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Aim: Diphtheria, caused by Corynebacterium diphtheriae, is still a major global health concern. This study aims to investigate the resurgence of diphtheria. Methods: We conducted a narrative review on Scopus, PubMed, and Google Scholar with no limitation on publication date for pertinent articles published in English that were succinctly discussed under several headings. Results: Diphtheria epidemiology has changed considerably since the 1970s, but outbreaks still occur due to gaps in vaccination, infrastructure failures, and civil unrest, particularly in countries like Venezuela, Yemen, and Bangladesh. The COVID-19 pandemic has exacerbated these challenges, particularly in low-resource regions like Nigeria. According to recent estimates, diphtheria epidemics are on the rise, especially in low-resource areas with poor sanitation and immunization rates. Antimicrobial resistance, the pathogenicity of disease-producing bacteria, and behavioral variables are some factors triggering this return. Transmission occurs via droplet spread for respiratory/oropharyngeal diphtheria and through direct person-to-person contact for the cutaneous form of diphtheria with pathogenesis involving toxin production leading to local and systemic effects. However, underreporting and low coverage persist, especially in Africa and Southeast Asia, leading to higher fatality rates. The resurgence of diphtheria brings to light more significant public health consequences, such as pressure on healthcare systems and socioeconomic effects. Maintaining robust immunization strategies and strengthening public health systems is crucial for global control, in addition to a comprehensive approach to combat the diphtheria resurgence, including assessing vaccine coverage rates, identifying barriers to vaccination, and improving immunization uptake, particularly in at-risk populations. Laboratory diagnosis is crucial for confirming cases, and preventive measures include immunization programs, early antibiotic administration, and outbreak control strategies. Management involves prompt administration of antitoxin and antibiotic therapy, patient isolation, and supportive care. Comprehensive global standards that highlight the value of vaccination, bolster the healthcare system, and implement measures to encourage vaccine uptake are required to address these issues. To maintain sustainable control of diphtheria epidemics and safeguard public health worldwide, long-term policies should include boosting funding for immunization programs, improving disease surveillance, and building collaborations. Conclusion: Long-term policies including boosting funding for immunization programs, improving disease surveillance, and building collaborations are expedient. [ABSTRACT FROM AUTHOR]

This study introduces a deterministic formulation for modelling the asymptotic spread of a vaccine preventable disease as well as the different stages for the progression of the disease. We derive the formula for the associated basic reproduction number. To illustrate the proposed model, we use data from the 2017–2018 diphtheria outbreak in Yemen and fit the parameters of the model. A sensitivity analysis of the basic reproduction number, with respect to the model parameters, show that this number increases with an increase of the transmission rate while this number decreases when vaccination rate increases. [ABSTRACT FROM AUTHOR]

Background: Frequent outbreak of diphtheria occurs in Nigeria and some developing nations due to poverty, poor environmental sanitation, and vaccination coverage. Aim: To determine the clinical presentation and outcome of diphtheria in cases admitted in a Yobe Specialist Hospital Potiskum, Yobe State, North-East Nigeria. Methods: This is an observational study involving consecutive cases of diphtheria admitted in diphtheria treatment unit (DTU) in the hospital. Cases were admitted from 27th May to 30th October 2023. Results: A total of 640 patients were admitted with median age of 9 (1–62), with males constituting 350 (54.6%). Only 9 (1)% of patients had vaccination. Common clinical features included pseudomembrane (90.7%), fever (79.7%), neck pain (78.3%), gross cervical lymphadenopathy (GCL; 69.1%), and sore throat (44.2%). The case fatality rate was 7%, higher in < 5 years (8.4%) than 5–14 years (7.4%) and ≥ 15 years (2.2%) respectively. Independent risk for fatality included delay in presentation (adjusted odd ratio (AOR) = 1.21, 95% confidence interval (CI) [1.10, 1.42], p < 0.001), vomiting (AOR = 3.6, 95% CI [1.36, 9.6], p = 0.01), bleeding from orifices (AOR = 3.76, 95% CI [5.76, 6.98], p < 0.001), blood transfusion (AOR = 8.12, 95% CI [3.34, 19.74], p < 0.001), and diphtheria antitoxin (DAT) administration (AOR = 3.17, 95% CI [1.37, 7.25], p = 0.07). Conclusion: Clinical presentation was consistent with diphtheria. Risk of fatality included vomiting, bleeding from orifices, anemia necessitating blood transfusion, delay in presentation, and DAT administration. [ABSTRACT FROM AUTHOR]

