Epidemiology and control of diphtheria in the Republic of Moldova, 1946-1996.
In 1994-1996, the Republic of Moldova was stricken with an epidemic of diphtheria after >30 years of routine diphtheria immunization and the near absence of the disease for nearly 20 years. The intensity of the epidemic gradually grew, reaching a peak in 1994-1995. The epidemiology of diphtheria in Moldova during this period is described along with laboratory findings and control measures. Pharyngeal diphtheria was the predominant clinical form of the disease (97% of cases), and it most often developed in a localized form (70%), with 20% in the toxic form. The clinical diagnosis of diphtheria was bacteriologically confirmed in 91% of cases: Of the cases tested for biotype, 91.3% were gravis, 8.5% were mitis, and 0. 2% were intermedius. Of 494 toxigenic isolates from cases and carriers at the beginning of the epidemic, 47% were nonphagotypeable strains, and 25.7% were phagotype VI strains. Aggressive population-based diphtheria control measures, a mass immunization campaign, rapid case identification, antibiotic prophylaxis and supplemental immunization of close contacts in clusters of infection, and high coverage with routine immunization rapidly controlled the epidemic within Moldova.
Magdei
M
M
Director General's Office, Ministry of Health,National Scientific and Practical Center for Preventive Medicine, Chisinau, Moldova.
Melnic
A
A
Benes
O
O
Bukova
V
V
Chicu
V
V
Sohotski
V
V
Bass
A
A
D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D003353:Corynebacterium diphtheriae / Q000145:classification / Q000302:isolation & purification; D004165:Diphtheria / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018563:Disease Notification / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008966:Moldova / Q000453:epidemiology; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D013745:Tetanus Toxoid; D017778:Vaccines, Combined
D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D013745:Tetanus Toxoid; D017778:Vaccines, Combined; D010401:Penicillin G Benzathine