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Melinda Wharton - One of the best experts on this subject based on the ideXlab platform.

  • epidemic diphtheria in the Newly Independent States of the former soviet union implications for diphtheria control in the united States
    The Journal of Infectious Diseases, 2000
    Co-Authors: Anne Golaz, Iain R B Hardy, Charles Vitek, Tanja Popovic, Peter M Strebel, Kristine M Bisgard, Melinda Wharton
    Abstract:

    The re-emergence of diphtheria in the Newly Independent States of the former Soviet Union in the 1990s raised global awareness of the potential for resurgent disease in countries with long-standing immunization programs. In the United States, the large population of susceptible adults and the possibility of a reintroduction of toxigenic strains of diphtheria create a setting in which diphtheria could spread. In addition, at least one focus of continued circulation of endemic toxigenic Corynebacterium diphtheriae has been identified. Few physicians now have expertise in the diagnosis and treatment of persons with diphtheria, and laboratory capacity is lacking throughout the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toxoid vaccination, surveillance, accessible and reliable laboratory testing, and training of health care providers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained. After 30 years of control, epidemic diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, re-emerged in the early 1990s in the Newly Independent States (NIS) of the former Soviet Union. The epidemic peaked in 1994‐1995 and was on the decline by 1996. This article reviews the diphtheria epidemic in the NIS, the epidemiology of diphtheria in the United States, and the implications of the NIS diphtheria epidemic for prevention of diphtheria in the United States. The Diphtheria Epidemic in the NIS In the late 1950s, universal childhood immunization with diphtheria toxoid was begun throughout the former Soviet Union, and the immunization program successfully controlled diphtheria for almost 30 years. In 1976, reported cases in the Soviet Union fell to !200 (incidence rate, 0.08/100,000 population) [1], compared with 1955, when 1100,000 cases were reported in Russia alone. During the 1970s, most of the reported cases were from the Central Asian Republics. In the mid-1980s, there was a small resurgence of almost 2000 cases per year, mostly in Russia, which was then followed by a decrease to 839 cases in 1989. a Deceased.

  • diphtheria surveillance and control in the former soviet union and the Newly Independent States
    The Journal of Infectious Diseases, 2000
    Co-Authors: Charles Vitek, Erika Y Bogatyreva, Melinda Wharton
    Abstract:

    The Newly Independent States (NIS) inherited a common approach to diphtheria control from the Soviet Union and maintained a centralized system of surveillance and control managed by Soviet-trained epidemiologists with a shared professional culture. This system had controlled a diphtheria resurgence in the 1980s. In response to the epidemic of the 1990s, NIS health authorities responded with a set of control measures based on the Soviet-era experience. These measures included intensified childhood vaccination, aggressive case investigation, widespread diphtheria screening in institutions, and vaccination of adults in high-risk occupation groups. These measures proved insufficient due to high levels of susceptibility among adults, excessive contraindications to childhood vaccination, and insufficient resources in many countries. After these initial delays in implementing effective measures in some countries, most of the NIS health authorities rapidly and successfully implemented mass immunization of the population against diphtheria once the strategy was adopted and sufficient vaccine was available.

  • immunogenicity of tetanus diphtheria toxoids td among ukrainian adults implications for diphtheria control in the Newly Independent States of the former soviet union
    The Journal of Infectious Diseases, 2000
    Co-Authors: Roland W Sutter, Iain R B Hardy, Irinia A Kozlova, Liudmila M Tchoudnaia, Tatiana G Gluskevich, Victor Marievsky, Adamadia Deforest, Melinda Wharton
    Abstract:

    After 30 years of control, epidemic diphtheria returned to the Soviet Union in 1990. To develop control strategies, the immunogenicity of the tetanus and diphtheria toxoids (Td) vaccine was assessed. Workers who were 18-67 years old received two Td immunizations separated by 30 days. A neutralization assay determined diphtheria antitoxin (DAT) on enrollment and on days 7, 30, 60, and 425. On enrollment, 43.0% of 488 workers had DAT /=0.1 IU/mL, after two doses, 92.2% had >/=0.1 IU/mL and >90% of participants /=50 years of age attained >/=1.0 IU/mL; however, only 78.4% of those who were 30-39 years old and 51.8% of those who were 40-49 years old achieved >/=1.0 IU/mL after two doses. To control the epidemic in Ukraine, one Td dose should be administered to virtually the entire population (persons 30-49 years old require three doses of Td for optimal individual protection and to maximize population immunity).

