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Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019
Abstract Background Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreak...
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| Published in: | The Journal of infectious diseases 2021-07, Vol.224 (2), p.318-325 |
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| container_end_page | 325 |
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| container_title | The Journal of infectious diseases |
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| creator | Weil, Lauren M Williams, Margaret M Shirin, Tahmina Lawrence, Marlon Habib, Zakir H Aneke, Janessa S Tondella, Maria L Zaki, Quazi Cassiday, Pamela K Lonsway, David Farrque, Mirza Hossen, Tanvir Feldstein, Leora R Cook, Nicholas Maldonado-Quiles, Gladys Alam, Ahmed N Muraduzzaman, A K M Akram, Arifa Conklin, Laura Doan, Stephanie Friedman, Michael Acosta, Anna M Hariri, Susan Fox, LeAnne M Tiwari, Tejpratap S P Flora, Meerjady S |
| description | Abstract
Background
Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh.
Methods
Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation.
Results
Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum.
Conclusions
We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
We confirmed a large diphtheria outbreak among the forcibly displaced Myanmar nationals in Bangladesh and identified frequent cocirculation with azithromycin-resistant C. pseudodiphtheriticum among cases. Our investigation highlights the need to better understand the role of C. pseudodiphtheriticum as a pathogen. |
| doi_str_mv | 10.1093/infdis/jiaa729 |
| format | article |
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Background
Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh.
Methods
Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation.
Results
Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum.
Conclusions
We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
We confirmed a large diphtheria outbreak among the forcibly displaced Myanmar nationals in Bangladesh and identified frequent cocirculation with azithromycin-resistant C. pseudodiphtheriticum among cases. Our investigation highlights the need to better understand the role of C. pseudodiphtheriticum as a pathogen.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1093/infdis/jiaa729</identifier><identifier>PMID: 33245764</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Corynebacterium ; Corynebacterium - isolation & purification ; Corynebacterium diphtheriae - isolation & purification ; Diphtheria ; Diphtheria - epidemiology ; Diphtheria Toxin ; Disease Outbreaks ; Epidemics ; Epidemiology ; Humans ; Laboratories ; Myanmar - epidemiology ; Outbreaks ; Patients ; Polymerase chain reaction ; Real-Time Polymerase Chain Reaction ; Respiratory diseases ; Species</subject><ispartof>The Journal of infectious diseases, 2021-07, Vol.224 (2), p.318-325</ispartof><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2020. 2020</rights><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c453t-4883506f611529c48cd35cdbbe87f83c1dc8309f328fd37031fe8f5cb74910e73</citedby><cites>FETCH-LOGICAL-c453t-4883506f611529c48cd35cdbbe87f83c1dc8309f328fd37031fe8f5cb74910e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33245764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weil, Lauren M</creatorcontrib><creatorcontrib>Williams, Margaret M</creatorcontrib><creatorcontrib>Shirin, Tahmina</creatorcontrib><creatorcontrib>Lawrence, Marlon</creatorcontrib><creatorcontrib>Habib, Zakir H</creatorcontrib><creatorcontrib>Aneke, Janessa S</creatorcontrib><creatorcontrib>Tondella, Maria L</creatorcontrib><creatorcontrib>Zaki, Quazi</creatorcontrib><creatorcontrib>Cassiday, Pamela K</creatorcontrib><creatorcontrib>Lonsway, David</creatorcontrib><creatorcontrib>Farrque, Mirza</creatorcontrib><creatorcontrib>Hossen, Tanvir</creatorcontrib><creatorcontrib>Feldstein, Leora R</creatorcontrib><creatorcontrib>Cook, Nicholas</creatorcontrib><creatorcontrib>Maldonado-Quiles, Gladys</creatorcontrib><creatorcontrib>Alam, Ahmed N</creatorcontrib><creatorcontrib>Muraduzzaman, A K M</creatorcontrib><creatorcontrib>Akram, Arifa</creatorcontrib><creatorcontrib>Conklin, Laura</creatorcontrib><creatorcontrib>Doan, Stephanie</creatorcontrib><creatorcontrib>Friedman, Michael</creatorcontrib><creatorcontrib>Acosta, Anna M</creatorcontrib><creatorcontrib>Hariri, Susan</creatorcontrib><creatorcontrib>Fox, LeAnne M</creatorcontrib><creatorcontrib>Tiwari, Tejpratap S P</creatorcontrib><creatorcontrib>Flora, Meerjady S</creatorcontrib><title>Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><description>Abstract
Background
Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh.
Methods
Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation.
Results
Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum.