Introduction: Diphtheria is an infectious disease whose epidemic is feared globally. In 2019, there were 529 cases with 23 deaths with a Case Fatality Rate (CFR) of 4.35%. Based on the Probolinggo City Health Profile in 2022, it is known that 3 cases of diphtheria were discovered. Diphtheria cases discovered must be immediately prevented from spreading and treated. Posyandu cadres are one of the intermediaries who can connect the community with health workers to find out the whereabouts of diphtheria cases. Therefore, a cadre must have sufficient knowledge accompanied by appropriate actions in dealing with problem in society. This study aims to analyze knowledge, attitudes, and actions of cadres in finding suspected cases of diphtheria in Probolinggo City in order to increase the role of posyandu cadres in preventing diphtheria cases. Materials and methods: This research used a quantitative method with a cross-sectional approach. The type of population is an infinite population, with the total number of cadres in the Probolinggo City being 1,095, spread across 6 Public Health Center work areas in 6 sub-districts at Probolinggo City, Indonesia. Determining and calculating the sample size using the Slovin formula (simple random sampling) and obtained 92 people. Next, the researcher used cluster random sampling to obtain samples in each working area of the Probolinggo public health center. Results: Based on the results of the research, conclusions can be drawn, namely, the characteristics of the highest respondents consist of an average age including 41-50 years of age as many as 34 people, the average occupation is Housewife (IRT) as many as 81 people, the average length of work is included in category >10 years as many as 61 people, and the average education is high school as many as 65 people. Conclusion: The results of the Chi-Square test analysis showed that age and education had a significant influence on cadre behavior, while cadre employment and length of service did not have a significant influence on cadre behavior. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionCTRI Registration number\nSUMMARYWHO and other health agencies recommend that tetanus toxoid (TT) should be replaced by tetanus-diphtheria (Td) vaccine taking into consideration the low coverage and waning immunity, especially for diphtheria. In this randomised, multicentre, non-inferiority study, the immunogenicity and safety of TeddyVac™ vaccine of Human Biologicals Institute were compared with an existing brand.The study involved 444 eligible subjects in two age groups at four centres across India. Group A included subjects of 18–60 years and Group B subjects of 10–18 years of age. All subjects received single dose of either TeddyVac™ or the comparator vaccine as per randomisation. Blood samples for antibody titre estimation were collected before vaccination and 4–6 weeks after vaccination. Immunogenicity was assessed by estimating seroconversion rate, seroprotection rate, and geometric mean titres of antibodies. Safety was evaluated by collection and analysis of data on solicited and unsolicited adverse events.Overall, 441 subjects completed the study. Both the vaccine arms showed comparable seroconversion after a single dose for both the components. Both arms showed increase in seroprotection and geometric mean titres after a single dose of vaccination for both vaccine components, being significantly better for the diphtheria component in the test vaccine arm. Only few minor local and systemic adverse events were observed in both the vaccine arms. No serious adverse event was reported.The study results indicate that the TeddyVac™ vaccine is immunogenic, safe and non-inferior to the comparator Vaccine when administered to healthy subjects of 10 to 60 years of age.CTRI/2021/07/035112In a randomised, multicentre study, TeddyVac™ vaccine of Human Biologicals Institute was found to be immunogenic, safe and non-inferior to an existing commercial brand when administered to healthy subjects of 10 to 60 years of age. [ABSTRACT FROM AUTHOR]

