épidémiologique de la diphtérie - 2018. [Epidemiological surveillance of diphtheria - 2018]. Brussels: Sciensano; 2019. French. Available from: https://www.sciensano.be/fr/biblio/surveillance-epidemiologique-de-la-diphterie-corynebacteries-toxinogenes-2018
-
Van Damme K, Peeters N, Jorens PG, Boiy T, Deplancke M, Audiens H, et al. Fatal diphtheria myocarditis in a 3-year-old girl-related to late availability and administration of antitoxin? Paediatr Int Child Health. 2018;38(4):285-9. https://doi.org/10.1080/20469047.2017.1378796 PMID: 28959916
-
World Health Organization (WHO). Diphtheria tetanus toxoid and pertussis (DTP) vaccination coverage. Geneva: WHO. [Accessed 23 Aug 2023]. Available from: https://immunizationdata.who.int/pages/coverage/dtp.html?CODE=EUR&ANTIGEN=DTPCV3&YEAR=
-
Meinel DM, Kuehl R, Zbinden R, Boskova V, Garzoni C, Fadini D, et al. Outbreak investigation for toxigenic Corynebacterium diphtheriae wound infections in refugees from Northeast Africa and Syria in Switzerland and Germany by whole genome sequencing. Clin Microbiol Infect. 2016;22(12):1003.e1-8. https://doi.org/10.1016/j.cmi.2016.08.010 PMID: 27585943
-
European Centre for Disease Prevention and Control (ECDC). Cutaneous diphtheria among recently arrived refugees and asylum seekers in the EU, 30 July 2015. Stockholm: ECDC; 2015. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/Diphtheria-cutaneous-EU-July-2015.pdf
-
Jablonka A, Behrens GMN, Stange M, Dopfer C, Grote U, Hansen G, et al. Tetanus and diphtheria immunity in refugees in Europe in 2015. Infection. 2017;45(2):157-64. https://doi.org/10.1007/s15010-016-0934-7 PMID: 27541038
-
European Border and Coast Guard Agency (Frontex). EU’s external borders in 2022: Number of irregular border crossings highest since 2016. Warsaw: Frontex; 2023. Available from: https://frontex.europa.eu/media-centre/news/news-release/eu-s-external-borders-in-2022-number-of-irregular-border-crossings-highest-since-2016-YsAZ29
-
European Union Agency for Asylum (EUAA). Latest Asylum Trends - Annual Overview 2022. Valletta: EUAA. [Accessed: 23 Aug 2023]. Available from: https://euaa.europa.eu/latest-asylum-trends-annual-overview-2022
-
Badenschier F, Berger A, Dangel A, Sprenger A, Hobmaier B, Sievers C, et al. Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022. Euro Surveill. 2022;27(46):2200849. https://doi.org/10.2807/1560-7917.ES.2022.27.46.2200849 PMID: 36398576
-
Kofler J, Ramette A, Iseli P, Stauber L, Fichtner J, Droz S, et al. Ongoing toxin-positive diphtheria outbreaks in a federal asylum centre in Switzerland, analysis July to September 2022. Euro Surveill. 2022;27(44):2200811. https://doi.org/10.2807/1560-7917.ES.2022.27.44.2200811 PMID: 36330823
-
Commissariat général aux réfugiés et aux apatrides (CGRA). Statistiques d’asile: aperçu 2022. [Asylum statistics: overview 2022]. Brussels: CGRA. [Accessed: 22 Aug 2023]. French. Available from: https://www.cgra.be/fr/actualite/statistiques-dasile-apercu-2022
-
Federal agency for the reception of asylum seekers (Fedasil). Review 2022. Brussels, Fedasil; Jun 2023. Available from: https://www.fedasil.be/sites/default/files/content/download/files/annual_report_2022.pdf
-
European Centre for Disease Prevention and Control (ECDC). Launch of EpiPulse, a new portal to strengthen the prevention and control of infectious diseases. Stockholm: ECDC; 22 Jun 2021. Available from: https://www.ecdc.europa.eu/en/news-events/launch-epipulse-new-portal-strengthen-prevention-and-control-infectious-diseases
-
Agenschap zorg and gezondheid. Richtlijn infectieziektebestrijding vlaanderen - Difterie -. [Infection control guideline Flanders – diphtheria]. Brussels: Agenschap zorg and gezondheid; 2022. Dutch. Available from: https://www.zorg-en-gezondheid.be/sites/default/files/2022-12/Difterie_2022.pdf
-
Commission Communautaire Commune (Cocom). Diphtérie - Protocoles médicaux de prise en charge des cas pour le public demandeur d’asile en situation de précarité. [Diphtheria – Medical case management protocols for asylum seekers in precarious situations]. Brussels: Cocom; 2022. French.
