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Botulinum Toxin and Related Neurological Disorders · Journal article
Open Forum Infectious Diseases · September 2, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a descriptive analysis of 1155 C. diphtheriae isolates submitted to the CDC between 2016 and 2023, documenting a >10-fold increase in reported isolates over the period. Toxigenic cases remained rare (0.9%, n=10), predominantly associated with recent international travel, while non-toxigenic disease was associated with housing instability and intravenous drug use.
Retrospective descriptive surveillance analysis. C. diphtheriae isolates submitted to CDC for confirmatory testing during 2016–2023 in the United States; patients ranged in age from <1 to 98 years.. n = 1,155. United States; CDC laboratory (centralised testing facility).
Total isolates submitted 2016–2023: 1155; 96.1% (n=1110) non-toxigenic, 3.0% (n=35) non-toxigenic tox-bearing, 0.9% (n=10) toxigenic Annual reported isolates increased >10-fold from 2016 to 2023 Median patient age 43 years (range <1–98); 68.6% (n=793) male
No clinical outcomes (morbidity, mortality, treatment response) reported; isolate presence does not establish disease burden or severity.
This surveillance finding alerts clinicians and public health authorities to a rising trend in C. diphtheriae detection in the United States, with a shift toward cutaneous and non-toxigenic presentations in vulnerable populations (housing instability, intravenous drug use), while toxigenic cases remain rare and linked to international travel. Clinical vigilance for recent travel history and awareness of risk factors may help prioritize screening and intervention.
Descriptive epidemiological surveillance report of laboratory isolates over 8 years with no comparator group, control arm, or inferential analysis; informs public health monitoring but does not establish clinical outcomes or causal relationships.
As stated by the source record.
Quoted from the source exactly as published.
This surveillance finding alerts clinicians and public health authorities to a rising trend in C. diphtheriae detection in the United States, with a shift toward cutaneous and non-toxigenic presentations in vulnerable populations (housing instability, intravenous drug use), while toxigenic cases remain rare and linked to international travel. Clinical vigilance for recent travel history and awareness of risk factors may help prioritize screening and intervention.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Diphtheria, commonly resulting in severe respiratory or cutaneous disease, is caused by toxigenic strains of Corynebacterium diphtheriae; non-toxigenic strains can also cause disease. In the United States, only toxigenic disease is reportable, and the Centers for Disease Control and Prevention (CDC) perform the only Elek testing to confirm diphtheria toxin production. We examine the epidemiology, toxigenicity, and trends of C. diphtheriae isolates reported during 2016—2023 in the United States. Methods C. diphtheriae isolates submitted to CDC were cultured and tested by PCR and Elek. Laboratory and epidemiological data were linked; we conducted descriptive statistics by toxigenicity status. Results A total of 1155 C. diphtheriae isolates were submitted during 2016—2023; 96.1% (n=1110) were non-toxigenic, 3.0% (n=35) were non-toxigenic tox-bearing (NTTB), and 0.9% (n=10) were toxigenic. From 2016 to 2023, the annual number of reported isolates increased over 10-fold. Median patient age was 43 years (range: <1-98), and 68.6% (n=793) were male. Isolates were primarily obtained from cutaneous sites (69.8%, n=806). Risk factors for non-toxigenic and NTTB infections included housing instability and history of intravenous drug use. Nine of the 10 toxigenic isolates were from patients with recent international travel to a diphtheria-endemic country, and none were from patients with respiratory symptoms. Conclusions There has been an increase in C. diphtheriae isolates identified in the United States. However, toxigenic cases remained infrequent and risk factors appear to differ between patients with toxigenic compared with non-toxin producing infections. Risk factor awareness may help to guide public health intervention prior to confirmation of toxigenicity.
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