Epidemic diphtheria in Ukraine, 1991-1997

In 1991., Ukraine experienced a return of epidemic diphtheria after decades of control that had resulted in <40 sporadic cases reported every year. In creased incidence was first recorded in Kiev, Lviv, and Odessa, By 1993, th e epidemic had spread to >50% of the oblasts (provinces) in the country, an d by 1995, all regions were affected. In 1995, at the peak of the epidemic, >5000 cases and >200 deaths were reported. As in Russia, >80% of these cas es were diagnosed in persons 16-59 years old. In 1993, the government of Uk raine initiated a program of increased immunization among children and at-r isk adults, and by 1995, a mass immunization strategy was adopted in an eff ort to arrest the epidemic, which was increasing exponentially. In 1996, th e number of cases started to decrease, and data from 1998 indicate that the downward trend has continued. It is likely that the diphtheria epidemic in Ukraine started among children, who had been left vulnerable due to inadeq uate childhood immunizations, and then quickly spread to inadequately prote cted adults.