A patient with respiratory toxigenic diphtheria in Greece after more than 30 years

T. Georgakopoulou, K. Tryfinopoulou, A. Doudoulakakis, F. Nikolaou, I. Magaziotou, A. Flountzi, Norman Fry, David Litt, M. Damala, I. Spiliopoulou, E. Liatsi-Douvitsa, E. Lebessi, G. Panayiotakopoulos, M. Tsolia, G. Saroglou, M. Theodoridou, S. Tsiodras*, A. Efstratiou

*Corresponding author for this work

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Introduction of treatment and systematic vaccination has significantly reduced diphtheria mortality, however toxigenic strains continue to circulate worldwide. The emergence of an indigenous diphtheria case with fatal outcome in Greece, after 30 years, raised challenges for laboratory confirmation, clinical and public health management. Toxigenic Corynebacterium diphtheriae was isolated from an incompletely vaccinated 8-year-old boy with underlying conditions. The child passed away due to respiratory distress syndrome, before administration of diphtheria antitoxin (DAT). All close contacts in family, school and hospital settings were investigated. Pharyngeal swabs were obtained to determine asymptomatic carriage. Chemoprophylaxis was given for 7 days to all close contacts and a booster dose to those incompletely vaccinated. Testing revealed a classmate, belonging to a subpopulation group (Roma), and incompletely vaccinated, as an asymptomatic carrier with an indistinguishable toxigenic strain (same novel multilocus sequence type, designated ST698). This case highlights the role of asymptomatic carriage, as entry of toxigenic strains into susceptible populations can put individuals and their environment at risk. Maintenance of high-level epidemiological and microbiological surveillance, implementation of systematic vaccination in children and adults with primary and booster doses, availability of a DAT stockpile, allowing timely administration, are the cornerstone to prevent similar incidents in the future.

Original languageEnglish
Article numbere274
JournalEpidemiology and Infection
Publication statusPublished - 28 Oct 2020

Bibliographical note

Funding Information: No external funding.

Open Access: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use,distribution, and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright: © The Author(s), 2020.

Citation: Georgakopoulou, T., Tryfinopoulou, K., Doudoulakakis, A., Nikolaou, F., Magaziotou, I., Flountzi, A., . . . Efstratiou, A. (2020). A patient with respiratory toxigenic diphtheria in Greece after more than 30 years. Epidemiology and Infection, 148, E274.

DOI: 10.1017/S0950268820002605


  • DAT
  • Diphtheria
  • Diphtheria vaccination
  • Epidemiological Surveillance
  • Greece


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