1. 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. 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. 3 Twenty century 1920 s’ : 100 000 to 200 000 cases / per year (USA) 1943 : 1 million cases in Europe (50 000 deaths) 1949 : 68 children died after diphtheria immunization ( improper aluminium phosphate toxoid) 1994 : 40 000 cases in the Russian Federation BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

4. 4 Today 2010 : cases in Port au Prince (earth quake) 2013 : -> Subsaharan African - > India - > Indonésia (around 47 000 cases in the world) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

5. 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. 6 Contamination - > direct contact - > throught the air - > by objects BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

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

13. 13 Results - 3000 workers (representative sample of a population of workers) BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

14. 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. 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. 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. 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. 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. 19 Discussion - Booster vaccination coverage against diphtheria is recommended for all workers BIT’S 7th World Congress of vaccine /WCV 2015 Nanjing China

20. 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