Berger Anja, Dangel Alexandra, Bengs Katja, Schlotmann Sandra, Thomaßen Peter, Maday Claudia, Rubach Carmen, Abdelgawad Inas, Namaschk Gabriele, Schneider Lena, Perriat Delphine, Badenschier Franziska, Rau Cornelius, Muscat Mark, Sing Andreas
World Health Organization (WHO) Collaborating Centre for Diphtheria, Oberschleißheim, Germany.
National Consiliary Laboratory for Diphtheria, Oberschleißheim, Germany.
Euro Surveill. 2025 Jul;30(27). doi: 10.2807/1560-7917.ES.2025.30.27.2500116.
In September 2024, a school-aged child (P1), unvaccinated against diphtheria, was hospitalised with severe respiratory diphtheria caused by toxigenic P1 subsequently died from the disease. The child's mother (P2) had pharyngitis 9 days before the onset of symptoms of P1 and subsequently tested positive for . In multilocus sequence typing (MLST), the isolates from P1 and P2 were of sequence type (ST) 574. In core genome (cg)MLST, they were clonal, suggesting recent human-to-human transmission. This indicates the first autochthonous respiratory diphtheria outbreak by toxigenic in Germany since 1984 with epidemiologically- and molecularly-confirmed transmission. Furthermore, the isolates were close to isolates from patients with cutaneous diphtheria among people experiencing homelessness in two major German cities in 2023 and 2024, and to isolates from an outbreak among newly arriving migrants across several European countries, including Germany, detected in 2022. This indicates transmission beyond vulnerable groups. Our findings illustrate the potential of spreading further from patients with cutaneous diphtheria and even causing outbreaks of respiratory diphtheria. Given the potentially serious complications of respiratory diphtheria, including death, equitably achieving and maintaining high vaccination coverage among the whole population, especially among vulnerable people is essential.
2024年9月，一名未接种白喉疫苗的学龄儿童（P1）因产毒的白喉棒状杆菌引起的严重呼吸道白喉住院，随后死于该疾病。该儿童的母亲（P2）在P1症状出现前9天患有咽炎，随后检测呈阳性。在多位点序列分型（MLST）中，来自P1和P2的分离株属于序列型（ST）574。在核心基因组（cg）MLST中，它们是克隆性的，表明最近存在人传人现象。这表明自1984年以来德国首次出现由产毒白喉棒状杆菌引起的本土呼吸道白喉疫情，且有流行病学和分子学确认的传播。此外，这些分离株与2023年和2024年德国两个主要城市无家可归者中皮肤白喉患者的分离株相近，也与2022年在包括德国在内的几个欧洲国家新抵达移民中爆发疫情的分离株相近。这表明传播超出了弱势群体范围。我们的研究结果表明产毒白喉棒状杆菌有从皮肤白喉患者进一步传播甚至引发呼吸道白喉疫情的可能性。鉴于呼吸道白喉可能引发包括死亡在内的严重并发症，公平地在全体人群中，尤其是在弱势群体中实现并维持高疫苗接种覆盖率至关重要。