Background: Pertussis is a highly contagious, vaccine-preventable acute respiratory infection caused by Bordetella pertussis (B. Pertussis) and affects all age groups. Since 1947, the Global Expanded Program on Immunization (EPI) was executed, and its incidence has been effectively curtailed. The reasons for the resurgence are multifactorial including the waning of vaccine acquired immunity, the difference in vaccination strategies, the adaptation of B. Pertussis strains, and an increase in disease awareness due to the strengthening of diagnostic sensitivity and surveillance sensitivity. Notably, Hewlett and Edwards proposed that the shift in pertussis transmission patterns plays an important role in pertussis resurgence. Diphtheria is an acute infectious disease of upper respiratory tract caused by toxigenic strains of Corynebacterium Diphtheriae (CD) and Corynebacterium other than diphtheriae (COD). The organism is locally invasive and causes exotoxin - mediated illness and can lead to complications like stridor, respiratory obstruction, myocarditis, nerve palsy, renal insufficiency and death in severe cases. The objective of the present study is to isolate and identify the etiological agents in clinically suspected cases of Diphtheria and Pertussis. Materials & Methods: This Prospective study has been conducted in the department of Microbiology from Feb 2022 to Aug 2024. Samples with high clinical suspicion were received and processed. Two Throat swabs were collected in patients with clinical suspicion of Diphtheria. They were inoculated on Blood agar, Potassium Tellurite agar, Tinsdale agar. Gram staining and Albert staining were done. Molecular testing also performed for C. diphtheriae. Two nasopharyngeal swabs were collected in patients with clinical suspicion of Pertussis. They were inoculated on Bordet Gengou medium, Charcoal Agar with Cephalexin and Blood Agar and Mac Conkey agar. Gram Staining was performed and Biochemical testing was carried out. Molecular testing was carried out for B. Pertussis and B. parapertussis. Results: Out of 53 samples with clinical suspicion of Diphtheriae, 6 were positive for Corynebacterium diphtheria by culture. Molecular testing was also done for testing of rpo B gene and Tox A gene. 6 samples came to be positive for C. diphtheria rpo B gene where as one was positive for tox gene production. Out of 20 cases with strong suspicion of Pertussis, culture was positive for Bordetella pertussis in 2 samples. Molecular testing came out to be positive for one sample. Testing for the antibodies by ELISA two patients were serologically positive for Pertussis. Both Culture and molecular testing was positive in one sample. Both culture and serology was positive in one sample. Only serology was positive in one sample. Conclusion: A constant surveillance is needed for vaccine preventable diseases to predict the outbreak or resurgence of cases. [ABSTRACT FROM AUTHOR]

Background: Dried blood spots (DBSs) enable the study of serological markers of various pathogens without the need to obtain serum/plasma through venipuncture. Methods: Sixty-four blood samples were prepared on Whatman™ 903 cards using specimens obtained by venipuncture to study the detection of serological markers of diphtheria, tetanus, and pertussis in DBSs, and their stability 4 months post-collection. An automated chemiluminescent immunoassay was used to investigate diphtheria, tetanus, and pertussis IgG levels from both DBSs and plasma samples. Results: An optimal cut-off value for DBSs was calculated to improve the performance of diphtheria and tetanus serological markers in DBSs, achieving high sensitivity (95% and 98%, respectively) and specificity (91.7% and 92.3%, respectively). No protection against pertussis was found in the population studied. The correlation observed between the plasma and the DBSs processed after sample collection was high (0.967–0.970) for all antibodies studied except pertussis (0.753), both considering hematocrit before sample elution or not. The correlation between DBSs and plasma for diphtheria and tetanus remained strong following a 4-month delay in DBS processing at 4 °C (0.925–0.964) and −20 °C (0.924–0.966), with only a minor decrease observed for diphtheria at room temperature (0.889), while maintaining a strong correlation for tetanus (0.960). For pertussis, the correlation between DBSs and plasma was drastically reduced after delaying its processing for 4 months at any temperature. Conclusions: To summarize, hematocrit levels within the normal range do not affect the processing of DBSs in the study of serological markers of diphtheria, tetanus, and pertussis. The DBS stability for serological diagnosis of diphtheria and tetanus is adequate when samples are stored at −20 °C for a period of 4 months. The pertussis serological marker does not appear to remain stable after 4 months, even when the DBS is stored frozen at −20 °C. [ABSTRACT FROM AUTHOR]

Abstract Background Frequent outbreak of diphtheria occurs in Nigeria and some developing nations due to poverty, poor environmental sanitation, and vaccination coverage. Aim To determine the clinical presentation and outcome of diphtheria in cases admitted in a Yobe Specialist Hospital Potiskum, Yobe State, North-East Nigeria. Methods This is an observational study involving consecutive cases of diphtheria admitted in diphtheria treatment unit (DTU) in the hospital. Cases were admitted from 27th May to 30th October 2023. Results A total of 640 patients were admitted with median age of 9 (1–62), with males constituting 350 (54.6%). Only 9 (1)% of patients had vaccination. Common clinical features included pseudomembrane (90.7%), fever (79.7%), neck pain (78.3%), gross cervical lymphadenopathy (GCL; 69.1%), and sore throat (44.2%). The case fatality rate was 7%, higher in

