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Abstract

In early 2017, a United Kingdom (UK)-born person in their 20s presented with a skin ulcer on the foot 3 weeks after returning from Ghana. The patient had last received a diphtheria-containing vaccine in 2013, completing the recommended course. MALDI-TOF of a cutaneous swab identified . Real-time PCR ascertained the species and presence of the diphtheria toxin gene. An Elek test confirmed toxigenicity. The isolate was macrolide sensitive and penicillin resistant. The local Public Health England (PHE) Health Protection Team obtained the patient’s clinical history and traced contacts to inform appropriate public health action. One close contact (in their early 80s with uncertain immunisation status who had not recently travelled) had a positive throat swab for toxigenic and reported a history of mild coryzal symptoms. Multilocus sequence typing revealed that strains from the index case and contact had Sequence Type 493*. Diphtheria is extremely rare in the UK due to high vaccine coverage and this is the first documented transmission in 30 years. Clinicians and laboratory staff should remain highly suspicious of lesions in overseas travellers, even when patients are fully vaccinated. Older individuals who might not have completed a full immunisation course may have higher diphtheria susceptibility.

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A corrected article has been published for this content:
Authors’ correction for Euro Surveill. 2018;23(39)
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/content/10.2807/1560-7917.ES.2018.23.39.1700681
2018-09-27
2024-12-03
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.39.1700681
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Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=David+Edwards&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Edwards David</a>, <a href="/search?value1=Dianne+Kent&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kent Dianne</a>, <a href="/search?value1=Caroline+Lester&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lester Caroline</a>, <a href="/search?value1=Colin+Stewart+Brown&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brown Colin Stewart</a>, <a href="/search?value1=Michael+E.+Murphy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Murphy Michael E.</a>, <a href="/search?value1=Nicholas+M.+Brown&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brown Nicholas M.</a>, <a href="/search?value1=Olajumoke+Sule&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sule Olajumoke</a>, <a href="/search?value1=Alexandra+Itani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Itani Alexandra</a>, <a href="/search?value1=Meera+Chand&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chand Meera</a>, <a href="/search?value1=Amy+Trindall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Trindall Amy</a>, <a href="/search?value1=Callum+Pearson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pearson Callum</a>, <a href="/search?value1=Iain+Roddick&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Roddick Iain</a>, <a href="/search?value1=Norman+K.+Fry&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fry Norman K.</a>, <a href="/search?value1=Jorg+Hoffmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoffmann Jorg</a>, <a href="/search?value1=Nalini+Iyanger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Iyanger Nalini</a>, <a href="/search?value1=Laurence+Kemp&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kemp Laurence</a>, <a href="/search?value1=Joanne+White&option1=author&noRedirect=true" class="nonDisambigAuthorLink">White Joanne</a>, <a href="/search?value1=Babak+Javid&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Javid Babak</a>, <a href="/search?value1=Isobel+D.+Ramsay&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ramsay Isobel D.</a>, <a href="/search?value1=Dominik+Zenner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zenner Dominik</a>, <a href="/search?value1=Aliko+Ahmed&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ahmed Aliko</a>, <a href="/search?value1=Gayatri+Amirthalingam&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Amirthalingam Gayatri</a>, <a href="/search?value1=Sultan+Salimee&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Salimee Sultan</a>, <a href="/search?value1=David+Litt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Litt David</a>, <a href="/search?value1=Mark+Reacher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reacher Mark</a></span>. Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(39):pii=1700681. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.39.1700681" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.39.1700681</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Oct 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 23 May 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.39.1700681
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