{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T18:01:20Z","timestamp":1781028080349,"version":"3.54.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      In the second half of 2022 and 2023, an increase of diphtheria cases among asylum seekers was observed in Europe, with 120 cases reported in the state of Baden-Wuerttemberg, Germany. We aimed to determine prevalence of infection or colonization with toxigenic\n                      <jats:italic>Corynebacterium<\/jats:italic>\n                      among asylum seekers arriving between August and October 2024 in Heidelberg, Germany. In addition, we assessed antimicrobial-resistant wound infections and diphtheria immunity levels in this population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross-sectional study with a random sample of 1073 newly arrived asylum seekers. Consenting participants received a throat and, if applicable, wound swabs. Demographic, clinical and migration-related information was collected to identify potential risk groups. Throat swabs were tested for toxigenic\n                      <jats:italic>Corynebacterium<\/jats:italic>\n                      species, while wound swabs were additionally tested for other antimicrobial-resistant pathogens with relevance to therapeutic management. IgG antibody levels against diphtheria toxoid were quantified in serum samples of a random sub-sample.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the participants, 75% were male (n\u2009=\u2009804), and ages ranged from 15 to 60 years (median\u2009=\u200927 years). The most common nationalities were Syrian (n\u2009=\u2009281), Turkish (n\u2009=\u2009189) and Afghan (n\u2009=\u2009117). No toxigenic\n                      <jats:italic>Corynebacterium<\/jats:italic>\n                      was identified. Thirty-seven participants carried inflamed wounds, of whom 18 (49%) had wounds infected with methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA), corresponding to 1.7% (95% CI 1.0\u20132.6%) of the entire study population. Overall, 38.0% (95% CI 33.3\u201344.8%) showed non-protective diphtheria antibody titers, while acceptance of the on-site diphtheria vaccination was high at 93% (n\u2009=\u2009998).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      While no toxigenic\n                      <jats:italic>Corynebacterium<\/jats:italic>\n                      was detected, low immunity levels and antimicrobial resistance findings underline the importance of early diagnosis, treatment and vaccination options in displaced populations.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0350513","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:26:07Z","timestamp":1781025967000},"page":"e0350513","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of diphtheria and antimicrobial-resistant wound infections among asylum seekers in Heidelberg, Germany, August\u2013October 2024"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2548-4577","authenticated-orcid":true,"given":"Bernadette","family":"Walter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"L\u00fcck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Adam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patryk","family":"Krauze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1213-3586","authenticated-orcid":true,"given":"J\u00f6rg","family":"Rau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Knab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"K\u00fchn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Welker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Aichinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Brockmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"pone.0350513.ref001","volume-title":"Annual epidemiological report 2016","author":"ECDC EC for DP and C","year":"2014"},{"key":"pone.0350513.ref002","volume-title":"AER for 2018","author":"ECDC"},{"key":"pone.0350513.ref003","unstructured":"European Centre for Disease Prevention and Control. Annual Epidemiological Report - Diphtheria 2021. 2021. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/AER-Diphtheria-2021.pdf"},{"key":"pone.0350513.ref004","unstructured":"Robert Koch-Institut. Infektionsepidemiologische Jahrbuch meldepflichtiger Krankheiten f\u00fcr 2021. 2025. https:\/\/doi.org\/10.25646\/10143.2"},{"key":"pone.0350513.ref005","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2019.24.2.1800683","article-title":"Whole genome sequencing suggests transmission of Corynebacterium diphtheriae-caused cutaneous diphtheria in two siblings, Germany, 2018","volume":"24","author":"A Berger","year":"2019","journal-title":"Euro Surveill"},{"key":"pone.0350513.ref006","unstructured":"European Centre for Disease Prevention and Control. Diphtheria - Annual Epidemiological Report for 2022. 2024. https:\/\/www.ecdc.europa.eu\/en\/publications-data\/diphtheria-annual-epidemiological-report-2022"},{"key":"pone.0350513.ref007","unstructured":"European Centre for Disease Prevention and Control. Epidemiological update: diphtheria cases in Europe. https:\/\/www.ecdc.europa.eu\/en\/news-events\/epidemiological-update-diphtheria-cases-europe? 2023. Accessed 2025 June 17."