Diphtheria epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Diphtheria is found worldwide but is rare in the United States. Diphtheria causes significant illness and death in developing countries where vaccination coverage is low.

Epidemiology and Demographics

Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend).

• Diphtheria is found worldwide; countries with endemic diphtheria are shown in Table below.
• During the 1990s, large epidemics occurred in the newly independent states of the former Soviet Union.
• More recently in the Americas, diphtheria outbreaks have occurred in Haiti and the Dominican Republic.
• Diphtheria is uncommon in industrialized countries because of longstanding routine use of DTP (diphtheria and tetanus toxoids and pertussis vaccine).
• Diphtheria is rare in the United States; the last case occurred in an elderly traveler returning from Haiti in 2003. Diphtheria causes significant illness and death in developing countries where vaccination coverage is low.
• By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths.
• This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease".
• Diphtheria is rare in the United States; the last case occurred in an elderly traveler returning from Haiti in 2003. Diphtheria causes significant illness and death in developing countries where vaccination coverage is low.

Table 3-01. Countries with endemic diphtheria

REGION	COUNTRIES
Africa	Algeria, Angola, Egypt, Eritrea, Ethiopia, Guinea, Niger, Nigeria, Sudan, Zambia, and other sub- Saharan countries
America	Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Haiti, and Paraguay
Asia/South Pacific	Bangladesh, Bhutan, Burma (Myanmar), Cambodia, China, India, Indonesia, Laos, Malaysia, Mongolia, Nepal, Pakistan, Papua New Guinea, Philippines, Thailand, and Vietnam
Middle East	Afghanistan, Iran, Iraq, Saudi Arabia, Syria, Turkey, and Yemen
Europe	Albania, Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan

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