While the number of reported diphtheria cases has dramatically declined, the case-fatality ratio reported for diphtheria in the United States has been approximately 10% (10 deaths/100 cases) for the past 50 years. To identify factors that contribute to the risk of death from diphtheria, we studied cases of nasopharyngeal diphtheria reported to the Center for Disease Control from 1959 to 1970. We found that the relative risk of death was greater for persons involved in small outbreaks, persons with a history of no toxoid inoculation, children (0 to 4 years old), and persons from whom toxigenic Corynebacterium diphtheriae was isolated. Our results suggest that major reductions in the case-fatality ratio for diphtheria can be made by earlier clinical diagnosis of the disease and by up-to-date diphtheria toxoid immunization for all persons.
(JAMA 229:1890-1893, 1974)
Munford RS, Ory HW, Brooks GF, Feldman RA. Diphtheria Deaths in the United States, 1959-1970. JAMA. 1974;229(14):1890–1893. doi:10.1001/jama.1974.03230520032026
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