Epidemiology and prevention. Humans are the sole pathogen reservoir for diphtheria. infection sources include infected persons and carriers (rare). The disease is usually transmitted by droplet infection, or less frequently indirectly via contaminated objects. The incubation period is two to five days. Incidence levels in central Europe are low. From 1975 to 1984, only 113 cases were reported in Germany. Incidence levels are higher in other countries (Russia). Protective immunization with diphtheria toxoid is the most important preventive measure (see Table 1.13, p. 33). Exposure prophylaxis involves isolation of infected persons until two cultures from specimens taken at least 24 hours apart are negative.
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