[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]
Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017
David Edwards1, Dianne Kent1, Caroline Lester1, Colin Stewart Brown2, Michael E. Murphy3, Nicholas M. Brown4, Olajumoke Sule4,Alexandra Itani5, Meera Chand6, Amy Trindall7, Callum Pearson7, Iain Roddick7, Norman K. Fry2, Jorg Hoffmann1, Nalini Iyanger2,Laurence Kemp5, Joanne White2, Babak Javid8, Isobel D. Ramsay8, Dominik Zenner2, Aliko Ahmed1, Gayatri Amirthalingam9, Sultan Salimee1,David Litt2, Mark Reacher7
Affiliations: 1 East of England Health Protection Team, Public Health England, Thetford, United Kingdom; 2 National Infection Service, Public Health England, London, United Kingdom; 3 Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; 4 PHE Public Health Laboratory Cambridge, Public Health England, Cambridge, United Kingdom. 5 Granta Medical Practices, Cambridge, United Kingdom; 6 NIHR Health Protection Research Unit in Respiratory Infections, Public Health England, London, United Kingdom; 7 Field Epidemiology Service, Public Health England, Cambridge, United Kingdom; 8 Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge Hospitals Trust, Cambridge, United Kingdom; 9 Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
Correspondence: David Edwards
Citation style for this article: Edwards David, Kent Dianne, Lester Caroline, Brown Colin Stewart, Murphy Michael E., Brown Nicholas M., Sule Olajumoke, Itani Alexandra,Chand Meera, Trindall Amy, Pearson Callum, Roddick Iain, Fry Norman K., Hoffmann Jorg, Iyanger Nalini, Kemp Laurence, White Joanne, Javid Babak, Ramsay Isobel D.,Zenner Dominik, Ahmed Aliko, Amirthalingam Gayatri, Salimee Sultan, Litt David, Reacher Mark. Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017. Euro Surveill. 2018;23(39):pii=1700681. https://doi.org/10.2807/1560-7917.ES.2018.23.39.1700681
Received: 10 Oct 2017; Accepted: 23 May 2018
In early 2017, a United Kingdom (UK)-born person in their 20s presented with a skin ulcer on the foot 3 weeks after returning from Ghana. The patient had last received a diphtheria-containing vaccine in 2013, completing the recommended course. MALDI-TOF of a cutaneous swab identified Corynebacterium diphtheriae. Real-time PCR ascertained the species and presence of the diphtheria toxin gene. An Elek test confirmed toxigenicity. The isolate was macrolide sensitive and penicillin resistant. The local Public Health England (PHE) Health Protection Team obtained the patient’s clinical history and traced contacts to inform appropriate public health action. One close contact (in their early 80s with uncertain immunisation status who had not recently travelled) had a positive throat swab for toxigenic C. diphtheriae and reported a history of mild coryzal symptoms. Multilocus sequence typing revealed that strains from the index case and contact had Sequence Type 463. Diphtheria is extremely rare in the UK due to high vaccine coverage and this is the first documented transmission in 30 years. Clinicians and laboratory staff should remain highly suspicious of lesions in overseas travellers, even when patients are fully vaccinated. Older individuals who might not have completed a full immunisation course may have higher diphtheria susceptibility.
© This work is licensed under a Creative Commons Attribution 4.0 International License.
Keywords: Diphtheria; UK; Ghana.