  • epidemic diphtheria in the Newly Independent States of the former soviet union
    1998
    Co-Authors: Melinda Wharton, Iain R B Hardy, Charles Vitek, Tanja Popovic, Roland W Sutter
    Abstract:

    In spite of decades of good control, in the Newly Independent States of the former Soviet Union epidemic diphtheria has reemerged. During the late 1980s, childhood immunization coverage levels were low in some regions of the Soviet Union. One of the factors contributing to lack of ontime vaccination of children was a long list of contraindications for vaccination. In the central Asian republics and Caucasian countries there were vaccine shortages due to disruption of the supply in 1992 and 1993, following the dissolution of the Soviet Union. Before the dissolution of the Soviet Union, Russian-manufactured diphtheria toxoid vaccine was used throughout the Soviet Union. Although morbidity data from the armed forces are not available to civilian public health authorities in the former Soviet Union, outbreaks of diphtheria among soldiers have been reported. High coverage among children (95% coverage with four doses of diphtheria toxoid in all districts) and administration of a single dose of diphtheria toxoid to each inhabitant were essential to achieve high population immunity. The risk of emergence of epidemic diphtheria in other countries is difficult to estimate, but clearly clinical and public health expertise in diagnosis and management of diphtheria cases must be maintained. Although previously a disease of children, diphtheria has emerged as an epidemic disease among adolescents and adults in the Newly Independent States of the former Soviet Union decades after the implementation of an effective childhood vaccination program.

Roland W Sutter - One of the best experts on this subject based on the ideXlab platform.

  • immunogenicity of tetanus diphtheria toxoids td among ukrainian adults implications for diphtheria control in the Newly Independent States of the former soviet union
    The Journal of Infectious Diseases, 2000
    Co-Authors: Roland W Sutter, Iain R B Hardy, Irinia A Kozlova, Liudmila M Tchoudnaia, Tatiana G Gluskevich, Victor Marievsky, Adamadia Deforest, Melinda Wharton
    Abstract:

    After 30 years of control, epidemic diphtheria returned to the Soviet Union in 1990. To develop control strategies, the immunogenicity of the tetanus and diphtheria toxoids (Td) vaccine was assessed. Workers who were 18-67 years old received two Td immunizations separated by 30 days. A neutralization assay determined diphtheria antitoxin (DAT) on enrollment and on days 7, 30, 60, and 425. On enrollment, 43.0% of 488 workers had DAT /=0.1 IU/mL, after two doses, 92.2% had >/=0.1 IU/mL and >90% of participants /=50 years of age attained >/=1.0 IU/mL; however, only 78.4% of those who were 30-39 years old and 51.8% of those who were 40-49 years old achieved >/=1.0 IU/mL after two doses. To control the epidemic in Ukraine, one Td dose should be administered to virtually the entire population (persons 30-49 years old require three doses of Td for optimal individual protection and to maximize population immunity).

  • evaluation of a single dose of diphtheria toxoid among adults in the republic of georgia 1995 immunogenicity and adverse reactions
    The Journal of Infectious Diseases, 2000
    Co-Authors: Nino Khetsuriani, Adamadia Deforest, Stanley Music, Roland W Sutter
    Abstract:

    n= 248 toxoids; manufactured by Serum Institute of India). By day 30, the seroprevalence of antitoxin levels >0.1 IU/mL increased from 22.6% to 81.5%; median antitoxin levels increased from 0.01 to 4.0 IU/mL. These parameters were lowest among subjects who were 40‐59 years old, especially among those 40‐49 years old. Adverse reactions (local redness, swelling, induration, fever 1397C) were reported by 5.3% of participants. Our findings suggest that, in general, one dose of the Indian-produced Td vaccine is efficacious and safe in inducing an adequate immune response against diphtheria in adults; however, in Georgia, persons 40‐59 years old, especially those 40‐49 years old, will require additional doses of toxoid to achieve protective levels of antitoxin. Since 1990, a large-scale resurgence of diphtheria began in the Russian Federation and subsequently spread to involve virtually all of the Newly Independent States (NIS) of the former Soviet Union. Routine diphtheria vaccination was introduced in the Republic of Georgia in the late 1950s. After almost 4 decades of successful control, epidemic diphtheria returned to the country in 1993: 28 cases of diphtheria were reported in 1993, 312 in 1994, 429 in 1995 [1], and 348 in 1996 [2]. The 1994 Strategy for Diphtheria Control in the NIS, which was outlined by the Regional Office for Europe, World Health Organization (WHO), and UNICEF, urged that population immunity be raised as rapidly as possible by mass vaccination of persons 3‐59 years of age with at least one dose of diphtheria Presented in part: International Conference on Emerging Infectious Dis

  • epidemic diphtheria in the Newly Independent States of the former soviet union
    1998
    Co-Authors: Melinda Wharton, Iain R B Hardy, Charles Vitek, Tanja Popovic, Roland W Sutter
    Abstract:

    In spite of decades of good control, in the Newly Independent States of the former Soviet Union epidemic diphtheria has reemerged. During the late 1980s, childhood immunization coverage levels were low in some regions of the Soviet Union. One of the factors contributing to lack of ontime vaccination of children was a long list of contraindications for vaccination. In the central Asian republics and Caucasian countries there were vaccine shortages due to disruption of the supply in 1992 and 1993, following the dissolution of the Soviet Union. Before the dissolution of the Soviet Union, Russian-manufactured diphtheria toxoid vaccine was used throughout the Soviet Union. Although morbidity data from the armed forces are not available to civilian public health authorities in the former Soviet Union, outbreaks of diphtheria among soldiers have been reported. High coverage among children (95% coverage with four doses of diphtheria toxoid in all districts) and administration of a single dose of diphtheria toxoid to each inhabitant were essential to achieve high population immunity. The risk of emergence of epidemic diphtheria in other countries is difficult to estimate, but clearly clinical and public health expertise in diagnosis and management of diphtheria cases must be maintained. Although previously a disease of children, diphtheria has emerged as an epidemic disease among adolescents and adults in the Newly Independent States of the former Soviet Union decades after the implementation of an effective childhood vaccination program.

  • current situation and control strategies for resurgence of diphtheria in Newly Independent States of the former soviet union
    The Lancet, 1996
    Co-Authors: Iain R B Hardy, Roland W Sutter, Sieghart Dittmann
    Abstract:

    Abstract Since 1990, an epidemic of diphtheria has spread throughout the Newly Independent States of the former Soviet Union, and by 1995 a total of 47 808 cases were reported. During the early stages of the epidemic, adequate control measures were not taken and vaccine was in short supply; possible contributing factors to the spread of the epidemic are the presence of highly susceptible child and adult populations, socioeconomic instability, population movement, and a deteriorating health infrastructure. Although WHO views the epidemic as an international public-health emergency and, together with UNICEF and the International Red Cross, has formulated a strategy to combat the epidemic, the necessary funds have not been made fully available. Current vaccination recommendations also need to be reviewed to ensure that population immunity will be adequate to prevent any resurgence of diphtheria in Europe and North America.

  • current situation and control strategies for resurgence of diphtheria in Newly Independent States of the former soviet union
    The Lancet, 1996
    Co-Authors: Iain R B Hardy, Roland W Sutter, Sieghart Dittmann
    Abstract:

    Abstract Since 1990, an epidemic of diphtheria has spread throughout the Newly Independent States of the former Soviet Union, and by 1995 a total of 47 808 cases were reported. During the early stages of the epidemic, adequate control measures were not taken and vaccine was in short supply; possible contributing factors to the spread of the epidemic are the presence of highly susceptible child and adult populations, socioeconomic instability, population movement, and a deteriorating health infrastructure. Although WHO views the epidemic as an international public-health emergency and, together with UNICEF and the International Red Cross, has formulated a strategy to combat the epidemic, the necessary funds have not been made fully available. Current vaccination recommendations also need to be reviewed to ensure that population immunity will be adequate to prevent any resurgence of diphtheria in Europe and North America.

