THE RETURN OF DIPHTHERIA IN EUROPE - IS T HE FRENCH POPULATION PROTECTED

Following the generalized vaccination of children, the European countr ies achieved the elimination of diphtheria. However the huge epidemic which rages since 1990 in the New Independant States of ex-URSS, culmi nating in 1994-1995 (with respectively 47,802 and 50,412 notified case s), has showed that diphtheria could be still threatening. A serosurve y was carried out in France on 1025 adult patients attending the emerg ency wards of three hospitals, located in different parts of this coun try. This study showed the insufficient immunity of adults, for lack o f a routine programme for revaccination : only half of them have antib odies assuring their protection. The antitoxic immunity decreases acco rding to age. This decline is more marked in women than in men, most o f them being reimmunized during the military service. These data confi rm the alarming results of similar serosurveys performed in others ind ustrialised countries. The present risk of importing diphtheria in the se countries requires a strengthening of clinical and bacteriological surveillance of all cases of infections attributable to C. diphtheriae , and could justify a revaccination programme for adult population, in cluding a regular booster, at 10 year-interval, of a reduced dose of d iphtheria toxoid (d), and/or using the combined toxoid Td in the wound ed, instead of tetanus toroid alone.