Diphtheria in the United Kingdom, 1986–2008: the increasing role ofCorynebacterium ulcerans

<jats:title>SUMMARY</jats:title><jats:p>Diphtheria is an uncommon disease in the UK due to an effective immunization programme; consequently when cases do arise, there can be delays in diagnosis and case-fatality rates remain high. We reviewed 102 patients with infections caused by toxigenic corynebacteria (an average of four per year) reported in the UK between 1986 and 2008: 42<jats:italic>Corynebacterium diphtheriae</jats:italic>, 59<jats:italic>C. ulcerans</jats:italic>and one<jats:italic>C. pseudotuberculosis</jats:italic>, as well as 23 asymptomatic carriers. Five fatalities were reported, all in unvaccinated patients. The major risk factor for<jats:italic>C. diphtheriae</jats:italic>infection continued to be travel to an endemic country.<jats:italic>C. ulcerans</jats:italic>infections became more common than<jats:italic>C. diphtheriae</jats:italic>infections in the UK; they were associated with contact with companion animals. The occurrence of indigenous severe<jats:italic>C. ulcerans</jats:italic>infections and imported<jats:italic>C. diphtheriae</jats:italic>cases highlights the need to maintain UK routine vaccination coverage at the 95% level in the UK, as recommended by the World Health Organization.</jats:p>