title: Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned.
abstract: Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.
authors.affiliation: International Immunization Consulting, 12681 Berlin, Germany. sd.internat.immun.consult@t-online.de
authors.forename: S
authors.initials: S
authors.lastname: Dittmann
authors.forename: M
authors.initials: M
authors.lastname: Wharton
authors.forename: C
authors.initials: C
authors.lastname: Vitek
authors.forename: M
authors.initials: M
authors.lastname: Ciotti
authors.forename: A
authors.initials: A
authors.lastname: Galazka
authors.forename: S
authors.initials: S
authors.lastname: Guichard
authors.forename: I
authors.initials: I
authors.lastname: Hardy
authors.forename: U
authors.initials: U
authors.lastname: Kartoglu
authors.forename: S
authors.initials: S
authors.lastname: Koyama
authors.forename: J
authors.initials: J
authors.lastname: Kreysler
authors.forename: B
authors.initials: B
authors.lastname: Martin
authors.forename: D
authors.initials: D
authors.lastname: Mercer
authors.forename: T
authors.initials: T
authors.lastname: Rønne
authors.forename: C
authors.initials: C
authors.lastname: Roure
authors.forename: R
authors.initials: R
authors.lastname: Steinglass
authors.forename: P
authors.initials: P
authors.lastname: Strebel
authors.forename: R
authors.initials: R
authors.lastname: Sutter
authors.forename: M
authors.initials: M
authors.lastname: Trostle
mesh_terms: D000328:Adult; D002648:Child; D017517:Commonwealth of Independent States / Q000453:epidemiology; D004165:Diphtheria / Q000453:epidemiology / Q000517:prevention & control*; D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs; D013745:Tetanus Toxoid; D014586:USSR / Q000453:epidemiology; D017778:Vaccines, Combined
chemical_list: D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine; D013745:Tetanus Toxoid; D017778:Vaccines, Combined