English Abstract In the past decades a worldwide strong fall in the
incidence of diphteria has been observed. This decrement is generally
attributed to the introduction of large scale immunization against
diphteria. In countries with high immunization coverage in childhood small
recent epidemics have mainly affected adults. One of the targets of the
European region of the World Health Organization is the elimination of
diphteria by the year 2000. The rarity of diphteria asks for highly
effective surveillance. For this reason the present surveillance system
should be optimized in order to reach and maintain the elimination goal.
Diagnosis of diphteria requires in the first place awareness of its possible
occurrence. Subsequently adequate swab and lab procedures are necessary for
a successful isolation and identification of Corynebacterium diphteria.
Standardized criteria for the clinical diagnosis are presented.
Standardized procedures for taking adequate swabs for the culture and
identification of the microorganism are given. The function of each
concerned health worker and authority is discussed. In order to perform an
effective surveillance of diphteria closed network on local, regional and
national level with a central coordination is necessary. This can be
achieved in the best way by a National Coordination Center. In this center
all clinical, research and lab expertise on diphteria should be
concentrated. Also all information on diphteria must be concentrated and
has to be analysed. The functions of this center include the continuous
monitoring of diphteria in the population by regular studies, blowing alarm
in case of diphteria cases or epidemics and the performance of an effective
assistance and/or efficacious handling in case of calamities. Furthermore,
the center will perform the quality control of the surveillance
system.
