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==Overview==
==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==
==Epidemiology and Demographics==
[[Image:Diphterie.png|thumb|left|Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend).]]
===Incidence===
*Diphtheria is a serious disease, with fatality rates between 5% and 10%.  
*Diptheria is very rare; the incidence in 2015 was approximately .07 individuals per 100,000.<ref name="urlWHOWorldHealthOrganizationImmunizationVaccinesAndBiologicalsVaccinepreventablediseases">{{cite web |url=http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencediphtheria.html |title=WHO World Health Organization: Immunization, Vaccines And Biologicals. Vaccine preventable diseases Vaccines monitoring system 2016 Global Summary Reference Time Series: DIPHTHERIA |format= |work= |accessdate=}}</ref><ref name="url2015 World Population Data Sheet">{{cite web |url=http://www.prb.org/Publications/Datasheets/2015/2015-world-population-data-sheet.aspx |title=2015 World Population Data Sheet |format= |work= |accessdate=}}</ref>
*In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%. Outbreaks, though very rare, still occur worldwide, even in developed nations.  
 
*After the breakup of the former Soviet Union in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR.  
===Case Fatality Rate===
*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.  
*The overall annual case fatality rate for diptheria ranges between 5 and 10%.<ref name="urlDiphtheria Infection | Home | CDC">{{cite web |url=https://www.cdc.gov/diphtheria/ |title=Diphtheria Infection &#124; Home &#124; CDC |format= |work= |accessdate=}}</ref>
*This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease".
**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.<ref name="urlWHO | Diphtheria">{{cite web |url=http://www.who.int/immunization/topics/diphtheria/en/index1.html |title=WHO &#124; Diphtheria |format= |work= |accessdate=}}</ref>
*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]].<ref name="pmid20696088">{{cite journal |vauthors=Wagner KS, White JM, Crowcroft NS, De Martin S, Mann G, Efstratiou A |title=Diphtheria in the United Kingdom, 1986-2008: the increasing role of Corynebacterium ulcerans |journal=Epidemiol. Infect. |volume=138 |issue=11 |pages=1519–30 |year=2010 |pmid=20696088 |doi=10.1017/S0950268810001895 |url=}}</ref><ref name="pmid23022148">{{cite journal |vauthors=Wagner KS, White JM, Andrews NJ, Borrow R, Stanford E, Newton E, Pebody RG |title=Immunity to tetanus and diphtheria in the UK in 2009 |journal=Vaccine |volume=30 |issue=49 |pages=7111–7 |year=2012 |pmid=23022148 |doi=10.1016/j.vaccine.2012.09.029 |url=}}</ref>
 
===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.<ref name="pmid9102270">{{cite journal |vauthors=Hasselhorn HM, Nübling M, Tiller FW, Hofmann F |title=[Diphtheria booster immunization for adults] |language=German |journal=Dtsch. Med. Wochenschr. |volume=122 |issue=10 |pages=281–6 |year=1997 |pmid=9102270 |doi=10.1055/s-2008-1047609 |url=}}</ref>
 
===Race===
There is no evidence of any racial predisposition to diphtheria.
 
===Developing Countries===
[[Image:Diphterie.png|thumb|left|Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend). - Source: http://www.who.int/en/]]
 
*The incidence of diphtheria is highest in developing countries due to a lack of available [[vaccines]] and, correspondingly, low rates of [[vaccination]].<ref name="urlPinkbook | Diphtheria | Epidemiology of Vaccine Preventable Diseases | CDC">{{cite web |url=http://www.cdc.gov/vaccines/pubs/pinkbook/dip.html |title=Pinkbook &#124; Diphtheria &#124; Epidemiology of Vaccine Preventable Diseases &#124; CDC |format= |work= |accessdate=}}</ref>
*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.<ref name="urlDiphtheria - Chapter 3 - 2016 Yellow Book | Travelers Health | CDC">{{cite web |url=http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/diphtheria#1932 |title=Diphtheria - Chapter 3 - 2016 Yellow Book &#124; Travelers' Health &#124; CDC |format= |work= |accessdate=}}</ref>
**A diphtheria resurgence occurred in former Soviet states that comprise present day Eastern Europe, spreading past Europe into Asia and the Middle East.<ref name="pmid7489783">{{cite journal |vauthors=Galazka AM, Robertson SE, Oblapenko GP |title=Resurgence of diphtheria |journal=Eur. J. Epidemiol. |volume=11 |issue=1 |pages=95–105 |year=1995 |pmid=7489783 |doi= |url=}}</ref>
***By 1998, there were an estimated 200,000 cases in Eastern Europe, with 5,000 fatalities.<ref name="urlCurrent Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books">{{cite web |url=https://books.google.com/books?id=8HN_CwAAQBAJ&pg=PA482&lpg=PA482&dq=1998,(according+to+Red+Cross+estimates),+there+were+as+many+as+200,000+cases+in+the+Commonwealth+of+Independent+States,+with+approximately+5,000+deaths&source=bl&ots=t9TiMzRnRU&sig=G5XmK2scw9Q88BGg3AeueTDLEyA&hl=en&sa=X&ved=0ahUKEwjU2ceostPPAhXFcz4KHemGANkQ6AEIHDAA#v=onepage&q=1998%2C(according%20to%20Red%20Cross%20estimates)%2C%20there%20were%20as%20many%20as%20200%2C000%20cases%20in%20the%20Commonwealth%20of%20Independent%20States%2C%20with%20approximately%205%2C000%20deaths&f=false |title=Current Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books |format= |work= |accessdate=}}</ref>
**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.<ref name="pmid14712177">{{cite journal |vauthors= |title=Fatal respiratory diphtheria in a U.S. traveler to Haiti--Pennsylvania, 2003 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=52 |issue=53 |pages=1285–6 |year=2004 |pmid=14712177 |doi= |url=}}</ref>




