Global epidemiology of diphtheria, 2000-2017

Kristie E.N. Clarke, Adam MacNeil, Stephen Hadler, Colleen Scott, Tejpratap S.P. Tiwari, Thomas Cherian

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria-tetanus-pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.

Original languageEnglish (US)
Pages (from-to)1834-1842
Number of pages9
JournalEmerging infectious diseases
Issue number10
StatePublished - 2019
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases


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