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Abstract

Background

Diphtheria is a potentially fatal disease caused by toxigenic strains of or

Aim

Our objective was to review the epidemiology of diphtheria in the United Kingdom (UK) and the impact of recent changes in public health management and surveillance.

Methods

Putative human toxigenic diphtheria isolates in the UK are sent for species confirmation and toxigenicity testing to the National Reference Laboratory. Clinical, epidemiological and microbiological information for toxigenic cases between 2009 and 2017 are described in this population-based prospective surveillance study.

Results

There were 33 toxigenic cases of diphtheria aged 4 to 82 years. Causative species were (n = 18) and (n = 15). Most cases were cutaneous (14/18) while more than half of cases had respiratory presentations (8/15). Two thirds (23/33) of cases were inadequately immunised. Two cases with infections died, both inadequately immunised. The major risk factor for aquisition was travel to an endemic area and for contact with a companion animal. Most confirmed or isolates (441/507; 87%) submitted for toxigenicity testing were non-toxigenic however, toxin positivity rates were higher (15/23) for than (18/469). Ten non-toxigenic toxin gene-bearing (NTTB) were also detected.

Conclusion

Diphtheria is a rare disease in the UK. In the last decade, milder cutaneous cases have become more frequent. Incomplete vaccination status was strongly associated with the risk of hospitalisation and death.

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/content/10.2807/1560-7917.ES.2020.25.11.1900462
2020-03-19
2020-09-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.11.1900462
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References

  1. Public Health England (PHE). Chapter 15: Diphtheria. The Green Book: Immunisation against infectious disease. London: PHE; 2013. Available from: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
  2. Wagner KS, White JM, Andrews NJ, Borrow R, Stanford E, Newton E, et al. Immunity to tetanus and diphtheria in the UK in 2009. Vaccine. 2012;30(49):7111-7.  https://doi.org/10.1016/j.vaccine.2012.09.029  PMID: 23022148 
  3. Public Health England (PHE).Childhood vaccination coverage statistics England, 2016-2017. London: PHE; 2017. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics/childhood-vaccination-coverage-statistics-england-2016-17
  4. Public Health England (PHE). Td/IPV school-based programme: vaccine coverage estimates, England, to 31 August 2019. London: PHE; 2017. Available from: https://www.gov.uk/government/publications/school-leaver-booster-tdipv-vaccine-coverage-estimates
  5. Wagner KS, White JM, Lucenko I, Mercer D, Crowcroft NS, Neal S, et al. Diphtheria in the postepidemic period, Europe, 2000-2009. Emerg Infect Dis. 2012;18(2):217-25.  https://doi.org/10.3201/eid1802.110987  PMID: 22304732 
  6. Dorella FA, Pacheco LGC, Oliveira SC, Miyoshi A, Azevedo V. Corynebacterium pseudotuberculosis: microbiology, biochemical properties, pathogenesis and molecular studies of virulence. Vet Res. 2006;37(2):201-18.  https://doi.org/10.1051/vetres:2005056  PMID: 16472520 
  7. Public Health England (PHE). Public health control and management of diphtheria (in England and Wales). 2015 Guidelines. London: PHE; 2015. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/774753/Diphtheria_Guidelines_Final.pdf
  8. Wagner KS, White JM, Crowcroft NS, De Martin S, Mann G, Efstratiou A. Diphtheria in the United Kingdom, 1986-2008: the increasing role of Corynebacterium ulcerans. Epidemiol Infect. 2010;138(11):1519-30.  https://doi.org/10.1017/S0950268810001895  PMID: 20696088 
  9. Tiwari TS, Golaz A, Yu DT, Ehresmann KR, Jones TF, Hill HE, et al. Investigations of 2 cases of diphtheria-like illness due to toxigenic Corynebacterium ulcerans. Clin Infect Dis. 2008;46(3):395-401.  https://doi.org/10.1086/525262  PMID: 18181738 
  10. Wagner KS, Stickings P, White JM, Neal S, Crowcroft NS, Sesardic D, et al. A review of the international issues surrounding the availability and demand for diphtheria antitoxin for therapeutic use. Vaccine. 2009;28(1):14-20.  https://doi.org/10.1016/j.vaccine.2009.09.094  PMID: 19818425 
  11. Martini H, Soetens O, Litt D, Fry NK, Detemmerman L, Wybo I, et al. Diphtheria in Belgium: 2010-2017. J Med Microbiol. 2019;68(10):1517-25.  https://doi.org/10.1099/jmm.0.001039  PMID: 31418673 
  12. De Zoysa A, Efstratiou A, Mann G, Harrison TG, Fry NK. Development, validation and implementation of a quadruplex real-time PCR assay for identification of potentially toxigenic corynebacteria. J Med Microbiol. 2016;65(12):1521-7.  https://doi.org/10.1099/jmm.0.000382  PMID: 27902437 
  13. Efstratiou A, Maple PAC. Manual for the laboratory diagnosis of diphtheria. Copenhagen: World Health Organization World Health Organization. Regional Office for Europe; 1994. Available from: https://apps.who.int/iris/handle/10665/108108
  14. Zakikhany K, Neal S, Efstratiou A. Emergence and molecular characterisation of non-toxigenic tox gene-bearing Corynebacterium diphtheriae biovar mitis in the United Kingdom, 2003-2012. Euro Surveill. 2014;19(22):20819.  https://doi.org/10.2807/1560-7917.ES2014.19.22.20819  PMID: 24925458 
  15. Hogg RA, Wessels J, Hart J, Efstratiou A, De Zoysa A, Mann G, et al. Possible zoonotic transmission of toxigenic Corynebacterium ulcerans from companion animals in a human case of fatal diphtheria. Vet Rec. 2009;165(23):691-2. PMID: 19966333 
  16. Edwards D, Kent D, Lester C, Brown CS, Murphy ME, Brown NM, et al. Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017. Euro Surveill. 2018;23(39).  https://doi.org/10.2807/1560-7917.ES.2018.23.39.1700681  PMID: 30280689 
  17. De Zoysa A, Hawkey PM, Engler K, George R, Mann G, Reilly W, et al. Characterization of toxigenic Corynebacterium ulcerans strains isolated from humans and domestic cats in the United Kingdom. J Clin Microbiol. 2005;43(9):4377-81.  https://doi.org/10.1128/JCM.43.9.4377-4381.2005  PMID: 16145080 
  18. Katsukawa C, Komiya T, Yamagishi H, Ishii A, Nishino S, Nagahama S, et al. Prevalence of Corynebacterium ulcerans in dogs in Osaka, Japan. J Med Microbiol. 2012;61(Pt 2):266-73.  https://doi.org/10.1099/jmm.0.034868-0  PMID: 21921111 
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