Iain R B Hardy - One of the best experts on this subject based on the ideXlab platform.

  • epidemic diphtheria in the Newly Independent States of the former soviet union implications for diphtheria control in the united States
    The Journal of Infectious Diseases, 2000
    Co-Authors: Anne Golaz, Iain R B Hardy, Charles Vitek, Tanja Popovic, Peter M Strebel, Kristine M Bisgard, Melinda Wharton
    Abstract:

    The re-emergence of diphtheria in the Newly Independent States of the former Soviet Union in the 1990s raised global awareness of the potential for resurgent disease in countries with long-standing immunization programs. In the United States, the large population of susceptible adults and the possibility of a reintroduction of toxigenic strains of diphtheria create a setting in which diphtheria could spread. In addition, at least one focus of continued circulation of endemic toxigenic Corynebacterium diphtheriae has been identified. Few physicians now have expertise in the diagnosis and treatment of persons with diphtheria, and laboratory capacity is lacking throughout the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toxoid vaccination, surveillance, accessible and reliable laboratory testing, and training of health care providers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained. After 30 years of control, epidemic diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, re-emerged in the early 1990s in the Newly Independent States (NIS) of the former Soviet Union. The epidemic peaked in 1994‐1995 and was on the decline by 1996. This article reviews the diphtheria epidemic in the NIS, the epidemiology of diphtheria in the United States, and the implications of the NIS diphtheria epidemic for prevention of diphtheria in the United States. The Diphtheria Epidemic in the NIS In the late 1950s, universal childhood immunization with diphtheria toxoid was begun throughout the former Soviet Union, and the immunization program successfully controlled diphtheria for almost 30 years. In 1976, reported cases in the Soviet Union fell to !200 (incidence rate, 0.08/100,000 population) [1], compared with 1955, when 1100,000 cases were reported in Russia alone. During the 1970s, most of the reported cases were from the Central Asian Republics. In the mid-1980s, there was a small resurgence of almost 2000 cases per year, mostly in Russia, which was then followed by a decrease to 839 cases in 1989. a Deceased.

  • immunogenicity of tetanus diphtheria toxoids td among ukrainian adults implications for diphtheria control in the Newly Independent States of the former soviet union
    The Journal of Infectious Diseases, 2000
    Co-Authors: Roland W Sutter, Iain R B Hardy, Irinia A Kozlova, Liudmila M Tchoudnaia, Tatiana G Gluskevich, Victor Marievsky, Adamadia Deforest, Melinda Wharton
    Abstract:

    After 30 years of control, epidemic diphtheria returned to the Soviet Union in 1990. To develop control strategies, the immunogenicity of the tetanus and diphtheria toxoids (Td) vaccine was assessed. Workers who were 18-67 years old received two Td immunizations separated by 30 days. A neutralization assay determined diphtheria antitoxin (DAT) on enrollment and on days 7, 30, 60, and 425. On enrollment, 43.0% of 488 workers had DAT /=0.1 IU/mL, after two doses, 92.2% had >/=0.1 IU/mL and >90% of participants /=50 years of age attained >/=1.0 IU/mL; however, only 78.4% of those who were 30-39 years old and 51.8% of those who were 40-49 years old achieved >/=1.0 IU/mL after two doses. To control the epidemic in Ukraine, one Td dose should be administered to virtually the entire population (persons 30-49 years old require three doses of Td for optimal individual protection and to maximize population immunity).

