Epidemiology and control of diphtheria in the Republic of Moldova, 1946-1996

In 1994-1996, the Republic of Moldova was stricken with an epidemic of diph theria after >30 years of routine diphtheria immunization and the near abse nce of the disease for nearly 20 years, The intensity of the epidemic gradu ally grew, reaching a peak in 1994-1995, The epidemiology of diphtheria in Moldova during this period is described along with laboratory findings and control measures. Pharyngeal diphtheria was the predominant clinical form o f the disease (97% of cases), and it most often developed in a localized fo rm (70%), with 20% in the toxic form. The clinical diagnosis of diphtheria was bacteriologically confirmed in 91% of cases: Of the cases tested for bi otype, 91.3% were gravis, 8.5% were mitis, and 0.2% were intermedius, Of 49 4 toxigenic isolates from cases and carriers at the beginning of the epidem ic, 47% were nonphagotypeable strains, and 25.7% were phagotype VI strains. Aggressive population-based diphtheria control measures, a mass immunizati on campaign, rapid case identification, antibiotic prophylaxis and suppleme ntal immunization of close contacts in clusters of infection, and high cove rage with routine immunization rapidly controlled the epidemic within Moldo va.