The Return of Diphtheria: Reflections From the Emergency Department

Abstract

Diphtheria has re-emerged in Australia in 2026, prompting significant public health concern and placing additional demands on healthcare services. This article examines the early phase of the outbreak, with particular focus on its impact on EDs. The outbreak has disproportionately affected Indigenous communities, highlighting the influence of social determinants of health, geographical isolation, skin infections and waning vaccine-induced immunity on disease transmission and outcomes. Emergency clinicians faced challenges in identifying suspected cases due to the overlap of diphtheria presentations with common respiratory and skin infections. The rapid development of clinical guidelines and close collaboration with infectious disease specialists were essential in supporting clinical decision-making and standardising patient management. The outbreak also revealed a broader spectrum of cutaneous diphtheria presentations than previously recognised, raising concerns regarding healthcare worker exposure. Operational pressures, contact tracing requirements and staff isolation contributed to workforce strain and psychological stress. This experience underscores the importance of preparedness, vaccination and adaptable healthcare systems in responding to the re-emergence of infectious diseases.