The #Threat of Emerging and Re-emerging #Infections in #Indonesia (Acta Med Indones., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Acta Med Indones. 2019 Jul;51(3):195-196.

The Threat of Emerging and Re-emerging Infections in Indonesia.

Nelwan EJ1.

Author information: 1 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia.



Human immunodeficiency virus (HIV) is one example of an emerging infection with total of 386 district of all province in Indonesia reported having such infection; with cumulative number of HIV infected patient from the year 1987 to 2014 is 150,296 while AIDS is 55,799 patients. The access to care only available for 153,887 patients among all HIV/AIDS patients of whom 70% are eligible for anti-retroviral (ARV) treatment and of these only half adhered to ARV treatment. In addition to that, there is an increased risk of other emerging diseases such as Zika virus, Monkey pox or Hanta pulmonary syndrome since a sporadic cases were reported around the region.

Beside new diseases, tuberculosis, dengue virus, malaria and diphteria are continuously reported in Indonesia and classified as re-emerging illnesses. On this edition data on diphteria epidemiology in Indonesia will be shown by Karyanti et al.6 A recent outbreak of diphteria in Indonesia which involved almost all province in the country has led to a response named ORI (outbreak response of Immunization). Regardless of immunization, proper treatment including the distribution of anti-toxin and antibiotics are needed to stop the spread of this particular bacteria, further decreasing the mortality rate. In conclusion, the author of this paper mentioned that immunization gap needs to be handle systematically. Immunization data released on 2017 showed that complete immunization was given only to 20% of targeted group, while almost 75% were either unvaccinated or unknown. During the outbreak of diphteria in Indonesia, the WHO also reported several countries with similar problem such as Bangladesh, Haiti and Yamen. It was shown that a coordination between doctors in clinic/hospital with public health officer to conduct an epidemiological investigation, in conjunction with giving prophylaxis and assuring the logistics of anti-diphteria toxin and antibiotics were accessible were  the key of success in eliminating diphteria like it was in Bangladesh.

Adherence to treatment are multifactorial for all illnesses. First, is the duration of treatment and the potential adverse event due to the medication. The Ministry of Health of the Republic of Indonesia has support the early diagnosis of HIV and delivering treatment as soon as possible, in order to avoid transmission of the disease. Second, looking at another side of the story for HIV infected patients, receiving ARV treatment as a long life treatment could possibly cause an adverse event somewhere along the line. Budiman reported factors that might contribute to liver injury. His study shows that measuring baseline liver function test AST routinely might minimize the toxicity of ARV to patients particularly with a low body mass index. Last, despite the adherence to treatment and procedures in minimizing the risk of adverse event to medication, we are now facing the primary resistance virus that transmitted in the community as mentioned by Megasari et al.8 on her report regarding the transmission of drug resistance HIV virus to naïve patients in Bali.

The Indonesian government through the Indonesian Ministry of Health has established a collaboration and one health approaches to tackle the threat of diseases in the country, particularly in infectious diseases.

KEYWORDS: AIDS; HIV; Infection; Virus

PMID: 31699941

Keywords: Indonesia; Public Health; Diphtheria; HIV/AIDS.


#Transmission of toxigenic #Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West #Africa, #UK, 2017 (Euro Surveill., abstract)

[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.

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.


#Fatal Case of #Diphtheria and #Risk for Reemergence, #Singapore (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 11—November 2018 / Dispatch

Fatal Case of Diphtheria and Risk for Reemergence, Singapore

Yingqi Lai  , Parthasarathy Purnima, Marc Ho, Michelle Ang, Rama N. Deepak, Ka Lip Chew, Shawn Vasoo, Dimatatac F. Capulong, and Vernon Lee

Author affiliations: Ministry of Health, Singapore (Y. Lai, M. Ho, M. Ang, V. Lee); Khoo Teck Puat Hospital, Singapore (P. Purnima, R.N. Deepak); National Public Health Laboratory, Singapore (M. Ang); National University Hospital, Singapore (K.L. Chew); Tan Tock Seng Hospital, Singapore (S. Vasoo, D.F. Capulong)



We report a fatal autochthonous diphtheria case in a migrant worker in Singapore. This case highlights the risk for individual cases in undervaccinated subpopulations, despite high vaccination coverage in the general population. Prompt implementation of public health measures and maintaining immunization coverage are critical to prevent reemergence of diphtheria.

Keywords: Diphtheria; Singapore.


