RESPIRATORY DIPHTHERIA IN THE UNITED-STATES, 1980 THROUGH 1995

Objectives. The purpose of this study was to describe the epidemiologi c, laboratory, and clinical features of respiratory diphtheria cases r eported in the United States during 1980 through 1995. Methods. Respir atory diphtheria cases reported to the Centers for Disease Control and Prevention were reviewed. Cases were defined as physician-diagnosed c ases with signs and symptoms compatible with respiratory diphtheria, i ncluding the presence of a pseudomembrane without other apparent cause . Results. From 1980 through 1994, 41 respiratory diphtheria cases wer e reported; none were reported in 1995, and no secondary cases were id entified. Nine (22%) case patients were 4 years of age or younger, and 28 (68%) were 15 years of age or older. None of the case patients wer e up to date with diphtheria vaccination; 4 unvaccinated children died . Seventeen (43%) of 40 case patients had positive culture results. Co nclusions. Available surveillance data suggest that respiratory diphth eria has become a ran disease in the United States. However, importati on and circulation of toxigenic strains continue to present a threat a nd require achieving and maintaining high coverage with diphtheria tor oid-containing vaccines in both children and adults.