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Abstract

Because of high vaccination rates, the Northern Territory of Australia had not seen locally transmitted toxigenic since the 1990s, until cutaneous diphtheria cases emerged in May 2025 and respiratory cases in March 2026. By 30 April 2026, there had been 131 cases (34 respiratory, 97 cutaneous) in an ongoing outbreak characterised by a high proportion of cutaneous cases with transmission driven by crowding and consequent poor skin health. Most patients have had mild disease due to prior vaccination.

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A corrected article has been published for this content:
Erratum for Euro Surveill. 2026;31(23)
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2026-06-11
2026-07-18
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References

  1. Australian Bureau of Statistics. Region summary: Northern Territory. Canberra: Australian Bureau of Statistics. [Accessed: 11 May 2026]. Available from: https://dbr.abs.gov.au/region.html?lyr=ste&rgn=7
  2. Australian Centre for Disease Control (A/CDC). Diphtheria. Surveillance case definition. Canberra: A/CDC; 2023. Available from https://www.cdc.gov.au/resources/publications/surveillance-case-definition-diphtheria
  3. Gordon CL, Fagan P, Hennessy J, Baird R. Characterization of Corynebacterium diphtheriae isolates from infected skin lesions in the Northern Territory of Australia. J Clin Microbiol. 2011;49(11):3960-2.  https://doi.org/10.1128/JCM.05038-11  PMID: 21918025 
  4. Howes M, Menouhos D, Christofis S, Hennessy J, Baird R. Characterisation of Corynebacterium diphtheriae isolates in the Northern Territory of Australia. Commun Dis Intell. 2023;47:47.  https://doi.org/10.33321/cdi.2023.47.31  PMID: 37226547 
  5. Schuhegger R, Lindermayer M, Kugler R, Heesemann J, Busch U, Sing A. Detection of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by a novel real-time PCR. J Clin Microbiol. 2008;46(8):2822-3.  https://doi.org/10.1128/JCM.01010-08  PMID: 18550743 
  6. Graham RMA, Rathnayake IU, Sandhu S, Bhandari M, Taunton C, Fisher V, et al. Genomic analysis of an outbreak of toxin gene bearing Corynebacterium diphtheriae in Northern Queensland, Australia reveals high level of genetic similarity. Epidemiol Infect. 2023;151:e92.  https://doi.org/10.1017/S0950268823000699  PMID: 37212056 
  7. Insitut Pasteur. Bacterial Isolate Genome Sequence Database BIGSdb-Pasteur. Corynebacterium diphtheriae complex. Paris: Institut Pasteur. [Accessed: 19 May 2026]. Available from: https://bigsdb.pasteur.fr/diphtheria
  8. Australian Centre for Disease Control (A/CDC). Diphtheria in Australia – Epidemiological update – 27 April 2026. Canberra: A/CDC; 2026. Available from: https://www.cdc.gov.au/resources/publications/diphtheria-australia-epidemiological-update-27-april-2026
  9. Northern Territory Government NT Health. Diphtheria for health professionals. Health alert. Darwin: NT Health; 2026. Available from: https://health.nt.gov.au/public-health-notifiable-diseases/diphtheria
  10. Australian Government Department of Health, Disability and Ageing. Diphtheria. In: Australian immunisation handbook. Canberra: Department of Health, Disability and Ageing; 2025. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/diphtheria
  11. Australian Government Department of Health, Disability and Ageing. Childhood immunisation coverage. Canberra: Department of Health, Disability and Ageing. [Accessed: 28 May 2026]. Available from: https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage
  12. Australian Centre for Disease Control (A/CDC). Diseases and surveillance. Diphtheria. Canberra: A/CDC. [Accessed: 11 May 2026]. Available from: https://www.cdc.gov.au/diseases/diphtheria
  13. Tiwari TST. Diphtheria. In: Heymann DL, editor. Control of Communicable Diseases Manual (21st Edn). Washington: American Public Health Association; 2022.
