Surveillance van difterie als zeldzame ziekte

Abstract

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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.