165
Epidemiology851601012694172211289351468506576615685755825
Sources851839012870141210265327390443
of1330839012870108
infection1474839012839108147209271310349418489
11:2000839012869138185
1.8511080012870106
Patients9911080012878141180218281350389444
with147010800128101140178249
any17541080012863131202
clinical19891080012863102141211250312375414
form24381080012846115163272
(most27431080012846156224279319
contagious30971080012863133202242304373412483552606
when373910800128101170233302
the40771080012839108171
oropharynx42821080012870117186257326389436506574645
and49631080012862131200
larynx8511321012839102149219287358
are12441321012863109172
affected).14511321012862107154217279317380449496531
2.8511563012870106
Convalescents9911563012894164234304366405468521584645715754809
(shed18351563012847100170233302
the21721563012839109171
pathogen23791563012870131170240310380443512
for29271563012846115162
up31241563012871140
to32981563012839110
334421563012870
weeks354815630128101163225295349
after39331563012862109146209256
clinical42241563012862100140209249311373412
recovery).46721563012846109171240310372419489534569
3.8511805012870106
Healthy99118050128102163226265303374444
carriers14691805012862125171218257320367420
of19231805012871118
toxigenic20761805012838108178217287350419457520
strains2631180501285593140202240311365
(carriage30311805012847110172217264302365435497
duration35631805012870139187249287326396466
-40641805012849
from4148180501284794164274
several44541805012855117188251297360398
days48861805012870133203256
to51771805012839110
months).85120460128109177248287358413459494
4.8512287012870106
Patients9912287012878141180218281350389444
with147022870128101140178249
atypical17542287012863100171239279340403442
forms22312287012847116163272325
(nasal,25912287012847117179234297335371
cutaneous29972287012862132170233302365434504559
diphtheria)35912287012870108178249287358420466505567614
-42402287012850
often43252287012870117155218288
remain46482287012847108217277316387
undiagnosed8512529012870141210249312382452521576638708
but15932529012870141180
actively18082529012862125162202271334373444
shed22852529012855125188257
the25782529012839108171
pathogen.27822529012871133171242311381444513548
Mechanisms85127710128117179241311381452490545647700
and15862771012870140209
routes18312771012855124194233295349
of22162771012870108
transmission2360277101283993162233287389427481536575644715
11:31132771012868139185
·8513012012847
Main93330120128125187226295
mechanism:126430120128109169231301364435475529638675
aerosol19743012012863125172242296367405
(airborne).24153012012846109146193264333380450512559594
·8513254012847
Routes9333254012894164234273335389
of13583254012870116
transmission:1509325401283986148217271381418473528567637707746
1.8513495012870106
Airborne99134950128102140187257327374443506
droplet15313495012870117187257295358397
-19643495012848
through20473495012837108155224294364434
coughing,25173495012862131201271341380450519555
sneezing,31073495012854124185248310349419489524
talking36663495012839101139210248318389
at40903495012863100
a42263495012862
distance43233495012870108162202264334396459
of48153495012871118
up49663495012871141
to51433495012837108
252853495012870
meters.85137370128109170209272319373409
2.8513978012870106
Airborne99139780128102140187257327374443506
dust15313978012870141195234
-18013978012847
through18843978012837107154223294363433
inhalation23523978012839109179241280343381419490559
of29473978012870116
infected30983978012839109156217279318381450
dust.35843978012870139193233268
3.8514220012870106
Contact-household99142200128941642342733353974364835536236927478108799499881058
-20834220012847
through21664220012838109156225295365435
toys,26374220012839108178231267
dishes,29384220012871110164235296350385
household33584220012870140210264327396467505575
items,3969422001283977142251303339
hands.43424220012871133204273328364
4.8514461012870106
Foodborne9914461012878149218289358428475544607
-16334461012847
through17164461012838108155224295364435
infected21874461012837108154216279317379450
dairy26714461012870133171218288
products29924461012871117187258328390429483
(rare).3511446101284693155202264310345
Susceptibility8514702012870141195258320389428467537576615653692755
and16404702012870140210
immunity18864702012837139240310380419458521
1,41,4:24444702012869104174244279348395
Susceptibility8514945012878148203265327398436475545584623662700771
is1655494501283994
universal.17854945012870140179248310357411474512548
Natural85151860128101163202273320381420
immunity13075186012837147255323393433472543
in18835186012839109
newborns20285186012870133234304374421490545
(transplacental)2608518601284785132194263317388427489552614683723785823870
persists35125186012870133180233273327366420
for39685186012847115163
3-641665186012870121190
months.439051860128110177248287358413449
Post-infection8515427012878148203242289327398445506568607646715786
immunity16735427012837147255323393433472543
is2249542701283994
robust23785427012847117187256311350
but27635427012871140178
not29775427012870139179
lifelong3191542701283877124186225295365435
(5-1036615427012847116166237307
years).40035427012870131193240294342377
Post-vaccination8515668012878148203242289358421483546584653716755794863934
immunity18205668012838147255326396435474545
requires23985668012847109179249288335397451
regular28855668012847109178247287349395
revaccination33145668012847109180242305367405474537575615684755
(every41045668012847108178240287357
1044955668012870141
years).46715668012871131193240295342377
Protection8515911012878125195233296359396436506576
criterion:14635911012862107146185248294332403473511
level20105911012839100170233271
of23165911012871117
antitoxic24695911012862131169209247318388426489
antibodies29935911012862131171209280349420458521575
in36035911012839108
the37475911012839108171
blood39525911012870109179250319
≥0.0143075911012877145181251321
IU/ml.46645911012847148185295331367