Geographically Diverse #Clusters of Nontoxigenic #Corynebacterium diphtheriae #Infection, #Germany, 2016–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 7—July 2018 / Research

Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017

Alexandra Dangel1  , Anja Berger1, Regina Konrad, Heribert Bischoff, and Andreas Sing

Author affiliations: Bavarian Health and Food Safety Authority, Oberschleissheim, Germany (A. Dangel, A. Berger, R. Konrad, H. Bischoff, A. Sing); German Consiliary Laboratory on Diphtheria, Oberschleissheim (A. Berger, R. Konrad, A. Sing)



From 2016 through the middle of 2017, the German Consiliary Laboratory on Diphtheria noted an increase in nontoxigenic Corynebacterium diphtheriae isolates submitted from cities in northern Germany. Many patients for whom epidemiologic data were available were homeless, alcohol or drug abusers, or both. After performing routine diagnostics and multilocus sequence typing (MLST), we analyzed isolates of sequence type (ST) 8 and previously submitted isolates by whole-genome sequencing. Results were analyzed for phylogenetic relationship by core genome MLST (cg-MLST) and whole-genome single-nucleotide polymorphism profiles. Next-generation sequencing–based cg-MLST revealed several outbreak clusters caused by ST8; the geographic focus was in the metropolitan areas of Hamburg and Berlin. To achieve enhanced analytical depth, we used additional cg-MLST target genes and genome-wide single-nucleotide polymorphisms. We identified patient characteristics and detected transmission events, providing evidence that nontoxigenic C. diphtheriae infection is a potential public health threat in industrialized countries.


Keywords: Diphtheria; Corynebacterium diphtheriae; Germany.


Long-term #maintenance of #diphtheria-specific #antibodies after booster #vaccination is hampered by latent #infection with #Cytomegalovirus (Immun Ageing, abstract)

[Source: Immunity & Ageing, full page: (LINK). Abstract, edited.]


Long-term maintenance of diphtheria-specific antibodies after booster vaccination is hampered by latent infection with Cytomegalovirus

Birgit Weinberger, Michael Keller and Beatrix Grubeck-Loebenstein

Immunity & Ageing – 201714:16 – DOI: 10.1186/s12979-017-0099-y

© The Author(s). 2017

Received: 1 March 2017 – Accepted: 19 June 2017 – Published: 26 June 2017



Many currently used vaccines are less immunogenic in the elderly compared to young adults. The impact of latent infection with Cytomegalovirus (CMV) on vaccine-induced antibody responses has been discussed controversially. We have demonstrated that recall responses to diphtheria vaccination are frequently insufficient in elderly persons and that antibody concentrations decline substantially within 5 years. In the current study we show that within a cohort of healthy elderly (n = 87; median age 71 years, range 66–92) antibody responses to a booster vaccination against diphtheria do not differ between CMV-negative and CMV-positive individuals 4 weeks after vaccination.. However, the goal of diphtheria-vaccination is long-term protection and this is achieved by circulating anti-toxin antibodies. Diphtheria-specific antibody concentrations decline faster in CMV-positive compared to CMV-negative older adults leading to an increased proportion of persons without protective antibody concentrations 5 years after booster vaccination and endangering long-term protection. This finding could be relevant for vaccination schedules.

Keywords: Cytomegalovirus – Diphtheria – Antibody maintenance – Elderly

Keywords: Cytomegalovirus; Diphtheria; Vaccines.


#Molecular Characterization of #Corynebacterium diphtheriae #Outbreak Isolates, #SouthAfrica, March–June 2015 (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 23, Number 8—August 2017 / Research

Molecular Characterization of Corynebacterium diphtheriae Outbreak Isolates, South Africa, March–June 2015

Mignon du Plessis, Nicole Wolter, Mushal Allam, Linda de Gouveia, Fahima Moosa, Genevie Ntshoe, Lucille Blumberg, Cheryl Cohen, Marshagne Smith, Portia Mutevedzi, Juno Thomas, Valentino Horne, Prashini Moodley, Moherndran Archary, Yesholata Mahabeer, Saajida Mahomed, Warren Kuhn, Koleka Mlisana, Kerrigan McCarthy, and Anne von Gottberg

Author affiliations: National Health Laboratory Service, Johannesburg, South Africa (M. du Plessis, N. Wolter, M. Allam, L. de Gouveia, F. Moosa, G. Ntshoe, L. Blumberg, C. Cohen, M. Smith, P. Mutevedzi, J. Thomas, K. McCarthy, A. von Gottberg); University of the Witwatersrand, Johannesburg (M. du Plessis, N. Wolter, C. Cohen, A. von Gottberg); National Health Laboratory Service, Cape Town, South Africa (V. Horne); University of KwaZulu-Natal, Durban, South Africa (P. Moodley, M. Archary, Y. Mahabeer, S. Mahomed, W. Kuhn, K. Mlisana); National Health Laboratory Service, Durban (Y. Mahabeer, K. Mlisana); National Department of Health, KwaZulu-Natal, South Africa (W. Kuhn)



In 2015, a cluster of respiratory diphtheria cases was reported from KwaZulu-Natal Province in South Africa. By using whole-genome analysis, we characterized 21 Corynebacterium diphtheriae isolates collected from 20 patients and contacts during the outbreak (1 patient was infected with 2 variants of C. diphtheriae). In addition, we included 1 cutaneous isolate, 2 endocarditis isolates, and 2 archived clinical isolates (ca. 1980) for comparison. Two novel lineages were identified, namely, toxigenic sequence type (ST) ST-378 (n = 17) and nontoxigenic ST-395 (n = 3). One archived isolate and the cutaneous isolate were ST-395, suggesting ongoing circulation of this lineage for >30 years. The absence of preexisting molecular sequence data limits drawing conclusions pertaining to the origin of these strains; however, these findings provide baseline genotypic data for future cases and outbreaks. Neither ST has been reported in any other country; this ST appears to be endemic only in South Africa.

