Epidemic investigation of diphtheria, Republic of Kazakhstan, 1990-1996

The diphtheria epidemic that began in Russia in 1990 reached Kazakhstan in 1992 when 45 case-patients (a 50% increase over 1991) were reported. In 199 3, 82 case-patients were reported, and 489 were reported in 1994, The epide mic peaked in 1995 when 1105 case-patients were reported (incidence rate = 6.7/100,000 population), In 1996, after public health practice modification s and several mass vaccinations, 455 case-patients were reported, From 1990 to 1996, children less than or equal to 14 years old represented 35% (2234 ) of the reported case-patients land 33% of the population) but had a dispr oportionate share (49%) of the fatalities. Females represented 63% of the a dult case-patients. In 1996, 297 (65%) of 455 case-patients and 26 (84%) of 31 fatalities were unvaccinated, Kazakhstan controlled the diphtheria epid emic by using a multifaceted public health strategy of prevention and contr ol, which included changing the routine immunization schedule, modifying th e official list of contraindications to vaccination, conducting mass campai gns to vaccinate persons, and treating close contacts of case-patients with antibiotics.