The detection, management and public health response to the first case of diphtheria in Spain in nearly 30 years has highlighted challenges for preparedness against diphtheria in the European Union. The case is a 6-year-old unvaccinated child. A case of diphtheria in an unvaccinated individual within a highly protected population is not unexpected, because vaccinated people can be asymptomatic carriers of toxigenic C. diphtheriae.
The challenges for diphtheria case management, preparedness and public health response experienced in Spain are shared by many EU Member States. The most urgent critical issue is the shortage of diphtheria antitoxin (DAT) for immediate use when clinicians suspect diphtheria. DAT must be given as early as possible to be effective, often on the suspicion of diphtheria before a laboratory confirmation. EU Member States have for a number of years reported difficulties with sourcing and maintaining adequate stockpiles of DAT for emergency use, a problem they share with many countries around the world. EU Member States have on occasion been forced to arrange emergency deliveries of DAT for patients with diphtheria.
Arrangements to ensure access to adequate quantities of DAT for medical management of diphtheria cases should be an integral part of preparedness for diphtheria. There is an urgent need to find solutions that will allow all EU Member States to have immediate access to DAT in case a diphtheria patient is detected.
As with other vaccine-preventable diseases, the detection of unvaccinated clusters and possible obstacles to vaccination uptake, vaccine supply and delivery should be identified in all EU/EEA Member States, and measures should be taken to improve immunisation coverage in under-vaccinated populations. In addition, surveillance systems that allow the early detection and diagnosis of sporadic diphtheria cases and outbreaks are essential.