Abstract
BackgroundDiphtheria is a potentially fatal disease caused by toxigenic strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotuberculosis.AimOur 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.MethodsPutative 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.ResultsThere were 33 toxigenic cases of diphtheria aged 4 to 82 years. Causative species were C. diphtheriae (n = 18) and C. ulcerans (n = 15). Most C. diphtheriae cases were cutaneous (14/18) while more than half of C. ulcerans cases had respiratory presentations (8/15). Two thirds (23/33) of cases were inadequately immunised. Two cases with C. ulcerans infections died, both inadequately immunised. The major risk factor for C. diphtheriae aquisition was travel to an endemic area and for C. ulcerans, contact with a companion animal. Most confirmed C. diphtheriae or C. ulcerans isolates (441/507; 87%) submitted for toxigenicity testing were non-toxigenic, however, toxin positivity rates were higher (15/23) for C. ulcerans than C. diphtheriae (18/469). Ten non-toxigenic toxin gene-bearing (NTTB) C. diphtheriae were also detected.ConclusionDiphtheria is a rare disease in the UK. In the last decade, milder cutaneous C. diphtheriae cases have become more frequent. Incomplete vaccination status was strongly associated with the risk of hospitalisation and death.
Highlights
Diphtheria was once one of the most feared childhood diseases in the United Kingdom (UK), with ca 60,000 cases per year, but dramatically reduced following introduction of mass immunisation in 1942 [1]
We present an updated epidemiological analysis of diphtheria in the UK based on surveillance and laboratory testing of all C. diphtheriae and C. ulcerans isolates from 2009 until 2017 and following the availability of a rapid national PCR service to assess the impact of changes in the surveillance system and inform public health risk assessment and practice
It is a legal requirement in the UK that all human isolates of C. diphtheriae, C. ulcerans and C. pseudotuberculosis identified by microbiological laboratories are reported to public health authorities and isolates should be sent for toxigenicity testing to the National
Summary
Diphtheria was once one of the most feared childhood diseases in the United Kingdom (UK), with ca 60,000 cases per year, but dramatically reduced following introduction of mass immunisation in 1942 [1]. Diphtheria vaccine coverage in the UK remains high; coverage of the primary course evaluated at 1 and 2 years of age has been between 91% and 95% since the early 1990s. Diphtheria is a potentially fatal disease caused by toxigenic strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotuberculosis. 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. Epidemiological and microbiological information for toxigenic cases between 2009 and 2017 are described in this population-based prospective surveillance study. Results: There were toxigenic cases of diphtheria aged 4 to 82 years.
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