背景:呼吸道白喉是一种潜在致命的毒素介导的疾病,在高度接种疫苗的人群中很少见。产毒素白喉棒杆菌的皮肤感染最常与前往流行区有关。溃疡棒状杆菌已经成为一种主要的,西欧呼吸道和皮肤白喉的局部获得性原因。最近,来自几个高度接种疫苗地区的公共卫生机构扩大了他们的指南,以调查产毒性皮肤白喉,无论旅行史如何。由于北美白喉梭菌的流行病学相对未知,在过去的十年里,白喉毒素的检测越来越多,这一变化可能导致公共卫生调查大幅增加,但获益不明确.
方法:这项研究检查了艾伯塔省高度接种疫苗的人群中,产毒性皮肤白喉调查的诊断和公共卫生益处。加拿大,皮肤白喉调查不需要旅行史。对2010年至2019年收集的所有白喉梭菌分离株进行了标本来源审查,毒性,Biovar,以及相关的临床和公共卫生数据。
结果:其中,5%的白喉梭菌分离物是产毒的,而82%是从皮肤部位分离的。确定了三例产毒素皮肤病,没有来自最近旅行的患者。接触者追踪发现0%-26%的密切接触者无症状白喉梭菌定植,在定殖接触者和主要病例之间具有相同的分离特征。
结论:非流行地区的皮肤白喉值得进行公共卫生调查,无论旅行史和总体疫苗接种水平如何。这项研究强调了在公共卫生指南中纳入溃疡以评估产毒棒杆菌的总体患病率和流行病学的重要性。
BACKGROUND: Respiratory diphtheria is a potentially fatal toxin-mediated disease that is rare among highly vaccinated populations. Cutaneous infections with toxigenic Corynebacterium diphtheriae are most commonly linked to travel to an endemic region. Corynebacterium ulcerans has emerged as a predominant, locally acquired cause of respiratory and cutaneous diphtheria in Western Europe. Recently, public health agencies from several highly vaccinated regions expanded their guidelines to investigate toxigenic cutaneous diphtheria regardless of travel history. With relatively unknown epidemiology of C diphtheriae in North America, and increasing diphtheria toxin testing over the last decade, this change could lead to substantial increases in public health investigations with unclear benefits.
METHODS: This study examined the diagnostic and public health benefits of toxigenic cutaneous diphtheria investigations in the highly vaccinated population of Alberta, Canada, where travel history is not required for cutaneous diphtheria investigations. All C diphtheriae isolates collected between 2010 and 2019 were reviewed for specimen source, toxigenicity, biovar, and associated clinical and public health data.
RESULTS: Of these, 5% of C diphtheriae isolates were toxigenic and 82% were isolated from cutaneous sites. Three cases of toxigenic cutaneous disease were identified, none from patients with recent travel. Contact tracing identified asymptomatic C diphtheriae colonization among 0%-26% of close contacts, with identical isolate profiles among colonized contacts and primary cases.
CONCLUSIONS: Cutaneous diphtheria in nonendemic regions warrants public health investigation regardless of travel history and overall vaccination levels. This study underscores the importance of including C ulcerans in public health guidelines to assess the overall prevalence and epidemiology of toxigenic corynebacteria.