CONGRESS 2023 - Recent increases in diphtheria cases in England

Last updated: 26th September 2023

Diphtheria is a potentially fatal disease caused by strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotubercolosis that express the diphtheria toxin. It can present as a respiratory infection or as non-healing skin wounds. Diphtheria was historically most likely to be caused by C. diphtheriae. It is very rare in England (typically <10 cases per year) due to a successful routine immunisation programme. However, there has been a recent gradual increase in cases over several years, particularly cutaneous infections and those caused by toxigenic C. ulcerans strains (which can be carried by household pets). In 2022, there was a particulary large increase in diphtheria in England, with 87 cases and 3 deaths. This included 72 toxigenic C. diphtheriae infections in asylum seekers, thought to be aquired during their travel to the UK. Symptoms ranged from severe respiratory diphtheria to cutaneous infections and asymptomatic carriage. Similar increases of C. diphtheriae infections in travelling migrants have been seen in several European countries. Some of these isolates are multidrug resistant, including to macrolides, the default recommendation for treatment, and this will require careful monitoring.

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27th September 2023
Venue: The International Convention Centre (ICC), Birmingham
Learning outcomes

Key learning outcomes:

  • Diphtheria cases are typically very low in the UK due to an effective vaccination programme.
  • There has been a gradual increase in cases since 2018, with increased detection of cutaneous C. ulcerans infections linked to household pets.
  • In 2022 there was a large increase in C. diphtheriae infections detected in asylum seekers.
  • Some of the strains isolated from asylum seekers possess multidrug resistance, which requires careful monitoring.