Successful control of epidemic diphtheria in the states of the former union of soviet socialist republics: Lessons learned

Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, d eteriorating health infrastructure, initial shortages of vaccine, and delay s in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decr eases of diphtheria; however, continued efforts by national health authorit ies and international assistance are still needed. The legacy of this epide mic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model f or future public health emergencies in the successful collaboration of mult iple international partners. The reemergence of diphtheria warns of an imme diate threat of other epidemics in the NIS and Baltic States and a longer-t erm potential for the reemergence of vaccine-preventable diseases elsewhere . Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.