},{"issue":"23","key":"pone.0350513.ref008","doi-asserted-by":"crossref","first-page":"2334","DOI":"10.1056\/NEJMoa2311981","article-title":"Corynebacterium diphtheriae Outbreak in Migrant Populations in Europe","volume":"392","author":"A Hoefer","year":"2025","journal-title":"N Engl J Med"},{"key":"pone.0350513.ref009","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s15010-024-02374-y","article-title":"Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023","volume":"53","author":"A Zink","year":"2025","journal-title":"Infection"},{"issue":"45","key":"pone.0350513.ref010","first-page":"1700797","article-title":"High rates of meticillin-resistant Staphylococcus aureus among asylum seekers and refugees admitted to Helsinki University Hospital, 2010 to 2017","volume":"23","author":"T Aro","year":"2018","journal-title":"Euro Surveill"},{"issue":"4","key":"pone.0350513.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0176481","article-title":"High prevalence of MRSA and ESBL among asylum seekers in the Netherlands","volume":"12","author":"SJ Ravensbergen","year":"2017","journal-title":"PLoS One"},{"key":"pone.0350513.ref012","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1111\/ced.15392","article-title":"Panton-Valentine leucocidin-producing Staphylococcus aureus: a clinical review","volume":"47","author":"K Hussain","year":"2022","journal-title":"Clinical and Experimental Dermatology"},{"issue":"3","key":"pone.0350513.ref013","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ijantimicag.2018.10.026","article-title":"Increase in the prevalence of Panton-Valentine leukocidin and clonal shift in community-onset methicillin-resistant Staphylococcus aureus causing skin and soft-tissue infections in the Rhine-Neckar Region, Germany, 2012-2016","volume":"53","author":"S Klein","year":"2019","journal-title":"Int J Antimicrob Agents"},{"key":"pone.0350513.ref014","unstructured":"Koch Institute R. Recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute \u2013 2026. 2026. https:\/\/www.rki.de\/EN\/Topics\/Infectious-diseases\/Immunisation\/STIKO\/STIKO-recommendations\/Downloads\/04_26_english.pdf?__blob=publicationFile&v=4"},{"key":"pone.0350513.ref015","doi-asserted-by":"crossref","first-page":"547","DOI":"10.3201\/eid3103.241217","article-title":"Diphtheria outbreak among persons experiencing homelessness, 2023, linked to 2022 diphtheria outbreak, Frankfurt am Main, Germany","volume":"31","author":"J Haller","year":"2025","journal-title":"Emerging Infectious Diseases"},{"key":"pone.0350513.ref016","volume-title":"Signal f\u00fcr bundesweiten Diphtherie-Ausbruch mit Corynebacterium diphtheriae ST-574","author":"Robert Koch Institute","year":"2025"},{"issue":"10","key":"pone.0350513.ref017","article-title":"National public health response to an outbreak of toxigenic Corynebacterium diphtheriae among asylum seekers in England, 2022: a descriptive epidemiological study","volume":"8","author":"S O\u2019Boyle","year":"2023","journal-title":"Lancet Public Health"},{"issue":"44","key":"pone.0350513.ref018","doi-asserted-by":"crossref","first-page":"2200811","DOI":"10.2807\/1560-7917.ES.2022.27.44.2200811","article-title":"Ongoing toxin-positive diphtheria outbreaks in a federal asylum centre in Switzerland, analysis July to September 2022","volume":"27","author":"J Kofler","year":"2022","journal-title":"Euro Surveill"},{"issue":"1","key":"pone.0350513.ref019","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/cid\/ciz808","article-title":"Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis","volume":"71","author":"SA Truelove","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0350513.ref020","article-title":"Up-to-date MALDI-TOF MS based identification of the complete Corynebacterium diphtheriae species complex for improved diagnostics","author":"J Rau","year":"2025","journal-title":"bioRxiv"},{"key":"pone.0350513.ref021","volume-title":"WHO laboratory manual for the diagnosis of diphtheria and other related infections","year":"2022","edition":"1"},{"issue":"5","key":"pone.0350513.ref022","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1093\/jac\/dkt494","article-title":"Rapid single-colony whole-genome sequencing of bacterial pathogens","volume":"69","author":"CU K\u00f6ser","year":"2014","journal-title":"J Antimicrob Chemother"},{"issue":"15","key":"pone.0350513.ref023","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1093\/bioinformatics\/btu170","article-title":"Trimmomatic: a flexible trimmer for Illumina sequence data","volume":"30","author":"AM Bolger","year":"2014","journal-title":"Bioinformatics"},{"issue":"1","key":"pone.0350513.ref024","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s13059-018-1540-z","article-title":"SKESA: strategic k-mer extension for scrupulous assemblies","volume":"19","author":"A Souvorov","year":"2018","journal-title":"Genome Biol"},{"issue":"7","key":"pone.0350513.ref025","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1128\/JCM.00262-14","article-title":"Bacterial whole-genome sequencing revisited: portable, scalable, and standardized analysis for typing and detection of virulence and antibiotic resistance genes","volume":"52","author":"SR Leopold","year":"2014","journal-title":"J Clin Microbiol"},{"issue":"11","key":"pone.0350513.ref026","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.00483-19","article-title":"Validating the AMRFinder Tool and Resistance Gene Database by Using Antimicrobial Resistance Genotype-Phenotype Correlations in a Collection of Isolates","volume":"63","author":"M Feldgarden","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0350513.ref027","unstructured":"World Health Organization. Recommendations to assure the quality, safety and efficacy of diphtheria vaccines (adsorbed). https:\/\/cdn.who.int\/media\/docs\/default-source\/biologicals\/vaccine-standardization\/diphtheria\/diphtheria-recommendations-trs-980-annex-4.pdf?sfvrsn=7b38b45d_2&download=true"},{"issue":"1","key":"pone.0350513.ref028","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"D Firth","year":"1993","journal-title":"Biometrika"},{"key":"pone.0350513.ref029","unstructured":"European Centre for Disease Prevention and Control. Outbreak of Corynebacterium diphtheriae ST-574 among migrants, people experiencing homelessness, older adults and unvaccinated people \u2013 Germany \u2013 2025. 2025. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/communicable-disease-threats-report-week-20-2025.pdf"},{"issue":"12","key":"pone.0350513.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.cmi.2016.08.010","article-title":"Outbreak investigation for toxigenic Corynebacterium diphtheriae wound infections in refugees from Northeast Africa and Syria in Switzerland and Germany by whole genome sequencing","volume":"22","author":"DM Meinel","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"pone.0350513.ref031","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.3201\/eid2407.172026","article-title":"Geographically diverse clusters of nontoxigenic Corynebacterium diphtheriae infection, Germany, 2016-2017","volume":"24","author":"A Dangel","year":"2018","journal-title":"Emerging Infectious Diseases"},{"key":"pone.0350513.ref032","doi-asserted-by":"crossref","first-page":"100016","DOI":"10.1016\/j.jmh.2020.100016","article-title":"High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018","author":"AH Eiset","year":"2020","journal-title":"J Migr Health"},{"key":"pone.0350513.ref033","volume-title":"Annual Brief 2024","author":"FRONTEX","year":"2024"},{"key":"pone.0350513.ref034","unstructured":"Immunization Data. https:\/\/immunizationdata.who.int\/global\/wiise-detail-page\/diphtheria-reported-cases-and-incidence?CODE=AFG&YEAR=. Accessed 2025 June 18."},{"issue":"2","key":"pone.0350513.ref035","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s15010-016-0934-7","article-title":"Tetanus and diphtheria immunity in refugees in Europe in 2015","volume":"45","author":"A Jablonka","year":"2017","journal-title":"Infection"},{"key":"pone.0350513.ref036","doi-asserted-by":"crossref","first-page":"2300206","DOI":"10.2807\/1560-7917.ES.2023.28.17.2300206","article-title":"Lack of seroprotection against diphtheria in the Austrian population, in light of reported diphtheria cases in Europe, 2022","volume":"28","author":"A Wagner","year":"2023","journal-title":"Euro Surveill"},{"key":"pone.0350513.ref037","doi-asserted-by":"crossref","first-page":"102801","DOI":"10.1016\/j.eclinm.2024.102801","article-title":"Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis - update from 2017 to 2023","author":"B Chukwudile","year":"2024","journal-title":"EClinicalMedicine"},{"key":"pone.0350513.ref038","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1017\/ice.2016.179","article-title":"Prevalence of Multidrug-Resistant Organisms in Hospitalized Pediatric Refugees in an University Children's Hospital in Germany 2015-2016","author":"T Tenenbaum","year":"2016","journal-title":"Infection control and hospital epidemiology"},{"key":"pone.0350513.ref039","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.3201\/eid2910.230285","article-title":"Imported Toxigenic Corynebacterium Diphtheriae in Refugees with Polymicrobial Skin Infections, Germany, 2022","volume":"29","author":"BD Spielberger","year":"2023","journal-title":"Emerging Infectious Diseases"},{"issue":"10","key":"pone.0350513.ref040","doi-asserted-by":"crossref","DOI":"10.1016\/j.cmi.2020.06.029","article-title":"Panton-Valentine leukocidin-positive Staphylococcus aureus in skin and soft tissue infections from primary care patients","volume":"26","author":"J Friesen","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"pone.0350513.ref041","unstructured":"Staphylococcus aureus cgMLST. https:\/\/www.cgmlst.org\/ncs\/schema\/Saureus\/ Accessed 2026 April 20."},{"key":"pone.0350513.ref042","article-title":"Evolution of MRSA during hospital transmission and intercontinental spread","author":"SR Harris","year":"2010","journal-title":"American Association for the Advancement of Science"},{"key":"pone.0350513.ref043","article-title":"H\u00e4ufigkeit, Eigenschaften und Verbreitung von MRSA in Deutschland \u2013 zur Situation 2021\/2022","author":"F Layer-Nicolaou","year":"2023","journal-title":"Epidemiologisches Bulletin"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0350513","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:26:18Z","timestamp":1781025978000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0350513"}},"subtitle":[],"editor":[{"given":"Igor","family":"Mokrousov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0350513","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}