  • epidemic diphtheria in the Newly Independent States of the former soviet union
    1998
    Co-Authors: Melinda Wharton, Iain R B Hardy, Charles Vitek, Tanja Popovic, Roland W Sutter
    Abstract:

    In spite of decades of good control, in the Newly Independent States of the former Soviet Union epidemic diphtheria has reemerged. During the late 1980s, childhood immunization coverage levels were low in some regions of the Soviet Union. One of the factors contributing to lack of ontime vaccination of children was a long list of contraindications for vaccination. In the central Asian republics and Caucasian countries there were vaccine shortages due to disruption of the supply in 1992 and 1993, following the dissolution of the Soviet Union. Before the dissolution of the Soviet Union, Russian-manufactured diphtheria toxoid vaccine was used throughout the Soviet Union. Although morbidity data from the armed forces are not available to civilian public health authorities in the former Soviet Union, outbreaks of diphtheria among soldiers have been reported. High coverage among children (95% coverage with four doses of diphtheria toxoid in all districts) and administration of a single dose of diphtheria toxoid to each inhabitant were essential to achieve high population immunity. The risk of emergence of epidemic diphtheria in other countries is difficult to estimate, but clearly clinical and public health expertise in diagnosis and management of diphtheria cases must be maintained. Although previously a disease of children, diphtheria has emerged as an epidemic disease among adolescents and adults in the Newly Independent States of the former Soviet Union decades after the implementation of an effective childhood vaccination program.

  • current situation and control strategies for resurgence of diphtheria in Newly Independent States of the former soviet union
    The Lancet, 1996
    Co-Authors: Iain R B Hardy, Roland W Sutter, Sieghart Dittmann
    Abstract:

    Abstract Since 1990, an epidemic of diphtheria has spread throughout the Newly Independent States of the former Soviet Union, and by 1995 a total of 47 808 cases were reported. During the early stages of the epidemic, adequate control measures were not taken and vaccine was in short supply; possible contributing factors to the spread of the epidemic are the presence of highly susceptible child and adult populations, socioeconomic instability, population movement, and a deteriorating health infrastructure. Although WHO views the epidemic as an international public-health emergency and, together with UNICEF and the International Red Cross, has formulated a strategy to combat the epidemic, the necessary funds have not been made fully available. Current vaccination recommendations also need to be reviewed to ensure that population immunity will be adequate to prevent any resurgence of diphtheria in Europe and North America.

  • current situation and control strategies for resurgence of diphtheria in Newly Independent States of the former soviet union
    The Lancet, 1996
    Co-Authors: Iain R B Hardy, Roland W Sutter, Sieghart Dittmann
    Abstract:

    Abstract Since 1990, an epidemic of diphtheria has spread throughout the Newly Independent States of the former Soviet Union, and by 1995 a total of 47 808 cases were reported. During the early stages of the epidemic, adequate control measures were not taken and vaccine was in short supply; possible contributing factors to the spread of the epidemic are the presence of highly susceptible child and adult populations, socioeconomic instability, population movement, and a deteriorating health infrastructure. Although WHO views the epidemic as an international public-health emergency and, together with UNICEF and the International Red Cross, has formulated a strategy to combat the epidemic, the necessary funds have not been made fully available. Current vaccination recommendations also need to be reviewed to ensure that population immunity will be adequate to prevent any resurgence of diphtheria in Europe and North America.

Charles Vitek - One of the best experts on this subject based on the ideXlab platform.

  • epidemic diphtheria in the Newly Independent States of the former soviet union implications for diphtheria control in the united States
    The Journal of Infectious Diseases, 2000
    Co-Authors: Anne Golaz, Iain R B Hardy, Charles Vitek, Tanja Popovic, Peter M Strebel, Kristine M Bisgard, Melinda Wharton
    Abstract:

    The re-emergence of diphtheria in the Newly Independent States of the former Soviet Union in the 1990s raised global awareness of the potential for resurgent disease in countries with long-standing immunization programs. In the United States, the large population of susceptible adults and the possibility of a reintroduction of toxigenic strains of diphtheria create a setting in which diphtheria could spread. In addition, at least one focus of continued circulation of endemic toxigenic Corynebacterium diphtheriae has been identified. Few physicians now have expertise in the diagnosis and treatment of persons with diphtheria, and laboratory capacity is lacking throughout the country. These concerns highlight the importance of maintaining high levels of age-appropriate diphtheria toxoid vaccination, surveillance, accessible and reliable laboratory testing, and training of health care providers. Although the risk of resurgence of diphtheria in the United States is low, public health authorities must ensure that the capacity to recognize, diagnose, and control diphtheria is maintained. After 30 years of control, epidemic diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, re-emerged in the early 1990s in the Newly Independent States (NIS) of the former Soviet Union. The epidemic peaked in 1994‐1995 and was on the decline by 1996. This article reviews the diphtheria epidemic in the NIS, the epidemiology of diphtheria in the United States, and the implications of the NIS diphtheria epidemic for prevention of diphtheria in the United States. The Diphtheria Epidemic in the NIS In the late 1950s, universal childhood immunization with diphtheria toxoid was begun throughout the former Soviet Union, and the immunization program successfully controlled diphtheria for almost 30 years. In 1976, reported cases in the Soviet Union fell to !200 (incidence rate, 0.08/100,000 population) [1], compared with 1955, when 1100,000 cases were reported in Russia alone. During the 1970s, most of the reported cases were from the Central Asian Republics. In the mid-1980s, there was a small resurgence of almost 2000 cases per year, mostly in Russia, which was then followed by a decrease to 839 cases in 1989. a Deceased.

  • diphtheria surveillance and control in the former soviet union and the Newly Independent States
    The Journal of Infectious Diseases, 2000
    Co-Authors: Charles Vitek, Erika Y Bogatyreva, Melinda Wharton
    Abstract:

    The Newly Independent States (NIS) inherited a common approach to diphtheria control from the Soviet Union and maintained a centralized system of surveillance and control managed by Soviet-trained epidemiologists with a shared professional culture. This system had controlled a diphtheria resurgence in the 1980s. In response to the epidemic of the 1990s, NIS health authorities responded with a set of control measures based on the Soviet-era experience. These measures included intensified childhood vaccination, aggressive case investigation, widespread diphtheria screening in institutions, and vaccination of adults in high-risk occupation groups. These measures proved insufficient due to high levels of susceptibility among adults, excessive contraindications to childhood vaccination, and insufficient resources in many countries. After these initial delays in implementing effective measures in some countries, most of the NIS health authorities rapidly and successfully implemented mass immunization of the population against diphtheria once the strategy was adopted and sufficient vaccine was available.

  • epidemic diphtheria in the Newly Independent States of the former soviet union
    1998
    Co-Authors: Melinda Wharton, Iain R B Hardy, Charles Vitek, Tanja Popovic, Roland W Sutter
    Abstract:

    In spite of decades of good control, in the Newly Independent States of the former Soviet Union epidemic diphtheria has reemerged. During the late 1980s, childhood immunization coverage levels were low in some regions of the Soviet Union. One of the factors contributing to lack of ontime vaccination of children was a long list of contraindications for vaccination. In the central Asian republics and Caucasian countries there were vaccine shortages due to disruption of the supply in 1992 and 1993, following the dissolution of the Soviet Union. Before the dissolution of the Soviet Union, Russian-manufactured diphtheria toxoid vaccine was used throughout the Soviet Union. Although morbidity data from the armed forces are not available to civilian public health authorities in the former Soviet Union, outbreaks of diphtheria among soldiers have been reported. High coverage among children (95% coverage with four doses of diphtheria toxoid in all districts) and administration of a single dose of diphtheria toxoid to each inhabitant were essential to achieve high population immunity. The risk of emergence of epidemic diphtheria in other countries is difficult to estimate, but clearly clinical and public health expertise in diagnosis and management of diphtheria cases must be maintained. Although previously a disease of children, diphtheria has emerged as an epidemic disease among adolescents and adults in the Newly Independent States of the former Soviet Union decades after the implementation of an effective childhood vaccination program.

Konstantin K Borisenko - One of the best experts on this subject based on the ideXlab platform.

  • epidemic syphilis in the Newly Independent States of the former soviet union
    Current Opinion in Infectious Diseases, 1998
    Co-Authors: Adrian Renton, Konstantin K Borisenko
    Abstract:

    Major syphilis epidemics are occurring in the former Soviet Union as a result of the effects of rapid political, economic and social reform on clinical services and sexual behaviour. Together with epidemics of injecting drug use-associated HIV infection, they pose a major threat of large sexually transmitted HIV epidemics. Economic realism demands that control efforts address the market and ideological forces driving the development of interventions, as well as technical aspects of their design.