'''Table 3-01. Countries with endemic diphtheria'''
{|
|-bgcolor="IndianRed"
| '''Region'''
| '''Countries'''
|-bgcolor="DarkSalmon"
| Africa
| Algeria, Angola, Egypt, Eritrea, Ethiopia, Guinea, Niger, Nigeria, Sudan, Zambia, and other sub- Saharan countries
|-bgcolor="DarkSalmon"
| America
| Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Haiti, and Paraguay
|-bgcolor="DarkSalmon"
| Asia/South Pacific
| Bangladesh, Bhutan, Burma (Myanmar), Cambodia, China, India, Indonesia, Laos, Malaysia, Mongolia, Nepal, Pakistan, Papua New Guinea, Philippines, Thailand, and Vietnam
|-bgcolor="DarkSalmon"
| Middle East
| Afghanistan, Iran, Iraq, Saudi Arabia, Syria, Turkey, and Yemen
|-bgcolor="DarkSalmon"
| 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]].<ref name="urlCurrent Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books">{{cite web |url=https://books.google.com/books?id=8HN_CwAAQBAJ&pg=PA482&lpg=PA482&dq=1998,(according+to+Red+Cross+estimates),+there+were+as+many+as+200,000+cases+in+the+Commonwealth+of+Independent+States,+with+approximately+5,000+deaths&source=bl&ots=t9TiMzRnRU&sig=G5XmK2scw9Q88BGg3AeueTDLEyA&hl=en&sa=X&ved=0ahUKEwjU2ceostPPAhXFcz4KHemGANkQ6AEIHDAA#v=onepage&q=1998%2C(according%20to%20Red%20Cross%20estimates)%2C%20there%20were%20as%20many%20as%20200%2C000%20cases%20in%20the%20Commonwealth%20of%20Independent%20States%2C%20with%20approximately%205%2C000%20deaths&f=false |title=Current Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books |format= |work= |accessdate=}}</ref>
*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.<ref name="pmid14712177">{{cite journal |vauthors= |title=Fatal respiratory diphtheria in a U.S. traveler to Haiti--Pennsylvania, 2003 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=52 |issue=53 |pages=1285–6 |year=2004 |pmid=14712177 |doi= |url=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 21:23, 29 July 2020

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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

  • Diptheria is very rare; the incidence in 2015 was approximately .07 individuals per 100,000.[1][2]

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

Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend). - Source: http://www.who.int/en/
  • 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]


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

  1. ↑ "WHO World Health Organization: Immunization, Vaccines And Biologicals. Vaccine preventable diseases Vaccines monitoring system 2016 Global Summary Reference Time Series: DIPHTHERIA".
  2. ↑ "2015 World Population Data Sheet".
  3. ↑ "Diphtheria Infection | Home | CDC".
  4. ↑ "WHO | Diphtheria".
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ "Pinkbook | Diphtheria | Epidemiology of Vaccine Preventable Diseases | CDC".
  9. ↑ "Diphtheria - Chapter 3 - 2016 Yellow Book | Travelers' Health | CDC".
  10. ↑ Galazka AM, Robertson SE, Oblapenko GP (1995). "Resurgence of diphtheria". Eur. J. Epidemiol. 11 (1): 95–105. PMID 7489783.
  11. ↑ 11.0 11.1 "Current Developments in Biotechnology and Bioengineering: Human and Animal ... - Google Books".
  12. ↑ 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.


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