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The sero-epidemiology of diphtheria in Western Europe

Published online by Cambridge University Press:  03 November 2000

W. J. EDMUNDS
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London, NW9 5EQ, UK
R. G. PEBODY
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London, NW9 5EQ, UK
H. AGGERBACK
Affiliation:
Statens Serum Institut, Copenhagen, Denmark
S. BARON
Affiliation:
Reseau National de Sante Publique, Paris, France
G. BERBERS
Affiliation:
National Institute of Public Health and the Environment, Bilthoven, The Netherlands
M. A. E. CONYN-VAN SPAENDONCK
Affiliation:
National Institute of Public Health and the Environment, Bilthoven, The Netherlands
H. O. HALLANDER
Affiliation:
Swedish Institute of Infectious Disease Control, Stockholm, Sweden
R. OLANDER
Affiliation:
National Public Health Institute, Helsinki, Finland
P. A. C. MAPLE
Affiliation:
Central Public Health Laboratory, London, UK
H. E. DE MELKER
Affiliation:
National Institute of Public Health and the Environment, Bilthoven, The Netherlands
P. OLIN
Affiliation:
Swedish Institute of Infectious Disease Control, Stockholm, Sweden
F. FIEVRET-GROYNE
Affiliation:
Pasteur-Mérieux Connaught, Paris, France
C. ROTA
Affiliation:
Istituto Superiore di Sanita, Rome, Italy
S. SALMASO
Affiliation:
Istituto Superiore di Sanita, Rome, Italy
A. TISCHER
Affiliation:
Robert Koch-Institut, Berlin, Germany
C. VON-HUNOLSTEIN
Affiliation:
Istituto Superiore di Sanita, Rome, Italy
E. MILLER
Affiliation:
PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London, NW9 5EQ, UK
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Abstract

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Seven countries in Western Europe collected large, representative serum banks across the entire age range and tested them for diphtheria anti-toxin (sample size ranged from 2991 to 7715). Although a variety of assays were used, the results were all standardized to those of a reference laboratory and expressed in international units. The standardization process, and the availability of similar, large data sets allowed comparative analyses to be performed in which a high degree of confidence could be ascribed to observed epidemiological differences. The results showed that there were large differences in the proportion of adults with insufficient levels of protection amongst different countries. For instance, roughly 35% of 50- to 60-year-olds were found to be seronegative (titre [les ] 0·01 IU/ml) in Finland compared with 70–75% in the United Kingdom. Furthermore, the proportion of seronegative adults would be expected to increase in some countries, notably Italy and the western part of Germany. In those countries with vaccination of military recruits there was a marked sex-related difference in the proportion of seropositive individuals. All countries have high levels of infant vaccine coverage (> 90%) but the accelerated schedule in the United Kingdom appears to result in lower anti-toxin titres than elsewhere. In Sweden, booster doses are not offered until 10 years of age which results in large numbers of children with inadequate levels of protection. Although the United Kingdom and Sweden both have higher proportions of seronegative children than elsewhere the likelihood of a resurgence of diphtheria in these countries seems remote.

Type
Research Article
Copyright
© 2000 Cambridge University Press