van Geldermalsen A A, Wenning U
Quthing Government Hospital, Lesotho, Germany.
Ann Trop Paediatr. 1993;13(1):13-9. doi: 10.1080/02724936.1993.11747620.
We report a diphtheria outbreak which occurred in the 1st 6 months of 1989 in the Quthing district of Lesotho in Southern Africa. Sixty-eight clinical cases were identified in patients with ages ranging from 14 months to 51 years. The 10-15-year age group represented 38% of the cases and the 15-20-year age group another 26%. Age-adjusted incidence rates were higher in patients aged between 15 and 35 than in those aged 0-15 years (p < 0.001). The overall case fatality rate was 23%. Most deaths occurred in the age range 10-14 years, but the case fatality rate tended to be higher in the younger age groups. The epidemic raises the question of the influence of the ongoing vaccination programme, established since 1977, and the importance of naturally acquired immunity. It is suggested that the number of throat carriers, who in the absence of skin diphtheria would provide most of the population's immunity, decreases as an indirect consequence of vaccination, and that certain groups not immediately reached by vaccination become more susceptible to diphtheria. This outbreak also illustrates that a sporadic case of diphtheria in a partially immunized community warrants serious efforts to curb the spread of the disease.
我们报告了1989年上半年在非洲南部莱索托的库廷区发生的一起白喉疫情。共确诊68例临床病例，患者年龄从14个月至51岁不等。10至15岁年龄组占病例的38%，15至20岁年龄组占26%。15至35岁患者的年龄调整发病率高于0至15岁患者（p<0.001）。总体病死率为23%。大多数死亡发生在10至14岁年龄组，但较年轻年龄组的病死率往往更高。此次疫情引发了关于自1977年以来实施的现行疫苗接种计划的影响以及自然获得性免疫的重要性的问题。有人认为，由于接种疫苗的间接影响，咽喉带菌者（在无皮肤白喉的情况下可提供大部分人群免疫力）数量减少，而某些未立即接种疫苗的群体对白喉更易感染。此次疫情还表明，在部分免疫的社区中出现的散发性白喉病例需要认真努力控制疾病传播。
