Abstract：
In July, 2022, an increase in diphtheria cases caused by toxigenic Corynebacterium diphtheriae (C diphtheriae) was reported among asylum seekers arriving by small boats to England. Rising case numbers presented challenges for case and contact management in initial reception centres, prompting changes to national guidance and implementation of population-based control measures. This study aimed to describe the outbreak of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022 by use of national surveillance data.
We undertook a descriptive epidemiological analysis of cases of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022, incorporating genomic sequencing data, antibiotic susceptibility testing results, and epidemiological data obtained through the UK Health Security Agency\'s national enhanced surveillance programme. Health Protection Teams conducted risk assessments, and operational data (including details regarding offer and uptake of antibiotics and vaccinations) were obtained from National Health Service partners supporting the intervention programme.
In 2022, C diphtheriae isolates from 86 asylum seekers arriving by small boats were submitted to the National Reference Laboratory for confirmation and testing. Toxigenic C diphtheriae was confirmed for 72 (84%) cases and one individual with typical diphtheritic lesions but from whom no C diphtheriae was isolated from clinical swabs was also included as a probable case, resulting in 73 cases of diphtheria. 71 (97%) were male, 39 (53%) were younger than 18 years, and 36 (49%) presented with cutaneous diphtheria. The prevalence of diphtheria was highest among Afghans (1·3%) compared with all other nationalities (<0·1%). Local antibiotic susceptibility testing identified six cases with a macrolide resistant strain.
The increase in diphtheria coincided with a high volume of asylum seekers arriving by small boats to England during 2022, and subsequently increased clinical awareness of the disease among this population. Long-term disruption to vaccination programmes in origin countries along with barriers to accessing health care along migrant routes puts asylum seekers arriving by small boats at risk of disease. With arrivals expected to continue in 2023, the UK Health Security Agency has recommended continuation of population-based control measures in England until October, 2023, subject to ongoing review.
The UK Health Security Agency.
We undertook a descriptive epidemiological analysis of cases of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022, incorporating genomic sequencing data, antibiotic susceptibility testing results, and epidemiological data obtained through the UK Health Security Agency\'s national enhanced surveillance programme. Health Protection Teams conducted risk assessments, and operational data (including details regarding offer and uptake of antibiotics and vaccinations) were obtained from National Health Service partners supporting the intervention programme.
In 2022, C diphtheriae isolates from 86 asylum seekers arriving by small boats were submitted to the National Reference Laboratory for confirmation and testing. Toxigenic C diphtheriae was confirmed for 72 (84%) cases and one individual with typical diphtheritic lesions but from whom no C diphtheriae was isolated from clinical swabs was also included as a probable case, resulting in 73 cases of diphtheria. 71 (97%) were male, 39 (53%) were younger than 18 years, and 36 (49%) presented with cutaneous diphtheria. The prevalence of diphtheria was highest among Afghans (1·3%) compared with all other nationalities (<0·1%). Local antibiotic susceptibility testing identified six cases with a macrolide resistant strain.
The increase in diphtheria coincided with a high volume of asylum seekers arriving by small boats to England during 2022, and subsequently increased clinical awareness of the disease among this population. Long-term disruption to vaccination programmes in origin countries along with barriers to accessing health care along migrant routes puts asylum seekers arriving by small boats at risk of disease. With arrivals expected to continue in 2023, the UK Health Security Agency has recommended continuation of population-based control measures in England until October, 2023, subject to ongoing review.
The UK Health Security Agency.
摘要：
背景：7月，2022年，据报道，在乘小船抵达英国的寻求庇护者中，由产毒素白喉棒杆菌（白喉C）引起的白喉病例增加。案件数量的增加给初始接待中心的案件和联系人管理带来了挑战，促使改变国家指导和实施基于人口的控制措施。这项研究旨在通过使用国家监测数据来描述2022年小船抵达英国的寻求庇护者中的产毒素白喉C的爆发。
方法：我们对2022年期间乘坐小船抵达英国的寻求庇护者中的产毒白喉C病例进行了描述性流行病学分析，并结合了基因组测序数据，抗生素药敏试验结果,以及通过英国卫生安全局的国家强化监测计划获得的流行病学数据。健康保护小组进行了风险评估，和操作数据(包括关于抗生素的提供和使用以及疫苗接种的细节)是从支持干预计划的国家卫生服务合作伙伴处获得的。
结果：2022年，来自86名寻求庇护者的白喉梭菌分离株通过小船到达国家参考实验室进行确认和测试。72例（84％）确诊了产毒性白喉C，其中一名患有典型白喉病变但未从临床拭子中分离出白喉C的患者也包括在内。导致白喉73例。71（97％）为男性，39人（53%）年龄小于18岁，36例（49%）出现皮肤白喉。与所有其他民族（<0·1％）相比，阿富汗人的白喉患病率最高（1·3％）。局部抗生素药敏试验确定了6例大环内酯耐药菌株。
结论：白喉的增加与2022年期间大量寻求庇护者乘坐小船抵达英格兰同时发生，随后增加了该人群对该疾病的临床认识。原籍国疫苗接种计划的长期中断以及沿移民路线获得医疗保健的障碍，使寻求庇护者乘小船抵达面临疾病的风险。预计2023年将继续到来，英国卫生安全局建议在10月之前继续在英格兰实施基于人口的控制措施。2023年，有待持续审查。
背景：英国卫生安全局。
方法：我们对2022年期间乘坐小船抵达英国的寻求庇护者中的产毒白喉C病例进行了描述性流行病学分析，并结合了基因组测序数据，抗生素药敏试验结果,以及通过英国卫生安全局的国家强化监测计划获得的流行病学数据。健康保护小组进行了风险评估，和操作数据(包括关于抗生素的提供和使用以及疫苗接种的细节)是从支持干预计划的国家卫生服务合作伙伴处获得的。
结果：2022年，来自86名寻求庇护者的白喉梭菌分离株通过小船到达国家参考实验室进行确认和测试。72例（84％）确诊了产毒性白喉C，其中一名患有典型白喉病变但未从临床拭子中分离出白喉C的患者也包括在内。导致白喉73例。71（97％）为男性，39人（53%）年龄小于18岁，36例（49%）出现皮肤白喉。与所有其他民族（<0·1％）相比，阿富汗人的白喉患病率最高（1·3％）。局部抗生素药敏试验确定了6例大环内酯耐药菌株。
结论：白喉的增加与2022年期间大量寻求庇护者乘坐小船抵达英格兰同时发生，随后增加了该人群对该疾病的临床认识。原籍国疫苗接种计划的长期中断以及沿移民路线获得医疗保健的障碍，使寻求庇护者乘小船抵达面临疾病的风险。预计2023年将继续到来，英国卫生安全局建议在10月之前继续在英格兰实施基于人口的控制措施。2023年，有待持续审查。
背景：英国卫生安全局。
