Diphtheria in Latvia – Still important healthcare problem

Abstract number: P1846

Rozentale B., Storozenko J., Aukstikalne A., Kuse V., Vingre I.

Introduction: Diphtheria in Latvia and other former USSR republics broke out during the last decade of the 20th century. The reason was shortcomings in diphtheria surveillance and immunisation programmes. The highest number of cases in Latvia was recorded in year. The aim defined by World Health Organisation in 1999 was to decrease diphtheria incidence in Europe by year 2010 to 0.1 cases per 100,000.

Aims, Material and Methods: Using retrospective analysis of case-records – to summarize results of immunological examinations, peculiarities of the course and outcomes of diphtheria in 25 patients treated in Infectology Center of Latvia (ICL) during the year 2006. The other aim was to detect level of antitoxic antibodies in blood of ICL employees by Corynebacterium diphtheriae IgG-ELISA (NovaTec immundiagnostica GmbH).

Results: There are 32 diphtheria patients registered in Latvia during the year 2006, it means – 1.4 per 100,000 inhabitants. Twenty five of them were treated in ICL. Patients age ranged from 18 to 63 years. In all cases Corynebacterium diphtheriae toxig. gravis was isolated from pharynx. From those only 2 patients in the age group between 20 and 25 years were vaccinated. Others either were not vaccinated according to defined scheme or considered themselves non-vaccinated. In ten patients severe course of disease with complications – myocarditis, nephritis, bulbar syndrome and polyneuropathy developed. There were 3 lethal cases. Mild course of disease was observed in two vaccinated 20 and 23 year old subjects. The level of determined antitoxic antibodies indicated that patients have not good individual protection from diphtheria.

Antitoxic antibodies against Corynebacterium diphtheriae were detected in 340 employees of ICL. Vaccination according to the defined immunisation scheme has been performed only in 209 persons. In 70 persons concentration of antibodies were below protective level of 0.1 IU/ml. Twenty two of them were vaccinated according to the defined scheme. The lowest level was observed in employees older than 45 years.

Conclusions:

1The high incidence of diphtheria in Latvia is due to lack of protective immunity.

2Priority in prevention of diphtheria is vaccination of all non-immune individuals.