Background Diphtheria can be effectively prevented by adequate immunization. A combined vaccine against diphtheria toxoid, pertussis, and tetanus toxoid (DPT) is currently used in routine pediatric immunizations. Outbreaks of diphtheria could emerge in Indonesia as a consequence of declining routine vaccination during the COVID-19 pandemic. Objective To analyze the impact of the first (administered at 18-24 months of age ) and second diphtheria boosters (administered at 5-7 years of age ) in retaining protective levels of anti-diphtheria toxoid antibodies. We also investigated for relevant factors associated with anti-diphtheria toxoid antibody titers. Methods This cross-sectional study was conducted in the Senen District of Jakarta, Indonesia. The inclusion criteria were healthy children aged 6 to 7 years with documented history of DPT vaccination. Primary vaccination defined as 3 doses of DPT at age less than 1 year , first booster was DPT vaccination at 18-24 years of age, and second booster was diphtheria-tetanus (DT) vaccination received at 5 to 7 years of age. Peripheral blood specimens were obtained from participating children, after informed consent was provided by their parents. Antibodies against diphtheria in sera specimens were assessed by commercial anti-diphtheria toxoid immunoglobulin G (IgG) enzyme-linked immunosorbent assay. Results There were 154 children included in the study, with a female majority (61%). Overall, specific humoral immunity against diphtheria was observed in 113 children (73.4%). There was no statistical difference in immunity level between genders. Importantly, children who received the first and second diphtheria booster had significantly higher anti-diphtheria antibody level than those who did not receive both diphtheria booster (P

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria. Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak. Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5–8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases

Abstract Background Certain infectious diseases are caused by specific bacterial pathogens, including syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, leprosy, and tuberculosis. These diseases significantly impact global health, contributing heavily to the disease burden. The study aims to thoroughly evaluate the global burden of syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, and leprosy. Methods Leveraging the Global Burden of Disease (GBD) study 2021, age-specific and Socio-demographic Index (SDI)-specific incidence, disability-adjusted life-years (DALYs), and death for eight specific bacterial infections across 204 countries and territories from 1990 to 2021 were analyzed. Percentage changes in age-standardized incidence rate (ASIR), DALY rate, and mortality rate (ASMR) were also examined, with a focus on disease distribution across different regions, age groups, genders, and SDI. Results By 2021, among the eight diseases, gonococcal infection had the highest global ASIR [1096.58 per 100,000 population, 95% uncertainty interval (UI): 838.70, 1385.47 per 100,000 population], and syphilis had the highest global age-standardized DALY rate (107.13 per 100,000 population, 95% UI: 41.77, 212.12 per 100,000 population). Except for syphilis and gonococcal infection, the age-standardized DALY rate of the remaining diseases decreased by at least 55% compared to 1990, with tetanus showing the largest decrease by at least 90%. Globally, significant declines in the ASIR, age-standardized DALY rate, and ASMR for these eight bacterial infections have been observed in association with increases in the SDI. Regions with lower SDI, such as sub-Saharan Africa, experienced a relatively higher burden of these eight bacterial infections. Conclusions Although there has been an overall decline in these eight diseases, they continue to pose significant public health challenges, particularly in low SDI regions. To further reduce this burden in these areas, targeted intervention strategies are essential, including multi-sectoral collaboration, policy support, improved WASH management, and enhanced research efforts. Graphical Abstract

Abstract Background This case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period. Case presentation A 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4 days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved. Conclusion This case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts.

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that. Objective To find out the profiles of children < 18-year-old with diphtheria admitted in RSHS between 2017-2021. Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021. Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull’s neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported. Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage.