Conclusions
We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
We confirmed a large diphtheria outbreak among the forcibly displaced Myanmar nationals in Bangladesh and identified frequent cocirculation with azithromycin-resistant C. pseudodiphtheriticum among cases. Our investigation highlights the need to better understand the role of C. pseudodiphtheriticum as a pathogen.</description><subject>Corynebacterium</subject><subject>Corynebacterium - isolation & purification</subject><subject>Corynebacterium diphtheriae - isolation & purification</subject><subject>Diphtheria</subject><subject>Diphtheria - epidemiology</subject><subject>Diphtheria Toxin</subject><subject>Disease Outbreaks</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Myanmar - epidemiology</subject><subject>Outbreaks</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>Respiratory diseases</subject><subject>Species</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkc1uEzEUhS0EomlhyxJZYgMS0_pvxp4VqgKFSoFuYG15_JM4TOzBnqmUHe_QPQ_Hk-CQNAI2SJaudO93ju71AeAZRucYtfTCB2d8vlh7pThpH4AZrimvmgbTh2CGECEVFm17Ak5zXiOEGG34Y3BCKWE1b9gM_LgOtzaPfqlGHwOMDiq4UGlp4Vs_rMaVTV7Bm2nsklVfoQoGzqP2SU_9UTCPaRtsp_RY4GkDh2wnE829fPS6NC83MSzhVUzad_22mOehV9oa-HGrwkYl-Om3n-rza0gQ5j-_35XSPgGPXOnZp4d6Br5cvfs8_1Atbt5fzy8XlWY1HSsmBK1R4xqMa9JqJrShtTZdZwV3gmpstKCodZQIZyhHFDsrXK07zlqMLKdn4M3ed5i6jTXahjGpXg7Jl922Miov_54Ev5LLeCsxEqypyc7h5cEhxW9T-VK58VnbvlfBxilLUjDGCGlQQV_8g67jlHa3S1Lz8niNd9T5ntIp5pysO26DkdxlL_fZy0P2RfD8zxuO-H3YBXi1B-I0_M_sF5pjvlk</recordid><startdate>20210715</startdate><enddate>20210715</enddate><creator>Weil, Lauren M</creator><creator>Williams, Margaret M</creator><creator>Shirin, Tahmina</creator><creator>Lawrence, Marlon</creator><creator>Habib, Zakir H</creator><creator>Aneke, Janessa S</creator><creator>Tondella, Maria L</creator><creator>Zaki, Quazi</creator><creator>Cassiday, Pamela K</creator><creator>Lonsway, David</creator><creator>Farrque, Mirza</creator><creator>Hossen, Tanvir</creator><creator>Feldstein, Leora R</creator><creator>Cook, Nicholas</creator><creator>Maldonado-Quiles, Gladys</creator><creator>Alam, Ahmed N</creator><creator>Muraduzzaman, A K M</creator><creator>Akram, Arifa</creator><creator>Conklin, Laura</creator><creator>Doan, Stephanie</creator><creator>Friedman, Michael</creator><creator>Acosta, Anna M</creator><creator>Hariri, Susan</creator><creator>Fox, LeAnne M</creator><creator>Tiwari, Tejpratap S P</creator><creator>Flora, Meerjady S</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210715</creationdate><title>Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019</title><author>Weil, Lauren M ; Williams, Margaret M ; Shirin, Tahmina ; Lawrence, Marlon ; Habib, Zakir H ; Aneke, Janessa S ; Tondella, Maria L ; Zaki, Quazi ; Cassiday, Pamela K ; Lonsway, David ; Farrque, Mirza ; Hossen, Tanvir ; Feldstein, Leora R ; Cook, Nicholas ; Maldonado-Quiles, Gladys ; Alam, Ahmed N ; Muraduzzaman, A K M ; Akram, Arifa ; Conklin, Laura ; Doan, Stephanie ; Friedman, Michael ; Acosta, Anna M ; Hariri, Susan ; Fox, LeAnne M ; Tiwari, Tejpratap S P ; Flora, Meerjady S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c453t-4883506f611529c48cd35cdbbe87f83c1dc8309f328fd37031fe8f5cb74910e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Corynebacterium</topic><topic>Corynebacterium - isolation & purification</topic><topic>Corynebacterium diphtheriae - isolation & purification</topic><topic>Diphtheria</topic><topic>Diphtheria - epidemiology</topic><topic>Diphtheria Toxin</topic><topic>Disease Outbreaks</topic><topic>Epidemics</topic><topic>Epidemiology</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Myanmar - epidemiology</topic><topic>Outbreaks</topic><topic>Patients</topic><topic>Polymerase chain reaction</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>Respiratory diseases</topic><topic>Species</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weil, Lauren M</creatorcontrib><creatorcontrib>Williams, Margaret M</creatorcontrib><creatorcontrib>Shirin, Tahmina</creatorcontrib><creatorcontrib>Lawrence, Marlon</creatorcontrib><creatorcontrib>Habib, Zakir H</creatorcontrib><creatorcontrib>Aneke, Janessa S</creatorcontrib><creatorcontrib>Tondella, Maria L</creatorcontrib><creatorcontrib>Zaki, Quazi</creatorcontrib><creatorcontrib>Cassiday, Pamela K</creatorcontrib><creatorcontrib>Lonsway, David</creatorcontrib><creatorcontrib>Farrque, Mirza</creatorcontrib><creatorcontrib>Hossen, Tanvir</creatorcontrib><creatorcontrib>Feldstein, Leora R</creatorcontrib><creatorcontrib>Cook, Nicholas</creatorcontrib><creatorcontrib>Maldonado-Quiles, Gladys</creatorcontrib><creatorcontrib>Alam, Ahmed