Urgent summer holiday warning as cases of highly contagious ‘bull-neck' infection spread rapidly across Europe
A total of 234 diphtheria cases have been reported in European countries since January 2023, according to the European Centre for Disease Prevention and Control (ECDC).
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Diphtheria can be a serious illness that sometimes turns fatal, especially in children, if it's not treated quickly.
It causes a thick grey-white coating at the back of the throat, nose and tongue, and fever.
More severe cases can lead to a characteristic swollen neck and throat, or "bull neck." This can make it hard for the person to breathe properly.
If the disease affects the skin, it can cause pus-filled blisters on the legs, feet and hands, as well as large ulcers surrounded by red, sore-looking skin.
Diphtheria is thought to be rare in Europe and the UK, with cases falling steadily since the 1950s after the introduction of vaccines.
Between 2009 and 2020, an average of 21 cases were reported each year in Europe.
But "a marked shift occurred in 2022", as 320 cases - two of them probable - were detected in European countries, the ECDC wrote in recent report.
"Similar trends" were also reported in the UK, according to the health watchdog.
"Ten European countries were affected by this outbreak, with Germany, Austria, the UK, Switzerland and France reporting the highest case numbers," the ECDC said.
The outbreak was "mainly linked to groups of migrants who had recently arrived in Europe" and been exposed to diphtheria on their journey, it added.
Since then, the number of diphtheria cases in Europe has "consistently declined", but the ECDC warned that infections were still being reported - especially among vulnerable people.
A total of 165 cases were flagged to the ECDC in 2023, 56 in 2024 and 13 so far into 2025.
"Published data and recent personal communications indicate that
after the 2022 outbreak, Corynebacterium diphtheriae continued to circulate in at least five EU/EEA countries and in Switzerland," the health watchdog said.
"A significant proportion of these cases has been among people more vulnerable to diphtheria," it added.
These include people experiencing homelessness, people living, working or volunteering in transitional housing centres, migrants, and those who use and inject drugs.
Bruno Ciancio, head of ECDC's unit for directly-transmitted and vaccine-preventable diseases, said: "The fact that we see diphtheria infections acquired by vulnerable populations in the EU/EEA indicates ongoing unnoticed transmission in the community.
"This is a cause for concern, and calls for more intense efforts to address barriers to vaccination among these vulnerable groups.
"Effective vaccination programmes have helped to almost eliminate diphtheria, but this also means that healthcare workers may be less likely to recognise the symptoms.
"Increasing awareness of symptoms, quick diagnosis and prompt public health action are essential."
The ECDC noted the risk of catching diphtheria remained low for the general population, thanks to high vaccination coverage in most European countries.
But for vulnerable people, it upped the risk to moderate.
"There could be sporadic cases among groups more vulnerable to infection and pockets of unvaccinated individuals," the health watchdog said.
It added that Germany in particular had "reported an increase in diphtheria cases with respiratory presentation, raising concerns about more severe clinical manifestations, and possibly wider community spread".
In places with high vaccines coverage, most diphtheria infections don't cause symptoms or are mild.
But respiratory diphtheria - when the infections affects the nose and throat - can kill up to 10 per cent of its victims, the ECDC said.
Diphtheria is mostly spread by coughs, sneezing or close contact.
You can, however, also get it from sharing items such as cups, clothing or bedding with an infected person.
In the UK, babies and children have been routinely vaccinated against diphtheria since the 1940s.
A case of the highly contagious disease was spotted in a UK primary school in 2023.
In 2022, 87 people in England were infected with the disease. This fell to 27 in 2023.
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