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
Worldwide, the incidence of diphtheria is low. In 2015, the incidence was approximately .07 individuals per 100,000. The overall annual case fatality rate for diphtheria ranges between 5 and 10%. The annual case fatality rates for patients younger than 5 or older than 40 years of age tend to be higher, ranging up to 20%. Diphtheria most commonly affects children under the age of 5 years and adults over 70 years of age. This is primarily due to the higher chance that patients in these age groups have not had a vaccination or booster. The incidence of diphtheria is highest in developing countries due to the lack of comprehensive vaccination; developing countries to which diphtheria is endemic include Indonesia, Thailand, Laos, and many other countries in Asia, the South Pacific, Middle East, Haiti, Dominican Republic, South America, and Eastern Europe. Diphtheria tends to be very rare in developed, industrialized countries. The majority of cases in developed countries involve travelers from diphtheria-endemic countries or patients from developed countries who were not vaccinated or did not receive the appropriate boosters.
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 who are younger than 5 or older than 40 years of age tend to be higher, ranging up to 20%.
Age
- Diphtheria most commonly affects children under the age of 5 years old who have not been properly vaccinated.[4]
- Individuals over 50 years of age are particularly susceptible to diphtheria, and especially those over 70 years of age due to the higher probability that they have not received proper vaccination.[5][6]
Gender
- There is evidence that women may be more prone than men to diphtheria infection due to lower antitoxin responses to vaccination, which necessitates more frequent booster administrations.[7]
Race
There is no evidence of any racial predisposition to diphtheria.
Developing Countries
- The incidence of diphtheria is highest in developing countries due to a lack of available vaccines and, correspondingly, low rates of vaccination.[8]
- Developing countries to which diphtheria is endemic include Indonesia, Thailand, Laos, and many other countries 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]
- By 1998, there were an estimated 200,000 cases in Eastern Europe, with 5,000 fatalities.[11]
- 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.[12]
- A diphtheria resurgence occurred in former Soviet states that comprise present day Eastern Europe, spreading past Europe into Asia and the Middle East.[10]
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
- Diphtheria is rare in developed, industrialized countries due to longstanding, widespread administration of TDaP vaccine.[11]
- The majority of cases in developed countries involve patients who are traveling from diphtheria-endemic countries, or those from developed countries who were not vaccinated and/or did not receive the appropriate boosters.[12]
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.
- ↑ 11.0 11.1 "Current Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books".
- ↑ 12.0 12.1 "Fatal respiratory diphtheria in a U.S. traveler to Haiti--Pennsylvania, 2003". MMWR Morb. Mortal. Wkly. Rep. 52 (53): 1285–6. 2004. PMID 14712177.