N</creatorcontrib><creatorcontrib>Muraduzzaman, A K M</creatorcontrib><creatorcontrib>Akram, Arifa</creatorcontrib><creatorcontrib>Conklin, Laura</creatorcontrib><creatorcontrib>Doan, Stephanie</creatorcontrib><creatorcontrib>Friedman, Michael</creatorcontrib><creatorcontrib>Acosta, Anna M</creatorcontrib><creatorcontrib>Hariri, Susan</creatorcontrib><creatorcontrib>Fox, LeAnne M</creatorcontrib><creatorcontrib>Tiwari, Tejpratap S P</creatorcontrib><creatorcontrib>Flora, Meerjady S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weil, Lauren M</au><au>Williams, Margaret M</au><au>Shirin, Tahmina</au><au>Lawrence, Marlon</au><au>Habib, Zakir H</au><au>Aneke, Janessa S</au><au>Tondella, Maria L</au><au>Zaki, Quazi</au><au>Cassiday, Pamela K</au><au>Lonsway, David</au><au>Farrque, Mirza</au><au>Hossen, Tanvir</au><au>Feldstein, Leora R</au><au>Cook, Nicholas</au><au>Maldonado-Quiles, Gladys</au><au>Alam, Ahmed N</au><au>Muraduzzaman, A K M</au><au>Akram, Arifa</au><au>Conklin, Laura</au><au>Doan, Stephanie</au><au>Friedman, Michael</au><au>Acosta, Anna M</au><au>Hariri, Susan</au><au>Fox, LeAnne M</au><au>Tiwari, Tejpratap S P</au><au>Flora, Meerjady S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019</atitle><jtitle>The Journal of infectious diseases</jtitle><addtitle>J Infect Dis</addtitle><date>2021-07-15</date><risdate>2021</risdate><volume>224</volume><issue>2</issue><spage>318</spage><epage>325</epage><pages>318-325</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><notes>Present affiliation: Division of Influenza, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.</notes><notes>Present affiliation: Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.</notes><notes>Present affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.</notes><notes>Present affiliation: Children’s Healthcare of Atlanta, Atlanta, Georgia, USA.</notes><notes>Present affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.</notes><notes>Present affiliation: Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.</notes><notes>Present affiliation: Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh</notes><notes>Present affiliation: Public Health Laboratory, Virgin Islands Department of Health, US Virgin Islands.</notes><notes>Present affiliation: Clark Atlanta University, Atlanta, Georgia, USA.</notes><abstract>Abstract
Background
Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh.
Methods
Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation.
Results
Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum.
Conclusions
We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
We confirmed a large diphtheria outbreak among the forcibly displaced Myanmar nationals in Bangladesh and identified frequent cocirculation with azithromycin-resistant C. pseudodiphtheriticum among cases. Our investigation highlights the need to better understand the role of C. pseudodiphtheriticum as a pathogen.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33245764</pmid><doi>10.1093/infdis/jiaa729</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-1899 |
| ispartof | The Journal of infectious diseases, 2021-07, Vol.224 (2), p.318-325 |
| issn | 0022-1899 1537-6613 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10846527 |
| source | Oxford University Press |
| subjects | Corynebacterium Corynebacterium - isolation & purification Corynebacterium diphtheriae - isolation & purification Diphtheria Diphtheria - epidemiology Diphtheria Toxin Disease Outbreaks Epidemics Epidemiology Humans Laboratories Myanmar - epidemiology Outbreaks Patients Polymerase chain reaction Real-Time Polymerase Chain Reaction Respiratory diseases Species |
| title | Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019 |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T09%3A27%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Investigation%20of%20a%20Large%20Diphtheria%20Outbreak%20and%20Cocirculation%20of%20Corynebacterium%20pseudodiphtheriticum%20Among%20Forcibly%20Displaced%20Myanmar%20Nationals,%202017%E2%80%932019&rft.jtitle=The%20Journal%20of%20infectious%20diseases&rft.au=Weil,%20Lauren%20M&rft.date=2021-07-15&rft.volume=224&rft.issue=2&rft.spage=318&rft.epage=325&rft.pages=318-325&rft.issn=0022-1899&rft.eissn=1537-6613&rft_id=info:doi/10.1093/infdis/jiaa729&rft_dat=%3Cproquest_pubme%3E2465442260%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c453t-4883506f611529c48cd35cdbbe87f83c1dc8309f328fd37031fe8f5cb74910e73%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2572577510&rft_id=info:pmid/33245764&rft_oup_id=10.1093/infdis/jiaa729&rfr_iscdi=true |