Diphtheria in the United Kingdom, 1986–2008: the increasing role ofCorynebacterium ulcerans

Abstract

SUMMARYDiphtheria is an uncommon disease in the UK due to an effective immunization programme; consequently when cases do arise, there can be delays in diagnosis and case-fatality rates remain high. We reviewed 102 patients with infections caused by toxigenic corynebacteria (an average of four per year) reported in the UK between 1986 and 2008: 42Corynebacterium diphtheriae, 59C. ulceransand oneC. pseudotuberculosis, as well as 23 asymptomatic carriers. Five fatalities were reported, all in unvaccinated patients. The major risk factor forC. diphtheriaeinfection continued to be travel to an endemic country.C. ulceransinfections became more common thanC. diphtheriaeinfections in the UK; they were associated with contact with companion animals. The occurrence of indigenous severeC. ulceransinfections and importedC. diphtheriaecases highlights the need to maintain UK routine vaccination coverage at the 95% level in the UK, as recommended by the World Health Organization.