白喉2023年年度流行病学报告

Diphtheria Annual Epidemiological Report for 2023 Key facts •In 2023, 216 cases of diphtheria due to toxigenicCorynebacterium diphtheriae (n=155) orC. ulcerans(n=61) were reported to ECDC.•The increase of diphtheria among migrants reported in several EU/EEA countries in the second half of2022 decreased to lower levels in 2023.•The highest proportion ofC. diphtheriaecases was among 15- to 24-year-old males.C. ulcerans caseswere more common in adults aged 45 years and above. Introduction Diphtheria is a bacterial infectious disease, which can be prevented by vaccination. Humans are the only knownsignificant reservoir forC. diphtheriae [1].Transmission occurs via airborne respiratory droplets, direct contact withrespiratory secretions, indirect contact with exudate from infected cutaneous lesions or with contaminated surfaces Following an infection, unvaccinated individuals may present with skin infections (cutaneous diphtheria), classicalrespiratory diphtheria and in rare cases, systemic diphtheria [3]. Case fatality of respiratory diphtheria can be ashigh as 5-10% [4]. In highly vaccinated populations, most infections are asymptomatic or have a mild clinicalcourse. Such cases are rarely diagnosed and reported unless detected during active case finding or contact tracing.The most common sites from which bacteria are isolated in symptomatic as well as asymptomatic infections are The other potentially toxigenic two Corynebacteria species,C. ulcerans and (very rarely)C. pseudotuberculosis,may also cause diphtheria disease. These infections are in the vast majority zoonotic, with human-to-humantransmission almost never reported [2]. The diphtheria toxin secreted by the two species is 95% homologous tothat ofC. diphtheriae and the biological effect and clinical presentation ofC. ulcerans andC. pseudotuberculosis Methods This report is based on data for 2023 retrieved from EpiPulse Cases on 12 March 2025. EpiPulse Cases is a systemfor the collection, analysis and dissemination of data on communicable diseases that replaced The EuropeanSurveillance System (TESSy) in October 2024. An overview of the national surveillance systems is available online [6]. Following an increase of diphtheria cases in 2022, ECDC updated its reporting mechanism for diphtheria to monitorany ongoing outbreaks. All diphtheria cases should be reported to EpiPulse Cases on a monthly basis; they arepublished in the interactive ‘Surveillance atlas of infectious diseases’ on a monthly basis [7]. An annual data call, In 2023, 29 European Union/European Economic Area (EU/EEA) countries reported data on diphtheria and relatedtoxigenic pathogens. Of these, 15 countries reported cases ofCorynebacterium diphtheriae orC. ulcerans. Most countries reported data on diphtheria according to the 2008 (n=6), 2012 (n=7) or 2018 (n=12) EU casedefinition. Five countries used an alternative case definition. Regardless of the case definition used, only casescaused by or with a clinical syndrome consistent with toxigenic strains should be reported at the EU level [8]. All countries reported data from a comprehensive and compulsory case-based surveillance system [6]. Epidemiology In 2023, 215 cases of laboratory-confirmed diphtheria and related toxigenic pathogens, one possible case and oneprobable case of diphtheria were reported (Table 1, Figure 1). Some 154 confirmed cases and one probable casewere reported asC. diphtheriae, 61 confirmed cases were reported asC. ulcerans, and for one possible case the Diphtheria caused byC. diphtheriae was reported by 14 countries (Table 2). Among these countries, Germany(n=95) and France (n=18) reported the highest number of cases, followed by the Netherlands (n=13).Diphtheria caused byC. ulcerans was reported by 12 countries. More than 65% of these cases were reported inGermany (n=22) and in France (n=19). Between 2019 and 2023, 754 cases of diphtheria were reported in the EU/EEA (Table 1), of which 563 cases weredue toC. diphtheriae. Age and gender distribution In 2023, cases were reported among all age groups, with a preponderance among those aged 15–24 years (42%)(Figure 2). Of all cases reported, 168 (77%) were males. Of the 155C. diphtheriae cases, 12 (8%) were below 15 years, 88 (57%) were reported in teenagers and youngadults from 15–24 years, and 55 (35%) were reported in adults 25 years and over (Figure 3). Of the 153 caseswith known gender, 135 (88%) were reported in males. Of the 61C. ulcerans cases, 10 (16%) were reported in individuals younger than 44 years, and 51 (84%) caseswere reported in adults 45 years and over (Figure 3). Thirty-three (54%) of theC. ulcerans cases were reported inmales. Source: Country reports from Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Estonia, Finland, France, Germany, Greece,Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal,Romania, Slovakia, Slovenia, Spain, and Sweden. So