title: Epidemic diphtheria in Ukraine, 1991-1997.
abstract: In 1991, Ukraine experienced a return of epidemic diphtheria after decades of control that had resulted in <40 sporadic cases reported every year. Increased incidence was first recorded in Kiev, Lviv, and Odessa. By 1993, the epidemic had spread to >50% of the oblasts (provinces) in the country, and by 1995, all regions were affected. In 1995, at the peak of the epidemic, >5,000 cases and >200 deaths were reported. As in Russia, >80% of these cases were diagnosed in persons 16-59 years old. In 1993, the government of Ukraine initiated a program of increased immunization among children and at-risk adults, and by 1995, a mass immunization strategy was adopted in an effort to arrest the epidemic, which was increasing exponentially. In 1996, the number of cases started to decrease, and data from 1998 indicate that the downward trend has continued. It is likely that the diphtheria epidemic in Ukraine started among children, who had been left vulnerable due to inadequate childhood immunizations, and then quickly spread to inadequately protected adults.
authors.affiliation: First Deputy Minister of Public Health, Chief State Sanitary Doctor of Ukraine, Ministry of Health, Kiev, Ukraine.
authors.forename: L S
authors.initials: LS
authors.lastname: Nekrassova
authors.forename: L M
authors.initials: LM
authors.lastname: Chudnaya
authors.forename: V F
authors.initials: VF
authors.lastname: Marievski
authors.forename: V G
authors.initials: VG
authors.lastname: Oksiuk
authors.forename: E
authors.initials: E
authors.lastname: Gladkaya
authors.forename: I I
authors.initials: II
authors.lastname: Bortnitska
authors.forename: D J
authors.initials: DJ
authors.lastname: Mercer
authors.forename: J V
authors.initials: JV
authors.lastname: Kreysler
authors.forename: A
authors.initials: A
authors.lastname: Golaz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003353:Corynebacterium diphtheriae / Q000276:immunology / Q000302:isolation & purification; D004165:Diphtheria / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D004168:Diphtheria Toxoid / Q000008:administration & dosage; 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; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D013745:Tetanus Toxoid; D014455:Ukraine / Q000453:epidemiology; D017778:Vaccines, Combined
chemical_list: D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D013745:Tetanus Toxoid; D017778:Vaccines, Combined