Epidemic diphtheria in the the newly independent states of the former Soviet Union: Implications for diphtheria control in the United States

The re-emergence of diphtheria in the Newly Independent States of the forme r Soviet Union in the 1990s raised global awareness of the potential for re surgent disease in countries with long-standing immunization programs. In t he United States, the large population of susceptible adults and the possib ility of a reintroduction of toxigenic strains of diphtheria create a setti ng in which diphtheria could spread. In addition, at least one focus of con tinued circulation of endemic toxigenic Corynebacterium diphtheriae has bee n identified. Few physicians now have expertise in the diagnosis and treatm ent of persons with diphtheria, and laboratory capacity is lacking througho ut the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toroid vaccination, surveillance, acc essible and reliable laboratory testing, and training of health care provid ers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained.