Epidemic diphtheria in the Republic of Georgia, 1993-1996: risk factors for fatal outcome among hospitalized patients.

Epidemic diphtheria reemerged in the republic of Georgia in November 1993. To identify risk factors for fatal outcomes, clinical and epidemiologic data on all hospitalized diphtheria patients were examined. Medical charts of patients from 1993-1995 were reviewed. A total of 659 cases and 68 deaths were identified (case fatality rate [CFR] = 10.3%). Fifty-two percent of all cases and 68% of deaths were in children </=14 years old. The highest CFR occurred among adults 40-49 years of age (CFR=19%) and children 5-9 years of age (CFR=16%). Children who did not have the complete primary vaccination series with diphtheria toxoid and adults 40-49 years of age were the 2 groups at highest risk. Being a rural resident and having a long interval (>3 days) between onset of symptoms to antitoxin treatment were significantly associated with fatal outcomes. Immunization of children and 40- to 49-year-old adults was required to rapidly control the epidemic.