Diphtheria in North America.

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Diphtheria incidence has significantly declined in North America over the past 50 years.
• This decline aligns with trends in developed nations implementing organized immunization programs.

Observation:

• Recent years show persistent diphtheria foci in specific low-socioeconomic populations.
• The skin serves as a significant reservoir for these lingering infections.
• Endemic cutaneous diphtheria has been noted in urban indigent adult males and in native Indian populations in Northern Canada.

Findings:

• In Northern Canada, diphtheria primarily affects infants and children, often presenting as skin or ear infections with uncommon toxic disease.
• Urban diphtheria outbreaks have ceased in recent years.
• Endemicity now appears restricted to northern native populations, with decreasing infection rates.

Implications:

• Highlights the importance of continued surveillance and targeted interventions in vulnerable populations.
• Suggests that non-respiratory transmission routes, like skin infections, require specific public health strategies.
• Underscores the success of vaccination programs while identifying persistent challenges in disease eradication.