Human infections with Corynebacterium diphtheriae species complex (CdSC) bacteria were rare in French Guiana until 2016, when the number of cases diagnosed increased. We conducted an epidemiologic, multicenter, retrospective study of all human CdSC infections diagnosed in French Guiana during January 1, 2016–December 31, 2021. A total of 64 infectious episodes were observed in 60 patients; 61 infections were caused by C. diphtheriae and 3 by C. ulcerans. Estimated incidence increased from 0.7 cases/100,000 population in 2016 to 7.7 cases/100,000 population in 2021. The mean patient age was 30.4 (+23.7) years, and male-to-female ratio was 1.7:1 (38/22). Of the 61 C. diphtheriae isolates, 5 tested positive for the diphtheria toxin gene, and all results were negative by Elek test; 95% (61/64) of cases were cutaneous, including the C. ulcerans cases. The increase in reported human infections underscores the need to raise awareness among frontline healthcare practitioners to improve prevention.

Background: Vaccine preventable diseases still account for a large proportion of childhood morbidity and mortality in children less than five of age. The decline in immunization coverage over the years has worsened this resulting in the re-emergence of hitherto controlled infections such as diphtheria. Objective: To review the presentation, management and outcome of cases of probable diphtheria seen at the children emergency centre at the Lagos University Teaching Hospital. Methods: The hospital records of all cases of suspected diphtheria adrnitted from September 2007 to September 2008 were reviewed retrospectively. The biodata, presenting complaints, duration of complaints, immunization status, management and outcome were analyzed. Results: Five cases of probable diphtheria were admitted during the study period. Two of the children died, two survived and one absconded. Three of the children had three doses each of diphtheria, pertussis and teranus (DPT) toxoid immunization but none had the 18month booster dose. Diphtheria specificantitoxin was not available for use in the management of any of the cases neither was bacteriological confirmation possible. Conclusion: Efforts to increase immunization coverage rates should be intensified and a policy to include an 18-month booster dose as part of the routine immunization in the National Programme on Immunization may be beneficial. It is recommended that diphtheria specific antitoxin be made available in the country in the event of cases with similar presentation.

Background: In Yemen, diphtheria has become an important health problem since 2017 when diphtheria re-emergence as a consequence of war and the collapse of the health system. In 2023, there has been a 57% increase in diphtheria cases compared to 2021 and 2022. Damt district of Al Dhalea Governorate had the highest reported cases for year 2023. The study aims to determine the risk factors associated with diphtheria outbreak in Damt District. Methods: A retrospective matched case–control (1:2) was used. All confirmed cases based on the WHO case definition reported from Damt district during 2023 were considered cases. Two age-matched (± 5years) neighborhood controls were recruited per case. A pretested questionnaire was used for collecting data during household interviews including demographic and household characteristics, knowledge of diphtheria, vaccination status, contact with a case of diphtheria, and travel history. Frequency and proportion for quantitative and median with interquartile range (IQR) for quantitative variables. Chi-square and Mann–Whitney tests to compare the distribution of categorical and numerical variables between cases and controls. Univariate and multivariate conditional binary logistic regression, and Adjusted Odds ratio (AOR) with a 95% confidence interval at P < 0.05 were used to identify risk factors. Results: A total of 118 cases and 236 controls were enrolled, 56% were females (63% of cases vs. 53% of controls). The median (IQR) age was 14 (9,22) years for cases vs 12(7,23) of control, it was significantly higher for females than males in the case group: (16(10,29) Vs 10(6,18), P < 0.001) and control group: (15(8,25) vs 12(7,18), p-value = 0.022). Partial vaccination status AOR = 13.7(6.1–31.1), P-value < 0.001), contacts with a case of diphtheria AOR = 8.5(2.3–31.0), P value < 0.001) and Female gender, AOR = 3.3(CI; 1.1–9.5, P value = 0.029), were the main risk factors. Conclusions: Poor vaccination and contact with a case of diphtheria were the main contributors to diphtheria in the Damt district particularly among adult females. Increasing the vaccination coverage with a diphtheria-containing vaccine through routine immunization as well as tetanus-diphtheria vaccine for childbearing age females along with community awareness regarding protection measures during home care of diphtheria cases. Vaccination services as well as gender barriers related to Td vaccination should be investigated. [ABSTRACT FROM AUTHOR]

