Diphtheria epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
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
Incidence
Case Fatality Rate
- The overall annual case fatality rate for diptheria ranges between 5 and 10%.[3]
- The annual case fatality rates for patients that are younger than 5 or older than 40 years old tend to be higher, ranging up to 20%.
Age
- Diphtheria most commonly affects children under the age of 5 years old and without vaccination.[4]
- Individuals over 50 years old are particularly susceptible to diphtheria, particularly those over 70 years old, due to the higher probability of lacking vaccination.[5][6]
Gender
- There is evidence that women are more prone than men to diphtheria infection due to lower antitoxin responses to vaccination, requiring more frequent booster administrations.[7]
Race
There is no racial predisposition to diphtheria.
Developing Countries
- Diphtheria incidence is highest in developing countries due to lack of available vaccination.[8]
- Developing countries of which Diphtheria is endemic to include Indonesia, Thailand, Laos, and many others in Asia, the South Pacific, Middle East, Haiti, Dominical Republic, South America, and Eastern Europe.[9]
- A diphtheria resurgence occurred in former Soviet states that comprise present day Eastern Europe, spreading past Europe into Asia and the Middle East.[10]
- Outbreaks in Haiti and the Dominican Republic led to a resurgence in the Americas, including a rare fatal case in the United States in 2003 involving a Pennsylvania resident returning from Haiti.[11]
- 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).
- 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".
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 |
Developed Countries
References
- ↑ "WHO World Health Organization: Immunization, Vaccines And Biologicals. Vaccine preventable diseases Vaccines monitoring system 2016 Global Summary Reference Time Series: DIPHTHERIA".
- ↑ "2015 World Population Data Sheet".
- ↑ "Diphtheria Infection | Home | CDC".
- ↑ "WHO | Diphtheria".
- ↑ Wagner KS, White JM, Crowcroft NS, De Martin S, Mann G, Efstratiou A (2010). "Diphtheria in the United Kingdom, 1986-2008: the increasing role of Corynebacterium ulcerans". Epidemiol. Infect. 138 (11): 1519–30. doi:10.1017/S0950268810001895. PMID 20696088.
- ↑ Wagner KS, White JM, Andrews NJ, Borrow R, Stanford E, Newton E, Pebody RG (2012). "Immunity to tetanus and diphtheria in the UK in 2009". Vaccine. 30 (49): 7111–7. doi:10.1016/j.vaccine.2012.09.029. PMID 23022148.
- ↑ Hasselhorn HM, Nübling M, Tiller FW, Hofmann F (1997). "[Diphtheria booster immunization for adults]". Dtsch. Med. Wochenschr. (in German). 122 (10): 281–6. doi:10.1055/s-2008-1047609. PMID 9102270.
- ↑ "Pinkbook | Diphtheria | Epidemiology of Vaccine Preventable Diseases | CDC".
- ↑ "Diphtheria - Chapter 3 - 2016 Yellow Book | Travelers' Health | CDC".
- ↑ Galazka AM, Robertson SE, Oblapenko GP (1995). "Resurgence of diphtheria". Eur. J. Epidemiol. 11 (1): 95–105. PMID 7489783.
- ↑ "Fatal respiratory diphtheria in a U.S. traveler to Haiti--Pennsylvania, 2003". MMWR Morb. Mortal. Wkly. Rep. 52 (53): 1285–6. 2004. PMID 14712177.