Keywords: Diphtheria; Corynebacterium Diphtheriae; South Africa.


More than 20 years after re-emerging in the 1990s, #diphtheria remains a #publichealth problem in #Latvia (@eurosurveillanc, abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Eurosurveillance, Volume 21, Issue 48, 01 December 2016  / Surveillance and outbreak report

More than 20 years after re-emerging in the 1990s, diphtheria remains a public health problem in Latvia

I Kantsone 1 2 , I Lucenko 2 , J Perevoscikovs 3

Author affiliations: 1. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden; 2. Infectious Diseases Surveillance and Immunisation Unit, Infectious Disease Risk Analysis and Prevention Department, Centre for Disease Prevention and Control, Riga, Latvia; 3. Infectious Disease Risk Analysis and Prevention Department, Centre for Disease Prevention and Control, Riga, Latvia

Correspondence: Ieva Kantsone (

Citation style for this article: Kantsone I, Lucenko I, Perevoscikovs J. More than 20 years after re-emerging in the 1990s, diphtheria remains a public health problem in Latvia. Euro Surveill. 2016;21(48):pii=30414. DOI:

Received:30 October 2015; Accepted:20 May 2016



In 1994, the World Health Organization (WHO) declared the goal of eliminating diphtheria within the WHO European Region by the year 2000. However, in 1990 an epidemic emerged within the Russian Federation and spread to other countries, including Latvia, by 1994. We describe national surveillance and immunisation coverage data in Latvia from 1994 to 2014 and present historical data from 1946. We defined a laboratory-confirmed case as a clinical case in which toxin-producing Corynebacterium diphtheriae, C. ulcerans or C. pseudotuberculosis was isolated. From 1994 to 2014, 1,515 cases were reported, giving an average annual incidence of 3.2 cases per 100,000 inhabitants (range 0.1–14.8), with the highest incidence in age groups 5–19 and 40–49 years (4.4 and 4.3/100,000, respectively); 111 deaths were reported, 83.8% cases were laboratory-confirmed. Most cases occurred in unvaccinated adults. To improve disease control a supplementary immunisation campaign for adults was initiated in 1995, and by the end of 1998 national coverage among adults reached 70%, and reached 77% in 2003, but declined to 59% by 2014. Diphtheria remains a problem in Latvia with continued circulation of toxin-producing strains of C. diphtheriae. We recommend to strengthen immunisation to cover adults, as well as the education of health professionals and a serological survey.

Keywords: Diphtheria; Latvia.


#Respiratory #diphtheria in an #asylum #seeker from #Afghanistan arriving to #Finland via #Sweden, December 2015 (@eurosurveillanc, abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Eurosurveillance, Volume 21, Issue 2, 14 January 2016 / Rapid communication

Respiratory diphtheria in an asylum seeker from Afghanistan arriving to Finland via Sweden, December 2015 [      ]

J Sane 1, T Sorvari 1, M Wideström 2, H Kauma 3, U Kaukoniemi 4, E Tarkka 5, T Puumalainen 6, M Kuusi 1, M Salminen 1, O Lyytikäinen 1

Author affiliations: 1. Department of Infectious Diseases, Infectious Disease Control Unit, National Institute for Health and Welfare, Helsinki, Finland 2. Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden 3. Department of Internal Medicine, Oulu University Hospital, Oulu, Finland 4. Department of Infectious Diseases, Länsi-Pohja Central Hospital, Finland 5. Helsinki University Central Hospital, Hospital District of Helsinki and Uusimaa, Laboratory Services, HUSLAB, Finland 6. Department of Health Protection, Vaccination Programme Unit, National Institute for Health and Welfare, Helsinki, Finland

Correspondence: Jussi Sane (

Citation style for this article: Sane J, Sorvari T, Wideström M, Kauma H, Kaukoniemi U, Tarkka E, Puumalainen T, Kuusi M, Salminen M, Lyytikäinen O. Respiratory diphtheria in an asylum seeker from Afghanistan arriving to Finland via Sweden, December 2015. Euro Surveill. 2016;21(2):pii=30105. DOI:

Received:15 December 2015; Accepted:13 January 2016



In December 2015, an asylum seeker originating from Afghanistan was diagnosed with respiratory diphtheria in Finland. He arrived in Finland from Sweden where he had already been clinically suspected and tested for diphtheria. Corynebacterium diphtheriae was confirmed in Sweden and shown to be genotypically and phenotypically toxigenic. The event highlights the importance of early case detection, rapid communication within the country and internationally as well as preparedness plans of diphtheria antitoxin availability.

Keywords: Research; Abstracts; Migrants; Finland; Sweden; Diphteria.