Background: Certain infectious diseases are caused by specific bacterial pathogens, including syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, leprosy, and tuberculosis. These diseases significantly impact global health, contributing heavily to the disease burden. The study aims to thoroughly evaluate the global burden of syphilis, gonorrhea, typhoid and paratyphoid fever, diphtheria, pertussis, tetanus, and leprosy. Methods: Leveraging the Global Burden of Disease (GBD) study 2021, age-specific and Socio-demographic Index (SDI)-specific incidence, disability-adjusted life-years (DALYs), and death for eight specific bacterial infections across 204 countries and territories from 1990 to 2021 were analyzed. Percentage changes in age-standardized incidence rate (ASIR), DALY rate, and mortality rate (ASMR) were also examined, with a focus on disease distribution across different regions, age groups, genders, and SDI. Results: By 2021, among the eight diseases, gonococcal infection had the highest global ASIR [1096.58 per 100,000 population, 95% uncertainty interval (UI): 838.70, 1385.47 per 100,000 population], and syphilis had the highest global age-standardized DALY rate (107.13 per 100,000 population, 95% UI: 41.77, 212.12 per 100,000 population). Except for syphilis and gonococcal infection, the age-standardized DALY rate of the remaining diseases decreased by at least 55% compared to 1990, with tetanus showing the largest decrease by at least 90%. Globally, significant declines in the ASIR, age-standardized DALY rate, and ASMR for these eight bacterial infections have been observed in association with increases in the SDI. Regions with lower SDI, such as sub-Saharan Africa, experienced a relatively higher burden of these eight bacterial infections. Conclusions: Although there has been an overall decline in these eight diseases, they continue to pose significant public health challenges, particularly in low SDI regions. To further reduce this burden in these areas, targeted intervention strategies are essential, including multi-sectoral collaboration, policy support, improved WASH management, and enhanced research efforts. [ABSTRACT FROM AUTHOR]

Background: This case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period. Case presentation: A 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4 days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved. Conclusion: This case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts. [ABSTRACT FROM AUTHOR]

Background: Diphtheria can be effectively prevented by adequate immunization. A combined vaccine against diphtheria toxoid, pertussis, and tetanus toxoid (DPT) is currently used in routine pediatric immunizations. Outbreaks of diphtheria could emerge in Indonesia as a consequence of declining routine vaccination during the COVID-19 pandemic. Objective: To analyze the impact of the first (administered at 18-24 months of age) and second diphtheria boosters (administered at 5-7 years of age) in retaining protective levels of anti-diphtheria toxoid antibodies. We also investigated for relevant factors associated with anti-diphtheria toxoid antibody titers. Methods: This cross-sectional study was conducted in the Senen District of Jakarta, Indonesia. The inclusion criteria were healthy children aged 6 to 7 years with documented history of DPT vaccination. Primary vaccination defined as 3 doses of DPT at age less than 1 year, first booster was DPT vaccination at 18-24 years of age, and second booster was diphtheria-tetanus (DT) vaccination received at 5 to 7 years of age. Peripheral blood specimens were obtained from participating children, after informed consent was provided by their parents. Antibodies against diphtheria in sera specimens were assessed by commercial anti-diphtheria toxoid immunoglobulin G (IgG) enzyme-linked immunosorbent assay. Results: There were 154 children included in the study, with a female majority (61%). Overall, specific humoral immunity against diphtheria was observed in 113 children (73.4%). There was no statistical difference in immunity level between genders. Importantly, children who received the first and second diphtheria booster had significantly higher anti-diphtheria antibody level than those who did not receive both diphtheria booster (P<0.001). Conclusion: Booster vaccinations are crucial among school-age children in Indonesia to improve their anti- diphtheria immunity and to minimize a risk of diphtheria outbreaks. [ABSTRACT FROM AUTHOR]

Patients undergoing immune effector cell therapy (IECT) are at high risk for infections. We assessed seropositivity against pneumococcus, tetanus, and diphtheria in patients before and after IECT and the patients' response to vaccination. We enrolled patients who underwent IECT from January 2020 to March 2022. Antibody levels for diphtheria, tetanus, and pneumococcus were measured before IECT, at 1 month, and 3–6 months after. Eligible patients were vaccinated after IECT. In non-seroprotected patients, we discontinued testing. Before IECT, most patients had seroprotective antibody levels against tetanus (68/69, 99%) and diphtheria (65/69, 94%), but fewer did against pneumococcus (24/67, 36%). After IECT, all patients had seroprotective antibody levels for tetanus at 1 month (68/68) and 3–6 months (56/56). For diphtheria, 65/65 patients (100%) had seroprotective antibody levels at 1 month, and 48/53 (91%) did at 3–6 months. For pneumococcus, seroprotective antibody levels were identified in 91% (21/23) of patients at 1 month and 79% (15/19) at 3–6 months following IECT. Fifteen patients received a pneumococcal vaccine after IECT, but none achieved seroprotective response. One patient received the tetanus-diphtheria vaccine and had a seroprotective antibody response. Because some patients experience loss of immunity after IECT, studies evaluating vaccination strategies post-IECT are needed. [ABSTRACT FROM AUTHOR]