-
World Health Organization (WHO). International Health Regulations (3rd edition). Geneva: WHO; 2005. Available from: https://www.who.int/publications-detail-redirect/9789241580496
-
European Union (EU). Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision No 2119/98/EC. Official Journal of the European Union. Luxembourg: Publications Office of the European Union, 5.11. 2013:L 293. Available from: https://eur-lex.europa.eu/eli/dec/2013/1082/oj
-
Hauser D, Popoff MR, Kiredjian M, Boquet P, Bimet F. Polymerase chain reaction assay for diagnosis of potentially toxinogenic Corynebacterium diphtheriae strains: correlation with ADP-ribosylation activity assay. J Clin Microbiol. 1993;31(10):2720-3. https://doi.org/10.1128/jcm.31.10.2720-2723.1993 PMID: 8253972
-
Engler KH, Glushkevich T, Mazurova IK, George RC, Efstratiou A. A modified Elek test for detection of toxigenic corynebacteria in the diagnostic laboratory. J Clin Microbiol. 1997;35(2):495-8. https://doi.org/10.1128/jcm.35.2.495-498.1997 PMID: 9003626
-
The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1, 2023. Available from: https://www.eucast.org/clinical_breakpoints
-
Zhou Z, Alikhan NF, Sergeant MJ, Luhmann N, Vaz C, Francisco AP, et al. GrapeTree: visualization of core genomic relationships among 100,000 bacterial pathogens. Genome Res. 2018;28(9):1395-404. https://doi.org/10.1101/gr.232397.117 PMID: 30049790
-
Jolley KA, Bray JE, Maiden MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res. 2018;3:124. https://doi.org/10.12688/wellcomeopenres.14826.1 PMID: 30345391
-
Guglielmini J, Hennart M, Badell E, Toubiana J, Criscuolo A, Brisse S. Genomic epidemiology and strain taxonomy of Corynebacterium diphtheriae. J Clin Microbiol. 2021;59(12):e0158121. https://doi.org/10.1128/JCM.01581-21 PMID: 34524891
-
Superior Health Council. Prise en charge des infections à Corynebacterium ulcerans et diphteriae. [Management of Corynebacterium ulcerans and diphtheriae infections] Brussels: Superior Health Council; 2019. French. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/20190820_css-9503_corynebacterium_vweb.pdf
-
European Centre for Disease Prevention and Control (ECDC). Expert Opinion on the public health needs of irregular migrants, refugees or asylum seekers across the EU’s southern and south-eastern borders. Stockholm: ECDC; 1 Oct 2015. Available from: https://www.ecdc.europa.eu/en/publications-data/expert-opinion-public-health-needs-irregular-migrants-refugees-or-asylum-seekers
-
Polonsky JA, Ivey M, Mazhar MKA, Rahman Z, le Polain de Waroux O, Karo B, et al. Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox’s Bazar, Bangladesh, 2017 to 2019: A retrospective study. PLoS Med. 2021;18(4):e1003587. https://doi.org/10.1371/journal.pmed.1003587 PMID: 33793554
-
World Health Organization (WHO). Operational protocol for clinical management of Diphtheria. Bangladesh, Cox’s Bazaar. Geneva: WHO; 2017. Available from: https://www.who.int/publications-detail-redirect/operational-protocol-for-clinical-management-of-diphtheria
-
Agence Fédéral des Médicaments et des Produits de Santé (AFMPS). Résumé des caracteristiques du produit. Azithromycine 500mg. [Summary of product characteristics. Azithromycine 500mg]. Brussels: AFMPS; 2022 Jun p. 18. French. Available from: https://app.fagg-afmps.be/pharma-status/api/files/62bc6ee11e5c015ab3ede178
-
Hennart M, Panunzi LG, Rodrigues C, Gaday Q, Baines SL, Barros-Pinkelnig M, et al. Population genomics and antimicrobial resistance in Corynebacterium diphtheriae. Genome Med. 2020;12(1):107. https://doi.org/10.1186/s13073-020-00805-7 PMID: 33246485
-
United Kingdom Health Security Agency (UKHSA). Public health control and management of diphtheria in England: supplementary guidance for cases and outbreaks in asylum seeker accommodation settings. London: UKHSA; 2023. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1177530/diphtheria-AS-supplementary-guidance-august-2023.pdf
-
Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet. 2007;369(9560):482-90. https://doi.org/10.1016/S0140-6736(07)60235-9 PMID: 17292768
-
Seth-Smith H, Palma F, Freschi L, Badell E, Berger A, Blaschitz M, et al. 2022 European outbreak of Corynebacterium diphtheriae among migrants: situational report illuminated through whole genome sequencing. Poster presented at: European Congress of Clinical Microbiology and Infectious Diseases, April 15-18, 2023; Copenhagen.
-
Risk management Group (RMG). Minutes of the meeting 29.09.22. Brussels: RMG; 2022. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/1.1_final_rmg_rapport_20220929_nl.pdf
-
Risk management Group (RMG). Minutes of the meeting 20.10.2022. Brussels: RMG; 2022. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/1.1_final_rmg_rapport_20221020_nlfr.pdf
-
Risk management Group (RMG). Minutes of the meeting 15.12.2022. Brussels: RMG; 2022. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/1.1_final_rmg_rapport_20221215_fr.pdf
Data & Media loading...