gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Susceptibility to Diphtheria in Northeast Germany: Prevalence and Relation to Sex and Social Variables

Meeting Abstract

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  • Henry Völzke - Ernst-Moritz-Arndt-Universität, Greifswald
  • Martina Dören - Charitè, Berlin
  • Wolfgang Hoffmann - Ernst-Moritz-Arndt-Universität, Greifswald
  • Ulrich John - Ernst-Moritz-Arndt-Universität, Greifswald

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds288

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Veröffentlicht: 8. September 2005

© 2005 Völzke et al.
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Studies from Western countries report a similarly high susceptibility to Diphtheria among adults like the one found in the NIS before endemic diphtheria had occurred in the 1990ies. Only little is done by authorities to cope this situation. Information campaigns regarding specific health risks would lead to a reduced risk of the corresponding disease that may be firstly observed in well educated persons and in individuals with high utilization of medical services. In the current absence of such campaigns we hypothesized that social factors are not associated with diphtheria immunity in adults.

During the epidemic in the NIS women accounted for a majority of adult cases. This corresponds to a lower proportion of seroprotection to diphtheria among women compared to men. These differences are not well investigated. We therefore screened our data for factors that modulated sex-related differences with respect to susceptibility to diphtheria.


A study population of 4275 individuals from the population-based Study of Health in Pomerania was available. IgG antibodies against diphtheria toxin were determined by ELISA. Subjects having an IgG titer of >1.0 IU/mL were immune against Diphtheria. An IgG titer of between 0.1 and 1.0 IU/ml was considered as basic immunity. Susceptibility to Diphtheria was defined as IgG titers < 0.1 IU/mL.


The proportions of immunity, basic immunity and susceptibility to diphtheria were 10.3%, 57.3% and 32.4%, respectively. The highest susceptibility proportions were observed in the oldest subjects ≥70 years (51.9%) and in middle-aged subjects aged 40-59 years (44.8%).

In multivariable analyses, women exhibited an increased risk of being susceptible to Diphtheria (OR 1.45; 95%-CI 1.18-1.78). Vaccinations against tetanus and diphtheria were inversely associated with this risk. None of the social factors were associated with the endpoint. The models obtained one two-way interaction between sex and vaccination against diphtheria (ß=0.431, standard error 0.209, p=0.04). Females without anti diphtheria vaccination during the past 10 years had a 4 fold increased risk of being susceptible to diphtheria than unvaccinated men. While the risk of susceptibility decreased by the factor 2.63 among males, this risk only declined by the factor 1.67 among females.


There is a high proportion of adults who are susceptible to diphtheria. Women are less protected than men which might be partly explained by sex-specific immune responses after vaccinations. There is a need for information campaigns which are aimed to improve the public awareness with respect to these problems.