  14. 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 
  15. Queensland Health. Diphtheria. Queensland health guidelines for public health units. Brisbane: Queensland Health; 2023. Available from: https://www.health.qld.gov.au/cdcg/index/diphtheria#appa
  16. Marshall C, Caro WP, Costa A, Ho LL, Gardner PJ, Guitton C, et al. Diphtheria antitoxin production and procurement practices and challenges. Emerg Infect Dis. 2025;31(12):1-7.  https://doi.org/10.3201/eid3112.250796  PMID: 41491021 
  17. Hempenstall A, Short J, Marquardt T, Fisher V, Johnson J. Clinician alert: toxigenic diphtheria cases across North Queensland are on the rise. Med J Aust. 2023;218(5):238.  https://doi.org/10.5694/mja2.51858  PMID: 36806213 
  18. Australian Institute of Health and Welfare. Australian burden of disease study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018. Canberra: Australian Institute of Health and Welfare; 2022. Available from: https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary
  19. Hoefer A, Seth-Smith H, Palma F, Schindler S, Freschi L, Dangel A, et al. Corynebacterium diphtheriae Outbreak in Migrant Populations in Europe. N Engl J Med. 2025;392(23):2334-45.  https://doi.org/10.1056/NEJMoa2311981  PMID: 40466062 
  20. Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLoS Negl Trop Dis. 2018;12(6):e0006577.  https://doi.org/10.1371/journal.pntd.0006577  PMID: 29897915 
  21. United Kingdom Health Security Agency (UKHSA). Public health control and management of diphtheria in England. 2025 guidelines. London: UKHSA; 2025. Available from https://assets.publishing.service.gov.uk/media/68778311f5eb08157f3637d8/National_diphtheria_guidance_July2025.pdf
  22. Jacquinet S, Martini H, Mangion JP, Neusy S, Detollenaere A, Hammami N, et al. Outbreak of Corynebacterium diphtheriae among asylum seekers in Belgium in 2022: operational challenges and lessons learnt. Euro Surveill. 2023;28(44):2300130.  https://doi.org/10.2807/1560-7917.ES.2023.28.44.2300130  PMID: 37917029 
  23. Roewer de Porto IF, Dangel A, Schneider L, Zasada AA, Haller J, Abdelgawad I, et al. Two diphtheria sub-clusters with autochthonous cases in Germany and Poland within a Corynebacterium diphtheriae ST-574 outbreak, 2022 to July 2025. Euro Surveill. 2025;30(33):2500539.  https://doi.org/10.2807/1560-7917.ES.2025.30.33.2500539  PMID: 40843519 
  24. Berger A, Dangel A, Bengs K, Schlotmann S, Thomaßen P, Maday C, et al. Autochthonous outbreak of respiratory diphtheria caused by Corynebacterium diphtheriae, Germany, September 2024. Euro Surveill. 2025;30(27):2500116.  https://doi.org/10.2807/1560-7917.ES.2025.30.27.2500116  PMID: 40642771 
  25. Ah Chee D. Diphtheria is a disease of poverty that has no place in modern Australia. When we talk about Closing the Gap, this is the gap. The Guardian. 2026 May 28. Available from: https://www.theguardian.com/australia-news/2026/may/29/diphtheria-outbreak-remote-communities-aboriginal-indigenous-health-ntwnfb
  26. Clinical and Laboratory Standards Institute (CLSI). 2015. CLSI M45. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria. 3rd Edition. Wayne: CLSI; 2016.
