Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease. 1998, Vitek, Emerg Infect Dis

  • The role of antibacterial immunity in protection against diphtheria has not been studied since the 30s.
  • Prior to the World War II, diphtheria was rarely observed in the countries of Western Europe. During the war, an epidemic started in Netherlands, Denmark and Norway, in the territories occupied by the Germans. It was the last diphtheria epidemic in developed European countries. The remaining isolated cases were observed mainly among the lower socioeconomic class.
  • In the early 90s Russia, diphtheria cases among the military were observed 6 times more often that among the civilian population. In the late 80s this proportion was even higher.
  • In the 90s epidemic in the former USSR countries, 83% of all cases were recorded in Russia. Most patients were adults.
    The patients were mainly homeless and patients of psychiatric hospitals, living in cramped quarters and poor sanitary conditions. Among the people working under normal conditions, there were very few cases of the disease.
    Children rarely got sick, but they were carriers of the disease. Economic crisis after the fall of the USSR worsened living conditions and intensified the epidemic.
    Since virtually the entire population of the USSR was vaccinated, it is hard to blame the epidemic on the lack of vaccination, but the authors succeeded. After all, the article was written by the CDC.


Diphtheria outbreak in St. Petersburg: clinical characteristics of 1860 adult patients. 1996, Rakhmanova, Scand J Infect Dis

1,860 cases of diphtheria in the Botkin hospital in St. Petersburg. Fatality rate was 2.3%. 69% of those who died were chronic alcoholics.
Among those who suffered from the toxic form of the disease, fatality rate was 26%. 6% of vaccinated patients and 14% of unvaccinated patients suffered from the toxic form. However, only those vaccinated in the last five years were considered as vaccinated.
Overall, the diphtheria fatality rate (2.3%) was relatively low, as compared to the last known epidemics. And if alcoholics were to be excluded, the fatality rate would be about 1%. Most of those who died got to the hospital at the late stages of the disease, and were either alcoholics or very busy people.
The authors conclude that diphtheria epidemic in developed countries is unlikely to have high fatality rate in the future. Also, since there was no vaccination data for the alcoholics, the authors believe that they were unvaccinated.
Vaccination provides immunity for a relatively short time. How exactly is diphtheria transmitted from person to person is not really known.


Death from diphtheria in developed countries is so rare that every such case is widely reported in the media. In 2015, a boy died of diphtheria in Spain, and in 2008, a girl died in England. These seem to be the only deaths of children from diphtheria in developed countries in the last 30 years.

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