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Volume 18, Number 2—February 2012


Diphtheria in the Postepidemic Period, Europe, 2000–2009

Karen S. WagnerComments to Author , Joanne M. White, Irina Lucenko, David Mercer, Natasha S. Crowcroft, Shona Neal, Androulla Efstratiou, and on behalf of the Diphtheria Surveillance Network
Author affiliations: Health Protection Agency, London, UK (K.S. Wagner, J.M. White, N.S. Crowcroft, S. Neal, A. Efstratiou); State Agency Infectology Center of Latvia, Riga, Latvia (I. Lucenko); World Health Organization Regional Office for Europe, Copenhagen, Denmark (D. Mercer); Public Health Ontario, Toronto, Ontario, Canada (N.S. Crowcroft); University of Toronto Dalla Lana School of Public Health, Toronto (N.S. Crowcroft)

Main Article

Table 3

Vaccination status of case-patients and clinical manifestations of toxigenic Corynebacterium diphtheriae infections and epidemiologically linked cases without laboratory confirmation, Latvia, Europe, 2000–2009*

Vaccination status Classic diphtheria (with membrane) Mild diphtheria/ severe pharyngitis Cutaneous Asymptomatic Not known Total
Full 64† 118 0 71 0 253
Partial 1 3 0 5 0 9
Unvaccinated 74 70 1 18 0 163
Not known 2 8 0 63 210 283
Total 141 199 1 157 210 708

*p<0.001 by test for trend (vaccination status and disease severity).
†Includes 52 fully vaccinated case-patients with classic respiratory diphtheria (with membrane) from an outbreak in the military in 2000. The outbreak comprised 145 symptomatic case-patients and 25 asymptomatic contacts. A total of 96% of these case-patients and contacts were 18–23 years of age at the time of diagnosis. Spread of disease was traced to use of a communal drinking cup (13).

Main Article

1Additional members of the Diphtheria Surveillance Network who contributed data are listed in Technical Appendix 1.

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