Epidemic diphtheria in the Republic of Georgia, 1993-1996: Risk factors for fatal outcome among hospitalized patients

Epidemic diphtheria reemerged in the republic of Georgia in November 1993, To identify risk factors for fatal outcomes, clinical and epidemiologic dat a on all hospitalized diphtheria patients were examined. Medical charts of patients from 1993-1995 were reviewed. A total of 659 cases and 68 deaths w ere identified (case fatality rate [CFR] = 10.3%). Fifty-two percent of all cases and 68% of deaths were in children less than or equal to 14 years ol d. The highest CFR occurred among adults 40-49 years of age (CFR = 19%) and children 5-9 years of age (CFR = 16%), Children who did not have the compl ete primary vaccination series with diphtheria toroid and adults 40-49 year s of age were the 2 groups at highest risk. Being a rural resident and havi ng a long interval (>3 days) between onset of symptoms to antitoxin treatme nt were significantly associated with fatal outcomes. Immunization of child ren and 40- to 49-year-old adults was required to rapidly control the epide mic.