Background Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. Methods We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). Findings Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n  = 7, 57.4% [95% confidence interval (CI): 43.1–71.7%] I 2 = 99% vs HIT 83–86%), measles (n  = 21, 83.7% [95% CI: 79.2–88.2] I 2 = 99% vs HIT 93–95%) and mumps (n  = 8, 67.1% [95% CI: 50.6–83.6] I 2 = 99% vs HIT 88–93%) and midway for rubella (n  = 29, 85.6% [95% CI: 83.1–88.1%] I 2 = 99% vs HIT 83–94%), with high heterogeneity across studies. Interpretation Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity. [ABSTRACT FROM AUTHOR]

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Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. It is characterized by the formation of pseudomembranes in the tonsils, pharynx, and/or nasal cavity, which can lead to severe complications such as airway obstruction, myocarditis, and paralysis of the palate muscles. Aims: This study aims to detail the clinical course and treatment of a pediatric diphtheria case, emphasizing the importance of early diagnosis and appropriate therapeutic interventions. Methods: The case of a 5-year-old girl presenting with a 3-day history of fever at K.R.M.T Wongsonegoro Hospital is described. Clinical evaluation, including history, physical examination, and supportive tests, led to a diagnosis of diphtheritic tonsillitis. Findings: The patient exhibited classic symptoms of diphtheria, including sore throat, fever, and the presence of a dirty, greyish-white pseudomembrane on the tonsils. The membrane extended to adjacent structures, causing a condition known as bullneck. The treatment protocol included the administration of diphtheria antitoxin (DAT), antibiotics, antipyretics, corticosteroids, and symptomatic management. Conclusion: Diphtheria remains a serious infectious disease requiring prompt diagnosis and treatment to prevent complications. The case highlights the importance of early intervention, continuous monitoring, and the evaluation of therapeutic efficacy to improve patient outcomes. Implications: This study underscores the necessity of vigilant clinical practices in managing diphtheria cases, particularly in pediatric patients, to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria. Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak. Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5–8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases <5 years of age (7.7%), female cases (5.9%), rural residence (7.7%) and cases from the northeast senatorial zone (8.2%) of the state. Significantly higher mortalities (8.8%, P = 0.003) were recorded amongst cases with nasopharyngitis. The odds of diphtheria-related mortality were higher amongst cases who presented clinically with nasopharyngitis and were 4 times more likely to die (adjusted odds ratio = 3.9; 95% confidence interval = 1.1–14.3) compared with those with no nasopharyngitis. Conclusions: Significantly higher mortalities were recorded amongst diphtheria cases whose samples were not taken, and those with nasopharyngitis. These findings underscored the importance of improved immunisation uptake, early and prompt case detection, investigation and proper management. [ABSTRACT FROM AUTHOR]

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that. Objective To find out the profiles of children =18-year-old with diphtheria admitted in RSHS between 2017-2021. Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021. Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull's neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported. Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage. [ABSTRACT FROM AUTHOR]

In South Korea, a combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b invasive infections (DTaP-IPV/Hib) is available since 2018 for vaccination of infants from the age of 2 months. This prospective, observational, non-comparative, post-marketing study evaluated the real-world safety of DTaP-IPV/Hib primary vaccination in eligible South Korean infants from the age of 2 months between 2018 and 2022. Infants were followed up for 30 days after each vaccine dose to assess the proportion of infants experiencing any adverse event (AE), including adverse drug reactions (ADRs), unexpected AEs, and serious AEs/serious ADRs (SAEs/SADRs). Of 660 infants vaccinated during the study period, 646 were included in the total safety cohort. A total of 194 AEs were reported in 143 (22.1%) infants; 158 AEs occurred after the first dose in 130 (20.1%) infants, 21 after the second dose in 20 (13.4%) infants, and 11 after the third dose in ten (8.1%) infants. The most frequent AEs by Medical Dictionary for Regulatory Activities Preferred Terms terminology were pyrexia (13.3%), injection site swelling (5.1%), and irritability (1.7%). Most of the AEs were mild, resolved without a medical visit, and were classified as possibly related to vaccination. The incidence proportions of ADRs, unexpected AEs, and SAEs/SADRs were 19.4%, 4.3%, and 0.9%, respectively. All SAEs/SADRs resolved after hospitalization or emergency room visit, and one event was possibly related to vaccination. These results are in line with the approved label and other national/international studies, confirming the acceptable safety profile of DTaP-IPV/Hib in the South Korean pediatric population.

