title: Respiratory diphtheria among highly vaccinated military trainees in Latvia: improved protection from DT compared with Td booster vaccination.
abstract: An outbreak of respiratory diphtheria occurred among highly-vaccinated trainees at a Latvian military academy in August-September 2000. We reviewed immunization, clinical and laboratory records and administered a questionnaire to obtain data on exposure factors. Among 207 trainees, 45 (22%) diphtheria cases and 79 (38%) carriers of toxigenic Corynebacterium diphtheriae were identified. All patients survived; 1 had severe myocarditis. Sharing cups was a risk factor for infection. Over 85% of trainees had received > or =5 doses of diphtheria toxoid. Neither infection nor disease was associated with the number of doses or interval since last dose. However, the risk of disease was lower and diphtheria antitoxin levels were higher among trainees who received their last booster dose with higher-antigen diphtheria toxoid (DT) instead of lower-antigen Td. Outbreaks of mild diphtheria can occur among highly-vaccinated persons living in crowded conditions with intense exposure; high-antigen diphtheria booster-vaccination might provide better protection under these conditions.
authors.affiliation: National Environmental Health Center, Riga, Latvia. Ugochima@hotmail.com
authors.forename: Chima
authors.initials: C
authors.lastname: Ohuabunwo
authors.forename: Jurijs
authors.initials: J
authors.lastname: Perevoscikovs
authors.forename: Aija
authors.initials: A
authors.lastname: Griskevica
authors.forename: Paul
authors.initials: P
authors.lastname: Gargiullo
authors.forename: Anita
authors.initials: A
authors.lastname: Brilla
authors.forename: Ludmila
authors.initials: L
authors.lastname: Viksna
authors.forename: Steffen
authors.initials: S
authors.lastname: Glismann
authors.forename: Melinda
authors.initials: M
authors.lastname: Wharton
authors.forename: Charles
authors.initials: C
authors.lastname: Vitek
mesh_terms: D000293:Adolescent; D000328:Adult; D004165:Diphtheria / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D004168:Diphtheria Toxoid / Q000008:administration & dosage*; D022422:Diphtheria-Tetanus Vaccine / Q000008:administration & dosage; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D007844:Latvia / Q000453:epidemiology; D008297:Male; D008889:Military Personnel; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D004168:Diphtheria Toxoid; D022422:Diphtheria-Tetanus Vaccine