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Volume 4, Number 4—December 1998

Perspective

Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease

Charles R. VitekComments to Author  and Melinda Wharton
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

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Table 3

Factors influencing the emergence of diphtheria, Newly Independent States (NIS), 1990–1996.

Technology and industry
Population of susceptible adults
Human demographics and behavior
Population resistance to vaccinating children
Changes in childhood vaccination schedule
High levels of militarization
Decreased social controls, increased travel
Microbial adaptation and change
Change in biotype or emergence of epidemic clones
Economic development and land use
Highly crowded and intense urbanization, substandard housing
Breakdown of public health measures
Decreased immunization in Central Asia and Caucasus due to breakup of Soviet Union
International travel and land use
Repatriation of Russian population from republics
Refugees from Tajikistan, refugees in Georgia

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