title: Public health action following an outbreak of toxigenic cutaneous diphtheria in an Auckland refugee resettlement centre.
abstract: Global forced displacement has climbed to unprecedented levels due largely to regional conflict. Degraded public health services leave displaced people vulnerable to multiple environmental and infectious hazards including vaccine preventable disease. While diphtheria is rarely notified in New Zealand, a 2 person outbreak of cutaneous diphtheria occurred in refugees from Afghanistan in February 2015 at the refugee resettlement centre in Auckland. Both cases had uncertain immunisation status. The index case presented with a scalp lesion during routine health screen and toxigenic Corynebacterium diphtheriae was isolated. A secondary case of cutaneous diphtheria and an asymptomatic carrier were identified from skin and throat swabs. The 2 cases and 1 carrier were placed in consented restriction until antibiotic treatment and 2 clearance swabs were available. A total of 164 contacts were identified from within the same hostel accommodation as well as staff working in the refugee centre. All high risk contacts (n=101) were swabbed (throat, nasopharynx and open skin lesions) to assess C. diphtheriae carriage status. Chemoprophylaxis was administered (1 dose of intramuscular benzathine penicillin or 10 days of oral erythromycin) and diphtheria toxoid-containing vaccine offered regardless of immunisation status. Suspected cases were restricted on daily monitoring until swab clearance. A group of 49 low risk contacts were also offered vaccination. Results suggest a significant public health effort was required for a disease rarely seen in New Zealand. In light of increased worldwide forced displacement, similar outbreaks could occur and require a rigorous public health framework for management.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Reynolds
authors.forename: Helen
authors.initials: H
authors.lastname: Saunders
authors.forename: Angela
authors.initials: A
authors.lastname: Matson
authors.forename: Fiona
authors.initials: F
authors.lastname: O'Kane
authors.forename: Sally A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Salvin K
authors.initials: SK
authors.lastname: Singh
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Voss
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kiedrzynski
mesh_terms: D002353:Carrier State; D002648:Child; D003353:Corynebacterium diphtheriae / Q000302:isolation & purification; D004165:Diphtheria / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D062486:Public Health Surveillance / Q000379:methods; D012036:Refugees; D012307:Risk Factors; D018571:Sentinel Surveillance