{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:02:35Z","timestamp":1791576155005,"version":"4.3.4"},"reference-count":61,"publisher":"Oxford University Press (OUP)","issue":"9","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Respiratory diphtheria is a toxin-mediated disease caused by Corynebacterium diphtheriae. Diphtheria-like illness, clinically indistinguishable from diphtheria, is caused by Corynebacterium ulcerans, a zoonotic bacterium that can also produce diphtheria toxin. In the United States, respiratory diphtheria is nationally notifiable: specimens from suspected cases are submitted to the Centers for Disease Control and Prevention (CDC) for species and toxin confirmation, and diphtheria antitoxin (DAT) is obtained from CDC for treatment. We summarize the epidemiology of respiratory diphtheria and diphtheria-like illness and describe DAT use during 1996\u20132018 in the United States.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We described respiratory diphtheria cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and C. ulcerans-related diphtheria-like illness identified through specimen submissions to CDC during 1996\u20132018. We reviewed DAT requests from 1997 to 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From 1996 to 2018, 14 respiratory diphtheria cases were reported to NNDSS. Among these 14 cases, 1 was toxigenic and 3 were nontoxigenic C. diphtheriae by culture and Elek, 6 were culture-negative but polymerase chain reaction (PCR)-positive for diphtheria toxin gene, 1 was culture-positive without further testing, and the remaining 3 were either not tested or tested negative. Five cases of respiratory diphtheria-like illness caused by toxigenic C. ulcerans were identified. DAT was requested by healthcare providers for 151 suspected diphtheria cases between 1997 and 2018, with an average of 11 requests per year from 1997 to 2007, and 3 per year from 2008 to 2018.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Respiratory diphtheria remains rare in the United States, and requests for DAT have declined. Incidental identification of C. ulcerans-related diphtheria-like illness suggests surveillance of this condition might be warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1218","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T19:26:20Z","timestamp":1597346780000},"page":"e2799-e2806","source":"Crossref","is-referenced-by-count":28,"title":["Respiratory Illness Caused by <i>Corynebacterium diphtheriae<\/i> and <i>C. ulcerans<\/i>, and Use of Diphtheria Antitoxin in the United States, 1996\u20132018"],"prefix":"10.1093","volume":"73","author":[{"given":"John O","family":"Otshudiema","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"Meningitis and Vaccine-Preventable Diseases Branch, Division 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C","family":"Hadler","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hariri","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejpratap S P","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"2021110300151435900_CIT0001","first-page":"259","article-title":"Diphtheria toxoid.","volume-title":"Vaccines","author":"Tiwari","year":"2018","edition":"7th ed"},{"key":"2021110300151435900_CIT0002","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.3201\/eid2510.190271","article-title":"Global epidemiology of diphtheria, 2000\u20132017(1)","volume":"25","author":"Clarke","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2021110300151435900_CIT0003","article-title":"Diphtheria.","volume-title":"Epidemiology and Prevention of Vaccine-Preventable Diseases","author":"Centers for Disease Control and Prevention","year":"2015","edition":"13th ed."},{"key":"2021110300151435900_CIT0004","doi-asserted-by":"crossref","first-page":"787","DOI":"10.2105\/AJPH.88.5.787","article-title":"Respiratory diphtheria in the United States, 1980 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