Abstract
In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria–tetanus–pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.
Highlights
In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004
Since 2000, the World Health Organization (WHO) South-East Asia region has reported most of the global diphtheria incidence each year
India has reported the largest proportion of diphtheria cases in aggregate Joint Reporting Form (JRF) data since 2000 (64%); in data compiled from the literature review, >50% of cases with age and vaccination status were from India in the full dataset (8,720 [57%])
Summary
In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. As national diphtheria–tetanus–pertussis (DTP) 3 coverage increased, the proportion of case-patients
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