1 Strategies for Neglected Infections Diseases The example of Diphthéria F. DESCHAMPS Dept Occupational Health Medicine Faculty Reims - France BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

2 History From Greek : Diphtheria meaning leather 1613 : Spain, epidemie of diphtheria (the year of strangulation) 1883 : Edwin Klebs identified the bacterium 1890 : immunization of guinea pig with heat-treated diphtheria toxin BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

3 Twenty century 1920 s’ : to cases / per year (USA) 1943 : 1 million cases in Europe ( deaths) 1949 : 68 children died after diphtheria immunization ( improper aluminium phosphate toxoid) 1994 : cases in the Russian Federation BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

4 Today 2010 : cases in Port au Prince (earth quake) 2013 : -> Subsaharan African - > India - > Indonésia (around cases in the world) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

5 The Disease (different severities) infection caused by corynebacterium diphtheria (Death 5 to 10 %) symptoms (mild to severe) - > sore throat - > fever - > cough - > blocking airways (possibility inflammation nerves, kidneys, myocarditis …) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

6 Contamination - > direct contact - > throught the air - > by objects BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

7 Mechanism - > diphtheria toxin - > binding to the cell surface - > internalization of the toxin - > inhibition of synthesis of new proteins BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

8 Aim The goal of this study is to assess the prevalence of diphtheria vaccination among a population of workers BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

9 Methodology - The study was conducted among a miscellaneous population of French workers - Cross sectional study - Recruited from a medical occupational center (periodic medical examination) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

10 Methodology - population including Housemaids police officers technicians administrative agents electricians healthcare workers other jobs ……. BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

11 Methodology - Medical occupational examination (each year, or more in relationship with occupational risk exposure) - Data were obtained from * personal file * medical occupational file BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

12 Results - Representative sample of a population of workers BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

13 Results workers (representative sample of a population of workers) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

14 Table 1 : Diphtheria vaccination coverage in relationship with high occupational risk exposure BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China percentage Vaccination status(55 %) (22.5%)

15 Table 2 : Diphtheria vaccination coverage in relationship with medium occupational risk exposure BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China percentage Vaccination status (50 %)(25 %)

16 Table 3 : Diphtheria vaccination coverage in relationship with low occupational risk exposure BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China percentage Vaccination status (46 %)(33%)(21%)

17 Discussion - There is significant vaccination gap against diphtheria - Half of the population has none or unknown vaccination against diphtheria BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

18 Discussion - Level of vaccination against diphtheria is independant of occupational risk exposure BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

19 Discussion - Booster vaccination coverage against diphtheria is recommended for all workers BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

20 Conclusion - The goal is to obtain a coverage rate to acceptably level of 90 % BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China