Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
BMC Infect Dis. 2023 Jun 21;23(1):420. doi: 10.1186/s12879-023-08388-5.
Diphtheria is a severe respiratory or cutaneous infectious disease, caused by exotoxin producing Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis. Diphtheria is once again prevalent due to breakdown of immunisation programmes, social disruption and unrest.
This study describes the notified diphtheria cases in the Netherlands between 2000-2021 and isolates that were sent to the National Institute for Public Health and the Environment (RIVM).
File investigation was performed including all notified cases and isolates of C. diphtheriae, C. ulcerans and C. pseudotuberculosis that were tested for toxin production using a toxin-PCR and Elek test. An exploratory review was performed to understand transmission in populations with a high vaccination uptake.
Eighteen diphtheria notifications were made with confirmed toxigenic C. diphtheriae (n = 9) or ulcerans (n = 9) between 2000 and 2021. Seventeen (94.4%) presented with a cutaneous infection. All cases with a suspected source abroad (n = 8) concerned infection with C. diphtheriae. In contrast, 9/10 cases infected in the Netherlands were caused by C. ulcerans, a zoonosis. Secondary transmission was not reported. Isolates of C. ulcerans sent to the RIVM produced more often the diphtheria exotoxin (11/31; 35%) than C. diphtheriae (7/89; 7.9%).
Both human-to-human transmission of C. diphtheriae and animal-to-human transmission of C. ulcerans rarely occurs in the Netherlands. Cases mainly present with a cutaneous infection. Travel-related cases remain a risk for transmission to populations with low vaccination coverage, highlighting the importance of immunization and diphtheria control measures.
白喉是一种由产毒素的棒状杆菌属（ Corynebacterium diphtheriae、C. ulcerans 和 C. pseudotuberculosis）引起的严重呼吸道或皮肤感染性疾病。由于免疫接种计划的崩溃、社会动荡和动乱，白喉再次流行。
本研究描述了 2000 年至 2021 年间荷兰报告的白喉病例以及送往国家公共卫生和环境研究所（RIVM）的分离株。
对所有报告的白喉病例和产毒素的 C. diphtheriae、C. ulcerans 和 C. pseudotuberculosis 分离株进行文件调查，这些分离株使用毒素 PCR 和 Elek 试验进行毒素产生检测。进行探索性综述以了解高疫苗接种率人群中的传播情况。
2000 年至 2021 年间，共报告了 18 例确诊产毒 C. diphtheriae（n = 9）或 C. ulcerans（n = 9）的白喉病例。17 例（94.4%）表现为皮肤感染。所有疑似境外来源的病例（n = 8）均为 C. diphtheriae 感染。相比之下，荷兰感染的 10 例 C. ulcerans 感染病例均为动物源性疾病。未报告继发传播。送往 RIVM 的 C. ulcerans 分离株更常产生白喉外毒素（31 株中的 11 株；35%），而 C. diphtheriae 仅 89 株中的 7 株（7.9%）。
荷兰人与人之间传播 C. diphtheriae 和动物与人之间传播 C. ulcerans 的情况很少发生。病例主要表现为皮肤感染。与旅行相关的病例仍然存在传播给疫苗接种率低的人群的风险，这凸显了免疫接种和白喉控制措施的重要性。
