Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017-2019.
Lauren M Weil, Margaret M Williams, Tahmina Shirin, Marlon Lawrence, Zakir H Habib, Janessa S Aneke, Maria L Tondella, Quazi Zaki, Pamela K Cassiday, David Lonsway, Mirza Farrque, Tanvir Hossen, Leora R Feldstein, Nicholas Cook, Gladys Maldonado-Quiles, Ahmed N Alam, A K M Muraduzzaman, Arifa Akram, Laura Conklin, Stephanie Doan, Michael Friedman, Anna M Acosta, Susan Hariri, LeAnne M Fox, Tejpratap S P Tiwari, Meerjady S Flora
Author Information
Lauren M Weil: Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Margaret M Williams: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Tahmina Shirin: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Marlon Lawrence: Laboratory Leadership Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Zakir H Habib: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Janessa S Aneke: IHRC Inc, Contractor to US Centers for Disease Control and Prevention, Division of Bacterial Diseases, Atlanta, Georgia, USA.
Maria L Tondella: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Quazi Zaki: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Pamela K Cassiday: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
David Lonsway: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Mirza Farrque: Bangladesh Field Epidemiology Training Program, Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Tanvir Hossen: Bangladesh Field Epidemiology Training Program, Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Leora R Feldstein: Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Nicholas Cook: IHRC Inc, Contractor to US Centers for Disease Control and Prevention, Division of Bacterial Diseases, Atlanta, Georgia, USA.
Gladys Maldonado-Quiles: IHRC Inc, Contractor to US Centers for Disease Control and Prevention, Division of Bacterial Diseases, Atlanta, Georgia, USA.
Ahmed N Alam: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
A K M Muraduzzaman: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Arifa Akram: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
Laura Conklin: Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Stephanie Doan: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Michael Friedman: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Anna M Acosta: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Susan Hariri: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
LeAnne M Fox: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Tejpratap S P Tiwari: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Meerjady S Flora: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
BACKGROUND: Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh. METHODS: Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation. RESULTS: Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum. CONCLUSIONS: We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
