Epidemic Diphtheria Research Articles

The first steps of the Zemstvo sanitary inspector N. A. Semashko in fight with epidemics in the Novouzensk Uyezd of the Samara Guberniya

The personality of N. A. Semashko presents incontestable interest as health care official and ideologist of the Soviet health care system who contributed significantly into development of health care. Great number of studies are devoted to analysis of activities of N. A. Semashko in the Soviet period holding position of the First People's Commissar of health care of the RSFSR, initiator and head of the chair of Social hygiene of the Medical Faculty of the First Moscow State University. The studies related to pre-revolutionary period of life of N. A. Semashko are presented in less degree. The article describes, on the basis of publications and archive sources (documents from the Central State Archive of the Samara Oblast, the foundations of the Russian State Library and also the family archive of E. G. Farobina, grand-daughter of N. A. Semashko) the period of life and and activity of N. A. Semashko in the Samara Gubernia after graduating the medical faculty of the Imperial Kazan University. In 1901-1902, after short training in bacteriological laboratory of the Samara Gubernia Zemstvo Hospital and appointment to the post of sanitary and epidemiological doctor of the Zemstvo, N. A. Semashko was directly involved in elimination of epidemics of diphtheria in Orlov Guy village and of anthrax in Alexandria village of the Novouzensky Uezd. The dangerous epidemics were eliminated owing to outstanding medical knowledge, courage and organizational skills of young doctor.

Ethnic conflict as a risk amplifier for resurgent P. vivax malaria in temperate zones: A case study from the Caucasus region

One of the most protracted post-Soviet conflicts of the 1990s was a territorial dispute between Armenia and Azerbaijan over the contested Karabakh region. Years of ethnic violence led to the displacement of nearly a million refugees, as well as a public health crisis that included epidemics of malaria, diphtheria and other preventable diseases. Malaria is not usually considered a health risk in temperate climates, but seasonal epidemics were widespread throughout the Caucasus in the early decades of the twentieth century. This paper combines qualitative historical research with geospatial analysis to explore how endemic malaria was controlled during the Soviet era, and how ethnic conflict reconfigured local ecologies to facilitate the re-emergence of P. vivax after the Soviet collapse in the 1990s. This research reveals that ethnic conflicts have specific qualities that increase risks of infectious and vector borne disease outbreaks, even in places that have successfully achieved a modern health and mortality profile. The risk amplifiers of ethnic conflicts include 1) the creation of contested spaces controlled by separatists that are outside of any national public health surveillance system; 2) mass population movements and refugee outflows due to ethnic violence; and 3) changes in land use that expand potential mosquito breeding sites throughout the conflict zone. Continued hostilities between Armenia and Azerbaijan, combined with the repopulation of key vector species (specifically An. sacharovi) lead us to conclude that populations in the Caucasus remain vulnerable to resurgent outbreaks of ethno-nationalist violence as well as the return of seasonal malaria, even after decades of successful control.

Vulgarly Called The Throat-Distemper: New Jersey’s Two-Century Struggle Against Diphtheria

In 1740, minister and physician Jonathan Dickinson of Elizabethtown, New Jersey, published “Observations on that Terrible Disease Vulgarly Called the Throat-Distemper,” a short treatise on the diagnosis and treatment of epidemic diphtheria for the benefit of physicians in Boston. Dickinson’s pamphlet was a landmark in American colonial medical literature. It was New Jersey’s first—and last—important original contribution to the medical literature on diphtheria. For the next two centuries, New Jersey, with no medical colleges or prestigious teaching hospitals of its own, would import the medical knowledge and innovations necessary to control and finally eradicate the disease that cruelly killed thousands of New Jersey children in the two centuries following Dickinson’s report. This article examines the processes by which New Jersey practitioners and public health officers imported, processed, disseminated, and applied the lessons of the germ theory and immunology in their two-century quest to banish one of the great scourges of childhood.

Professionalisation and Professionalism: Diphtheria and Medical Practice in Minnesota 1850–1910

Summary The evolution of professionalism in Minnesota began when allopathic and homeopathic physician leaders organised medical societies and colleges to define and perpetuate their styles of practice. The epidemics of diphtheria that ravaged the state demanded prompt public health measures of quarantine to reduce the spread of the disease. Then the successful utilization of diphtheria antitoxin in Europe encouraged its local production in Minnesota and the re-education of all physicians there to convince them that they were no longer helpless to treat this infection that killed so many children. Their professionalisation was completed when they implemented the cure for diphtheria that laboratory science had produced. Homeopathic and allopathic practices converged as Minnesota physicians transformed their occupation from merely caring and comforting to actively treating and curing a serious infection.

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas.

Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

Exudative Pharyngitis by Corynebacterium pseudodiphtheriticum-A Diagnostic Challenge during Diphtheria Epidemic

Exudative Pharyngitis by Corynebacterium pseudodiphtheriticum-A Diagnostic Challenge during Diphtheria Epidemic

The 1925 Diphtheria Antitoxin Run to Nome - Alaska: A Public Health Illustration of Human-Animal Collaboration.

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin (DAT) played a pivotal role in the history of public health and vaccinology prior to the advent of the diphtheria-tetanus toxoids and acellular pertussis (DTaP) vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative.

Infant mortality and epidemic diseases. Wartime Finnmark in a comparative perspective

<p>The effects of war on the health of the population have never been systematically studied. The article explores the impact of war on the general health condition of Finnmark’s population during the war years. The indicators chosen are infant mortality and the epidemic diseases diphtheria, scabies and acute gastroenteritis. The development of the indicators in Finnmark is compared with the averages in Norway and Finnish Lapland. The findings deserve attention. The article discusses the statistical indicators and findings in a social and historical context with a range of sources. The article is a broad as well as penetrating analysis of the war’s impact on the health of the civilian population of Finnmark and on their everyday living and survival.</p>

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

BackgroundEpidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years.MethodsThis study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non- clinical variable using Microsoft™ Excel® 2010.ResultsOur findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district.ConclusionsThe outbreak raises several concerns regarding the epidemiology of diphtheria in Dhule. The reason for shift in the median age despite consistently poor immunization coverage (below 50%) remains unclear. Concomitant efforts should now focus on improving and monitoring primary immunization and booster coverages across all age groups. Gradually introducing adult immunization at ten year intervals may become necessary to prevent future vulnerabilities. Laboratory networks for genotyping and toxigenicity testing are urgently mandated at district level given the endemicity of the disease in the surrounding region and its recent introduction in remote Dhule. Contingency funds with pre- agreements to obtain ADS and DT/Td vaccines at short notice and developing standard case management protocols at district level are necessary. Monitoring the disease, emerging strains and mutations, alongside drug resistance through robust and effective surveillance is a pragmatic way forward.

Tracheostomy in children: an ancient procedure still under debate

Tracheostomy is one of the oldest surgical procedures reported in ancient medicine books. It became widely used in the 19th century during the diphtheria epidemics in Europe, and then in the 20th century following a series of devastating poliomyelitis epidemics in the 1950s [1–3]. Around the turn of the 20th century, Jackson [4] standardised the indications for tracheostomy, the technique itself and the instruments used; he developed anatomically correct tracheostomy tubes and paved the way for further improvement of the technique. The role of tracheostomy in the ventilatory management of the critically ill adult has been endorsed by the American College of Chest Physicians to improve patients’ comfort, to reduce the incidence of pneumonia and to facilitate respiratory weaning [5]. Adults that are clinically stable and necessitate prolonged mechanical ventilation have an indication for tracheostomy [5]; patients with acute respiratory failure, acute exacerbations of chronic pulmonary disease, coma and neuromuscular disorders may also require it [6, 7]. While tracheostomy in adults is accepted, in children it is perceived as an aggressive procedure, but over time the indication in paediatrics has changed from an emergency procedure during diphtheria and poliomyelitis epidemics into aid for children dependent on assisted ventilation. In children the most frequent indications are upper airway obstruction (craniofacial malformations, craniofacial and laryngeal tumours, and obstructive sleep apnoea), …

Types of the Diphtheria Bacillus and Clinical Diphtheria.

Acta Medica ScandinavicaVolume 129, Issue 5 p. 415-440 Types of the Diphtheria Bacillus and Clinical Diphtheria. Observations daring the Diphtheria Epidemic in Copenhagen in the Winter of 1943–44, with special reference to the Relation between the Types of the Bacillus and the Clinical Symptoms, Complications, Prognosis and Autopsy Findings. E. AMMUNDSEN, E. AMMUNDSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorJ. BANG, J. BANG Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorG. FRANCK, G. FRANCK Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorA. HANSEN, A. HANSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorH. C. A. LASSEN, H. C. A. LASSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorJ. P. VALD. POULSEN, J. P. VALD. POULSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorE. SNORRASON, E. SNORRASON Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorP. THYGESEN, P. THYGESEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorBJ. VIMSTRUP, BJ. VIMSTRUP Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorH. H. ZIMSEN, H. H. ZIMSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this author E. AMMUNDSEN, E. AMMUNDSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorJ. BANG, J. BANG Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorG. FRANCK, G. FRANCK Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorA. HANSEN, A. HANSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorH. C. A. LASSEN, H. C. A. LASSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorJ. P. VALD. POULSEN, J. P. VALD. POULSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorE. SNORRASON, E. SNORRASON Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorP. THYGESEN, P. THYGESEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorBJ. VIMSTRUP, BJ. VIMSTRUP Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this authorH. H. ZIMSEN, H. H. ZIMSEN Blegdam Hospital, Copenhagen (Chief Physician: Professor H. C. A. Lassen)Search for more papers by this author First published: January/December 1948 https://doi.org/10.1111/j.0954-6820.1948.tb09315.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume129, Issue5January/December 1948Pages 415-440 RelatedInformation