  27. Berger A, Badell E, Åhman J, Matuschek E, Zidane N, Kahlmeter G, et al. Corynebacterium diphtheriae and Corynebacterium ulcerans: development of EUCAST methods and generation of data on which to determine breakpoints. J Antimicrob Chemother. 2024;79(5):968-76.  https://doi.org/10.1093/jac/dkae056  PMID: 38497937 
  28. Timms VJ, Nguyen T, Crighton T, Yuen M, Sintchenko V. Genome-wide comparison of Corynebacterium diphtheriae isolates from Australia identifies differences in the Pan-genomes between respiratory and cutaneous strains. BMC Genomics. 2018;19(1):869.  https://doi.org/10.1186/s12864-018-5147-2  PMID: 30509172 
Diphtheria outbreak, Northern Territory of Australia, 2025 to 2026
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Anthony+DK+Draper&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Draper Anthony DK</a>, <a href="/search?value1=Mark+Sistrom&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sistrom Mark</a>, <a href="/search?value1=Kimberley+McMahon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McMahon Kimberley</a>, <a href="/search?value1=Robert+Duguid&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Duguid Robert</a>, <a href="/search?value1=Jerry+Chen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chen Jerry</a>, <a href="/search?value1=Georgia+Cramp&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cramp Georgia</a>, <a href="/search?value1=Thomas+Cherian&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cherian Thomas</a>, <a href="/search?value1=Mirsaed+Miri+Nargesi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Miri Nargesi Mirsaed</a>, <a href="/search?value1=Dzulfikaar+Sutandar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sutandar Dzulfikaar</a>, <a href="/search?value1=Kevin+Freeman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Freeman Kevin</a>, <a href="/search?value1=Kelly+Lomas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lomas Kelly</a>, <a href="/search?value1=Tarrant+Tolotta&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tolotta Tarrant</a>, <a href="/search?value1=Jenine+C+Gunn&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gunn Jenine C</a>, <a href="/search?value1=Rowena+Boyd&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Boyd Rowena</a>, <a href="/search?value1=Jann+Hennessy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hennessy Jann</a>, <a href="/search?value1=Tinus+Creeper&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Creeper Tinus</a>, <a href="/search?value1=Jaimee+Harbidge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harbidge Jaimee</a>, <a href="/search?value1=Fatima+Sarmiento&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sarmiento Fatima</a>, <a href="/search?value1=Rebecca+Curr&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Curr Rebecca</a>, <a href="/search?value1=Jennifer+Yan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yan Jennifer</a>, <a href="/search?value1=Joshua+R+Francis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Francis Joshua R</a>, <a href="/search?value1=Robert+Baird&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Baird Robert</a>, <a href="/search?value1=Hayley+Stratton&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stratton Hayley</a>, <a href="/search?value1=Jane+Davies&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davies Jane</a>, <a href="/search?value1=Catherine+S+Marshall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marshall Catherine S</a>, <a href="/search?value1=Sonja+Janson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Janson Sonja</a>, <a href="/search?value1=Nerida+Moore&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Moore Nerida</a>, <a href="/search?value1=Rebecca+Wardell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wardell Rebecca</a>, <a href="/search?value1=Eugene+Athan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Athan Eugene</a>, <a href="/search?value1=George+Drewett&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Drewett George</a>, <a href="/search?value1=Liz+Moore&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Moore Liz</a>, <a href="/search?value1=Elly+Layton&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Layton Elly</a>, <a href="/search?value1=Unni+Susil+Kumar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Susil Kumar Unni</a>, <a href="/search?value1=Rosalind+Webby&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Webby Rosalind</a>, <a href="/search?value1=Ashish+Yadav&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yadav Ashish</a>, <a href="/search?value1=Vicki+L+Krause&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Krause Vicki L</a>, <a href="/search?value1=Bhavi+Ravindran&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ravindran Bhavi</a>, <a href="/search?value1=Ella+M+Meumann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meumann Ella M</a></span>. Diphtheria outbreak, Northern Territory of Australia, 2025 to 2026. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(23):pii=2600443. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.23.2600443" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.23.2600443</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 May 2026;&nbsp;&nbsp; <span class="generated">Accepted</span>: 10 Jun 2026 </span> </p>
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