{Excerpt from ''Weekly Communicable Disease Threats Report, Week 35, 22–28 August 2026''}
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Overview:
Summary
° On 20 August 2026, media sources reported a fatal case of diphtheria in Palermo, Sicily, involving a four-year-old {girl}. According to media reports, the case manifested initial symptoms, including fever, reduced appetite and vomiting between 10 and 11 August. The patient's condition deteriorated progressively, with the development of high fever and respiratory distress on 15 August. Owing to the worsening clinical presentation, the child was hospitalised in the intensive medical care unit.
° Despite receiving organ-supportive treatment and diphtheria antitoxin, the patient died on 20 August. The child had not been vaccinated against diphtheria.
° Clinical specimens were submitted to Italy's National Institute of Health (Istituto Superiore di Sanità , ISS) for laboratory confirmation of suspected diphtheria. On 25 August, the ISS confirmed the detection of Corynebacterium diphtheriae and identified the presence of the diphtheria toxin gene, indicating infection with a toxigenic strain capable of causing respiratory diphtheria.
° A second probable case was reported in a four-year-old cousin of the first case, who was admitted to hospital with milder symptoms. According to media reports, the child had been previously vaccinated against diphtheria. The patient is being managed in isolation and is reported to be in a stable clinical condition.
° Local health authorities have initiated an epidemiological investigation, including contact tracing and active monitoring of contacts to identify potential additional cases and limit further transmission.
° Public health measures have also been implemented, including chemoprophylaxis of contacts and vaccination of the siblings of the first case.
° Media sources have reported that 10 additional family members have tested positive for C. diphtheriae. These individuals were reported to be vaccinated and in good clinical condition.
° However, as of 25 August, no additional cases besides the two described above have been reportedofficially by local health authorities.
Background
° Diphtheria is a vaccine-preventable bacterial disease caused by Corynebacterium diphtheriae.
° Transmission can occur from person to person through respiratory droplets, direct contact with respiratory secretions, contact with exudate from infected skin lesions or contaminated surfaces.
° Infection may present as respiratory or cutaneous diphtheria. Asymptomatic infection is also common, particularly in highly vaccinated populations. The pathogenicity of C. diphtheriae is primarily related to the production of the diphtheria toxin, which can cause local tissue damage, severe systemic complications and even death.
° Diphtheria is largely preventable through vaccination, and unvaccinated or under-vaccinated individuals are at higher risk of severe disease and death.
° Without timely diagnosis and treatment, respiratory diphtheria can be life-threatening, especially in unvaccinated, young children.
° Diphtheria remains a relatively rare disease in the EU/EEA due to high vaccination coverage. In 2022, a large multi-country outbreak was recorded, primarily affecting migrants and asylum seekers, with limited evidence of spread to the general population. Reported cases declined in subsequent years, although sporadic cases and localised transmission continue to occur, particularly among vulnerable populations, including migrants, people experiencing homelessness, and unvaccinated or under-vaccinated individuals.
ECDC assessment:
° The probability of widespread transmission of diphtheria in the general population in the EU/EEA is considered low, due to high levels of population immunity achieved through routine vaccination programmes. The impact on the general population is also assessed as low, as high vaccination coverage reduces the risk of severe disease and death. Therefore, the overall risk to the general population in the EU/EEA is considered low.
° Nevertheless, sporadic cases and localised clusters may occur in settings where vaccination coverage is suboptimal or where conditions facilitate transmission, such as overcrowded environments and settings with poor hygiene. Imported cases may also occur among individuals travelling from endemic geographical areas. Severe disease is more likely among susceptible groups, including unvaccinated or under-vaccinated individuals, young children, older adults, and immunocompromised individuals.
° Achieving and sustaining high vaccination coverage in the population is crucial to prevent serious or fatal disease. In the event of cases, rapid clinical recognition, prompt laboratory confirmation, timely administration of appropriate treatment, and the identification and management of close contacts are essential to reduce morbidity, mortality, and onward transmission.
Actions:
° ECDC continues to monitor this event through epidemic intelligence activities and is liaising with the relevant national public health authorities to collect additional information on the case and ongoing contact tracing and contact follow-up activities.
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Source:
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