Molecular epidemiology of C. diphtheriaestrains during different phases of the diphtheria epidemic in Belarus

BackgroundThe reemergence of epidemic diphtheria in Belarus in 1990s has provided us with important information on the biology of the disease and the diversity of the causative agent Corynebacterium diphtheriae. Molecular investigations were conducted with the aim to analyze the genetic variability of C diphtheriae during the post-epidemic period.MethodsThe biotype and toxigenicity status of 3513 C. diphtheriae strains isolated from all areas in Belarus during a declining period of diphtheria morbidity (1996–2005) was undertaken. Of these, 384 strains were isolated from diphtheria cases, 1968 from tonsillitis patients, 426 from contacts and 735 from healthy carriers. Four hundred and thirty two selected strains were ribotyped.ResultsThe C diphtheriae gravis biotype, which was prevalent during 1996–2000, was "replaced" by the mitis biotype during 2001–2005. The distribution of toxigenic C. diphtheriae strains also decreased from 47.1% (1996) to 5.8% (2005). Changes in the distribution of the epidemic ribotypes Sankt-Peterburg and Rossija were also observed. During 2001–2005 the proportion of the Sankt-Peterburg ribotype decreased from 24.3% to 2.3%, in contrast to the Rossija ribotype, that increased from 25.1% to 49.1%. The circulation of other toxigenic ribotypes (Otchakov, Lyon, Bangladesh), which were prevalent during the period of high diphtheria incidence, also decreased. But at the same time, the proportion of non-toxigenic strains with the Cluj and Rossija ribotypes dramatically increased and accounted for 49.3% and 30.1%, respectively.ConclusionThe decrease in morbidity correlated with the dramatic decrease in the isolation of the gravis biotype and Sankt Peterburg ribotype, and the prevalence of the Rossija ribotype along with other rare ribotypes associated with non-toxigenic strains (Cluj and Rossija, in particular).

Poor Law versus Public Health: Diphtheria, Sanitary Reform, and the ‘Crusade’ against Outdoor Relief, 1870–1900

This article focuses on several high-profile, rural diphtheria epidemics of the later nineteenth century to explore the links between public health reform and disease control, and the changing character of the Poor Law. It explains that a Poor Law retrenchment policy, dubbed by contemporaries as the 'crusade' against outdoor relief, dominated Local Government Board (hereafter LGB) spending policies. The policy had a profound impact on all areas of local government administration. Notably, it exposed the fact that there were many over-lapping personnel, sitting as both Poor Law and sanitary officials. Holding joint offices compromised objectivity. It also encouraged administrators to cut local taxation ruthlessly. Doctors, the poor, and the LGB Medical Department objected strongly to the fact that too much financial power was delegated to self-interested ratepayers. In particular, urgently needed sanitary reform was frustrated. Large-scale investment was needed to improve drinking water, sewage supplies, and support research into preventive medicine, but few ratepayers were prepared to foot the bill, unless compelled to do so. This situation was further exacerbated by the permissive, rather than statutory, nature of public health legislation. Curiously, both historians of medicine and the Poor Law have under-estimated the extent to which the 'crusade' ethos dominated national and regional government spending. This article shows that studying rural diphtheria outbreaks can begin to uncover the degree of central government collaboration with ratepayers for Poor Law cost-cutting reasons, to the detriment of national public health reform in late Victorian England.

Prevalence of IgG diphtheria antitoxin in blood donors in Rio de Janeiro

The lack of information on the immunity of adults in Brazil against diphtheria prompted us to analyse sera from 234 blood donors aged 18-61 years (30.3% females and 69.7% males). IgG diphtheria antitoxin levels determined by means of an ELISA, validated by toxin neutralization test in Vero cells, showed that 30.7% (95% CI 25.0-37.1) of the population was fully protected (>or=1 IU/ml). The highest percentage of subjects fully protected was in the 31-40 years age group. Most of the subjects with uncertain or no protection (<1 IU/ml) were found in the 18-30 years age group (43.8%, OR 2.18, P=0.01). Antitoxin levels were not influenced by the increase in age. Males were more protected than females (80.5%, OR 0.44, P=0.01). The prevalence of 30% of individuals fully protected against diphtheria in blood donors in Rio de Janeiro supports the fact that immunity to diphtheria among healthy Brazilian adults is inadequate. To avoid diphtheria epidemics in the future the immunity among adults should be raised in the coming years.

The emerging epidemic of cardiovascular disease.

