From diphtheria to tuberculosis, up to malaria, West Nile and measles: a journey through the infections that are circulating again in Italy and Europe
Diphtheria in Palermo, tuberculosis in Milan, malaria in Frankfurt, West Nile in Campania, measles almost everywhere: the summer of 2026 is marked by diseases that seemed relegated to medical books. Behind this sequence there are different phenomena: diseases re-emerging after years of absence, imported infections, various outbreaks and pathologies favored by environmental changes and intercontinental travel. The most dramatic case is diphtheria in Palermo, where a four-year-old girl, Anna Rosa Bartolotta, died on the night of August 20th. The Higher Institute of Health has confirmed the presence of Corynebacterium diphtheriae and the toxin gene: the last case of infection in Italy dates back to 1996. In 2022, however (data from the New England Journal of Medicine, June 2025), Europe recorded 362 cases of diphtheria in 10 countries, a strong surge compared to previous years. 96.1% of patients had a recent history of migration, close contact with migrants or had just entered the country where the infection was diagnosed. Almost half (48.1%) lived in migrant centres.
Among the 266 patients whose country of origin was known, 83.5% came from Afghanistan or Syria and many had traveled the Western Balkans route. Genomic sequencing has identified four main genetic clusters, present in several European countries, indicating cross-border spread. In 2023, a further 178 cases were recorded and the same four clusters continued to circulate, with cases also outside migrant centres. The study’s authors call the episode “the largest increase in diphtheria in Western Europe in 70 years.”
«With the arrival of people from countries where diphtheria is still endemic, it is possible that toxigenic strains of Corynebacterium diphtheriae will also be introduced into Italy», says Professor Antonio Cascio, director of the Infectious Diseases Unit of the Palermo Polyclinic.
«This is not to point the finger at anyone: it is simply an epidemiological fact. In Italy the disease has become very rare thanks to vaccination, while in some areas of the world it continues to circulate and therefore we must also consider the possibility of importing cases or bacterial strains.”
The tuberculosis outbreak discovered in Milan
And it’s not just diphtheria that reminds us that some diseases we thought were extinct can return. Tuberculosis, the “subtle disease” that ran through Dostoevsky’s literature does not belong only to the nineteenth century. The Global tuberculosis report 2025 lists it among the ten major causes of death in the world. In Milan, at the Institute of Forensic Medicine of the University of Milan, an outbreak with 8 cases emerged a few days ago.
The hypothesis of contagion is linked to an autopsy on a corpse, but the investigations are still ongoing. The most recent data on diffusion in Italy comes from the 2026 ECDC/WHO Europe document, with data referring to 2024, Tuberculosis surveillance and monitoring in Europe. Italy remains among the countries with a low incidence, even if notifications have increased in the last four years, after the decline in 2020, presumably linked to the pandemic and the reduction in global travel. In 2024, 3,150 cases were reported. 63.2% occurred in people of foreign origin, with an average age of 38.8 years; the disease was more frequent among males. It is not certain that these are recent immigrants: the risk may remain high even in the years following arrival. A 2025 report in the Journal of Preventive Medicine and Hygiene examined all the cases notified by the Syracuse Local Health Authority between 2014 and 2023: out of 183 cases, 72 were born in Italy, 26 were legally resident foreigners and 85 were irregular foreigners. Moreover, already last year, in an investigation by Panorama on “diseases of the past”, Professor Marco Falcone, director of the Infectious Diseases Operational Unit of the University Hospital of Pisa, observed: “Many cases come from African countries, or from the Philippines, from Romania or from Ukraine, places where tuberculosis is endemic. This increases the likelihood that it will spread in reception centres, or even in contexts of domestic coexistence with carers or domestic workers from these countries.
One case in a temporary detention center, or in an RSA, is enough to spread the disease to hundreds of people.”
Airport malaria: cases and victims in Frankfurt
And malaria, which killed two people (with another 4 infected) in Frankfurt between July and August? The German cases are probably attributable to the so-called “airport malaria”, i.e. mosquitoes that entered the plane or the hold and were then responsible for biting ground service workers.
However, even for this pathology there is evidence of correlation with migrations. The relationship between migration and imported malaria in Europe has been documented for over a decade. The 2012 Migration and Malaria in Europe review already noted a growing share of cases among immigrants, especially among those returning to their countries of origin to visit family and friends, with sub-Saharan Africa as the main area of origin. A trend confirmed by the Italian ISS data 2017-2023: 4,372 total cases, with an annual average of 624 cases: those among Italians are just 16%.
Because diseases of the past can return
We therefore called “diseases of the past” those that we had simply stopped encountering. But bacteria and viruses do not know the past and do not recognize borders. When conditions change, they can return to occupy a space that we thought was empty. And to kill.
