Reynolds Gary E, Saunders Helen, Matson Angela, O'Kane Fiona, Roberts Sally A, Singh Salvin K, Voss Lesley M, Kiedrzynski Tomasz
Commun Dis Intell Q Rep. 2016 Dec 24;40(4):E475-E481.
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.
全球被迫流离失所人数攀升至前所未有的水平，这主要是由地区冲突导致的。公共卫生服务的退化使流离失所者容易受到多种环境和传染性危害的影响，包括疫苗可预防疾病。虽然新西兰很少通报白喉病例，但2015年2月在奥克兰的难民安置中心，两名来自阿富汗的难民爆发了皮肤白喉。两例病例的免疫状况均不确定。首例病例在常规健康筛查时出现头皮病变，分离出产毒白喉棒状杆菌。通过皮肤和咽喉拭子检测，发现了一例皮肤白喉继发病例和一名无症状携带者。在获得抗生素治疗及两份清除性拭子检测结果之前，这两名病例和一名携带者被同意进行隔离。在同一宿舍住宿的人员以及难民中心的工作人员中，共确定了164名接触者。对所有高风险接触者（n = 101）进行了拭子检测（咽喉、鼻咽和开放性皮肤损伤处），以评估白喉棒状杆菌携带状况。无论免疫状况如何，均给予化学预防（一剂肌内注射苄星青霉素或口服红霉素10天）并提供含白喉类毒素的疫苗。疑似病例在每日监测期间进行隔离，直至拭子检测结果呈阴性。还为49名低风险接触者提供了疫苗接种。结果表明，对于新西兰罕见的一种疾病，需要做出重大的公共卫生努力。鉴于全球被迫流离失所情况增加，类似的疫情可能会发生，需要一个严格的公共卫生管理框架。
