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Some epidemiological aspects of diphtheria in Malaysia

Chen ST, Puthucheary SD

Trop Geogr Med, 1976 Sep;28(3):211-5.
PMID: 1006789

In Malysia, the proportion of children fully immunized againest diphtheria is generally low (20%). On the other hand, the Schick conversion rate rises with age and reaches 90% by 11 years of age. It is noted that asymptomatic carriers are an important epidemiological factor in diphtheria and that carrier rates for school children are high (prevalence of 7.5% while the rate of coloization with C. diphtheriae over a period of one year was 30%). Although immunization protects against clinical diphtheria, it does not prevent the carrier state. Thus, for the control of diphtheria, one should aim for 100% compliance. Some suggestions as to how higher levels of immunity may be achieved are described.

Matched MeSH terms: Diphtheria/epidemiology*
Expanded programme on immunization. Diphtheria control

Wkly. Epidemiol. Rec., 1990 Feb 9;65(6):41-2.
PMID: 2386719
Matched MeSH terms: Diphtheria/epidemiology*
Molecular characterization of Corynebacterium diphtheriae isolates in Malaysia between 1981 and 2016

Mohd Khalid MKN, Ahmad N, Hii SYF, Abd Wahab MA, Hashim R, Liow YL

J Med Microbiol, 2019 Jan;68(1):105-110.
PMID: 30465638 DOI: 10.1099/jmm.0.000881

Sporadic diphtheria cases in Malaysia have remained low in number since the 1990s. However, in 2016 a total of 31 cases were reported nationwide and to investigate this we performed molecular characterization of 30 Corynebacterium diphtheriae isolates collected from 1981 to 2016 using multilocus sequence typing (MLST). C. diphtheriae isolates were identified and biotyped using the API Coryne kit, while the toxigenicity was determined by PCR and the Elek test. All of the 2016 isolates belonged to biotype mitis, caused respiratory diphtheria and were toxigenic strains. MLST analysis identified 17 sequence types (STs), including 11 new ones. ST453 was the most common clone (7/30, 23.3 %), followed by ST141 (5/30, 16.7 %), ST451 (3/30, 10.0 %) and ST248 (2/30, 6.7 %). The clones identified in 2016 had not been detected in previous isolations and they were phylogenetically distinct. Our results suggest that the diphtheria cases in 2016 were caused by the emergence and spread of new clones in Malaysia.

Matched MeSH terms: Diphtheria/epidemiology
Fulltext Seroprevalence of diphtheria toxoid IgG antibodies in the Malaysian population

Yusoff AF, Mohd Sharani ZZ, Kee CC, Md Iderus NH, Md Zamri ASS, Nagalingam T, et al.

BMC Infect Dis, 2021 Jun 16;21(1):581.
PMID: 34134646 DOI: 10.1186/s12879-021-06285-3

BACKGROUND: Despite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population.
METHODS: A total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (diphtheriae infection.
RESULTS: Among the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1-2 years old (0.59 IU/mL) and 6-7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4-6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p diphtheria toxoid IgG antibody level.
CONCLUSIONS: About 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5-6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.

Matched MeSH terms: Diphtheria/epidemiology*
Fulltext Screening for Corynebacterium diphtheriae

Wilson AP, Matthews S, Bahl M, Efstratiou A, Cookson BD

J Clin Pathol, 1992 Nov;45(11):1036-7.
PMID: 1452782 DOI: 10.1136/jcp.45.11.1036

A throat swab from a 9 year old girl with pharyngitis yielded a non-toxigenic strain of Corynebacterium diphtheriae var mitis and Streptococcus group G. C pseudodiphtheriticum was isolated from the throats of two of her four brothers. In each case the isolate was sent to the reference laboratory before full identification. The growth was found to be mixed for one brother; the other isolate being a toxin producing C diphtheriae var gravis. The child was asymptomatic and the case proves that all colonial types on the Hoyles plate should be identified.

Matched MeSH terms: Diphtheria/epidemiology
Comparative genomic and phylogenetic analysis of a toxigenic clinical isolate of Corynebacterium diphtheriae strain B-D-16-78 from Malaysia

Hong KW, Asmah Hani AW, Nurul Aina Murni CA, Pusparani RR, Chong CK, Verasahib K, et al.

Infect Genet Evol, 2017 Oct;54:263-270.
PMID: 28711373 DOI: 10.1016/j.meegid.2017.07.015

In this study, we report the comparative genomics and phylogenetic analysis of Corynebacterium diphtheriae strain B-D-16-78 that was isolated from a clinical specimen in 2016. The complete genome of C. diphtheriae strain B-D-16-78 was sequenced using PacBio Single Molecule, Real-Time sequencing technology and consists of a 2,474,151-bp circular chromosome with an average GC content of 53.56%. The core genome of C. diphtheriae was also deduced from a total of 74 strains with complete or draft genome sequences and the core genome-based phylogenetic analysis revealed close genetic relationship among strains that shared the same MLST allelic profile. In the context of CRISPR-Cas system, which confers adaptive immunity against re-invading DNA, 73 out of 86 spacer sequences were found to be unique to Malaysian strains which harboured only type-II-C and/or type-I-E-a systems. A total of 48 tox genes which code for the diphtheria toxin were retrieved from the 74 genomes and with the exception of one truncated gene, only nucleotide substitutions were detected when compared to the tox gene sequence of PW8. More than half were synonymous substitution and only two were nonsynonymous substitutions whereby H24Y was predicted to have a damaging effect on the protein function whilst T262V was predicted to be tolerated. Both toxigenic and non-toxigenic toxin-gene bearing strains have been isolated in Malaysia but the repeated isolation of toxigenic strains with the same MLST profile suggests the possibility of some of these strains may be circulating in the population. Hence, efforts to increase herd immunity should be continued and supported by an effective monitoring and surveillance system to track, manage and control outbreak of cases.

Matched MeSH terms: Diphtheria/epidemiology