When Northern Sweden applied for membership in the WHO MONICA study in 1984, the high prevalence of cardiovascular disease in the region had become a great concern in the population as well as among policy makers and healthcare providers. Earlier, myocardial infarction and stroke were more common in highly educated groups. What once was regarded as a symptom of affluence now turned out to be affecting poorly educated people most. In the nineteenth century, every First Medical Officer in every Swedish county reported on the health status in the province in an Annual Report on health status (1). In the Northern Sweden regions these reports stated that dysentery, diphtheria, and pneumonia epidemics were common and together with tuberculosis, measles, and whooping cough were dreaded public health problems. In transition towards a modern welfare state, Sweden paid attention to differences in social conditions, including health.

Seventh International Meeting of the European Laboratory Working Group on Diphtheria - Vienna, June 2002.

The Seventh International Meeting of the European Laboratory Working Group on Diphtheria (ELWGD) was held in Vienna, Austria in June 2002 and brought together the microbiologists and epidemiologists responsible for diphtheria in many countries throughout the world. The ELWGD was formed in 1993 in response to the epidemics of diphtheria in Russia and the Newly Independent States (NIS) of the former Soviet Union (1,2). These epidemics, and others elsewhere, highlighted the importance of strengthening and maintaining both epidemiological surveillance and reliable laboratory screening. Since December 2001, these areas have been progressed and strengthened by European Commission (EC) funding to undertake a feasibility study for diphtheria surveillance amongst European Union (EU) member states and accession countries, and to establish a definitive and official European diphtheria surveillance network called DIPNET (EC DG SANCO Agreement No. S12.324473 (2001 CVG4-012)). This was the first international meeting of the ELWGD to be organised and funded under the auspice of the DIPNET (European Diphtheria Surveillance Network).

Immunity against diphtheria and tetanus in German blood donors.

After the recent diphtheria epidemics in Eastern Europe in the early 1990s, we re-evaluated the diphtheria and tetanus immunity of 321 German blood donors (192 men and 129 women). The mean antitoxin levels of all blood donors in this study, measured by commercial ELISA, revealed a questionable protection (0.1-1.0 IU/ml) against diphtheria. In 1994, 66.4% were without immunity against diphtheria (55.0% in 1997/98), 32.1% (41.5% in 1997/98) showed questionable protection and only 1.5% (3.5% in 1997/98) had protective antitoxin levels. The evaluation of tetanus immunity revealed only 0.5% (1.1% in 1997/98) of the subjects with no protection and 9.1% (8.5% in 1997/98) with questionable protection. For this reason, we conclude that the diphtheria epidemics only lead to an insufficient improvement of the immunization status in a healthy German population.

DIPHTHERIA IN A VACCINATED ADULT IN RIO DE JANEIRO, BRAZIL

In 1999, a case of diphtheria in a 32-year-old woman was reported. The patient developed a sore throat immediately after participating of a five-day meeting with European workers in Rio de Janeiro. Her history included complete pediatric immunization (DTP) and three doses of adult formulation tetanus and diphtheria toxoid (dT) two years earlier. Clinical diagnosis of diphtheria was not made until microbiologic examination of specimens confirmed toxigenicity of Corynebacterium diphtheriae var. gravis, a biotype currently found circulating within Europe where diphtheria remains epidemic. This case reinforces the potential susceptibility of Brazilian adults to epidemic diphtheria in the vaccine era.

"The Awful Judgements of God upon the Land": Smallpox in Colonial Cambridge, Massachusetts

tures were destroyed. English settlers, by no means immune to many of these same outbreaks, were also stricken with periodic epidemics of smallpox, measles, and diphtheria. Sickness was normally attributed to an act of God, and because the colonists had little understanding of either the transmission or the nature of most illnesses, the community knew of few actions that it could take to prevent outbreaks. New England, in 1721, faced such an epidemic. Smallpox spread throughout the region and was responsible for the deaths of almost one thousand people in Boston alone. The extent of the epidemic, combined with the belief that God was punishing the colonists for breaking their covenant with him, created a psychological frenzy within New England. Unlike in previous smallpox outbreaks, however, inoculation (actually variolation, or the use of a live virus) offered an alternative to passive acceptance. It also dramatically pitted religion against science and ministers against doctors, albeit in unusual alliances.'

Persistence of a distinct Corynebacterium diphtheriae clonal group within two communities in the United States and Canada where diphtheria is endemic.

Molecular characterization of 53 U.S. and Canadian Corynebacterium diphtheriae isolates by multilocus enzyme electrophoresis, ribotyping, and random amplified polymorphic DNA showed that strains with distinct molecular subtypes have persisted in the United States and Canada for at least 25 years. These strains are endemic rather than imported from countries with current endemic or epidemic diphtheria.