This research introduces a novel approach to combating diphtheria by presenting a comprehensive optimal control strategy focused on awareness campaigns to avoid direct contact with infected individuals and promote vaccinations. These campaigns highlight the severe complications of diphtheria, such as acute respiratory issues, myocarditis, and neurological paralysis. Additionally, the campaigns emphasize the negative impacts of an unbalanced lifestyle and environmental factors, as well as the importance of timely treatment and psychological support. The model aims to improve control strategies by reducing the number of infected individuals I(t) and exposed individuals E(t), as well as asymptomatic carriers A(t), which we have integrated into the model as an aspect that has been relatively unexplored in diphtheria transmission. The optimal controls are meticulously determined using Pontryagin’s maximum principle. The resulting optimality system is solved iteratively, ensuring precision and clarity in the results. Extensive numerical simulations rigorously support and confirm the theoretical analysis using MATLAB, providing concrete evidence of the strategy’s effectiveness. The broader implications and potential applications of this optimal control strategy extend to other infectious diseases, enhancing its relevance and utility in public health.

ABSTRACTThailand has incorporated the whole-cell (wP) pertussis vaccine into the expanded program on immunization since 1977 and has offered the acellular pertussis (aP) vaccine as an optional vaccine for infants since 2001. We followed healthy children from a clinical trial (ClinicalTrials.gov NCT02408926) in which children were randomly assigned to receive either pentavalent (DTwP-HB-Hib) or hexavalent (DTaP-IPV-HB-Hib) vaccines for their primary series (administered at 2, 4, and 6 months) and first booster vaccination (18 months). Both groups received Tdap-IPV as a second booster at the age of 4 y. Blood samples were collected for evaluation of antibody persistence to diphtheria toxoid (DT), tetanus toxoid (TT), and Bordetella pertussis (B. pertussis) between 2 and 6 y of age annually, and for the immunogenicity study of Tdap-IPV at 1 month after the second booster. Antibody persistence to Haemophilus influenzae type b (Hib) was followed until 3 y of age. A total of 105 hexavalent-vaccinated children and 91 pentavalent-vaccinated children completed this study. Both pentavalent and hexavalent groups demonstrated increased antibody levels against DT, TT, and B. pertussis antigens following the second booster with Tdap-IPV. All children achieved a seroprotective concentration for anti-DT and anti-TT IgG at 1 month post booster. The hexavalent group possessed significantly higher anti-pertactin IgG (adjusted p = .023), whereas the pentavalent group possessed significantly higher anti-pertussis toxin IgG (adjusted p

Background: Limited data exists regarding population immunity against diphtheria, tetanus, and pertussis in Thailand during the post-COVID-19 pandemic period. This study aimed to evaluate the age-specific seroprevalence of anti-diphtheria toxoid (anti-DT) IgG, anti-tetanus toxoid (anti-TT) IgG, and anti-pertussis toxin (anti-PT) IgG in individuals across diverse age groups in Chonburi province, Thailand following the COVID-19 pandemic. Methods: Between October 2022 and January 2023, a total of 657 participants from Chonburi Province, Thailand, were included in this study. The participants were categorized into 9 age groups: 70 years. Analysis of anti-DT, anti-TT, and anti-PT IgG levels was conducted using commercial ELISA kits (EUROIMMUN, Lübeck, Germany). Results: Overall, 65.4 % of the population had seroprotection against diphtheria (antibody level ≥0.1 IU/mL), while 95.1 % had seroprotection against tetanus (antibody level ≥0.1 IU/mL). The 31–40 years age group exhibited the lowest seroprotection for diphtheria (48.9 %), and the >70 years age group had the lowest seroprotection for tetanus (73.3 %). The