The changing epidemiology of diphtheria in Jordan (original) (raw)
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Status of Diphtheria Immunity Among Saudi Population
Journal of Pure and Applied Microbiology, 2017
The aim of this study was to determine the prevalence of diphtheria by a crosssectional in Saudi population. The size of the population consisted of five-hundred healthy subjects from the western regions of Saudi Arabia from six months to 96 years age. ELISA assay kits was used to titers anti-diphtheria IgG. According to the widely used criteria, 31.7% of the total population was susceptible to diphtheria (IgG level <0.15 IU/ ml), 15.7% had basic protection (0.15-1.0 IU/ml), and 52.6% had full protection (>1.0 IU/ ml). The majority (82%) of the population from 6 months to 96 years had a protective level of IgG against diphtheria. The frequencies of susceptibility were relatively high in middle-aged periods (30.2-37.5% of subjects aged 21-50 years). Significantly, more females (20.7%) than males (15%) were unprotected against diphtheria. In conclusion, monitoring immunization status and administering the diphtheria vaccine as required are essential to ensure adequate and long-lasting antibody levels.
Diphtheria: Epidemiological update and review of prevention and control strategies
European Journal of Epidemiology, 1997
The importance of anti-diphtheria immunity in adults through periodic booster doses of vaccine is now increasing after last years diphtheria outbreaks in Newly Independent States (NIS) and Algeria and a few cases found in Europe and USA. Diphtheria cases notified in Italy between 1991–1994 have been reported. In 1995 WHO outlined the need to review vaccination schedules against diphtheria in
Diphtheria is a re-emerging disease with a changing epidemiology. It is thus essential to recognize diphtheria's clinical profile, patterns of morbidity and mortality, and the level of immunization. This study aimed to analyze the clinical-epidemiological profile of patients with diphtheria at the Infectious Disease Hospital, New Delhi, India. The present study was a cross-sectional investigation conducted on 94 patients diagnosed with diphtheria. The data collection tool was a questionnaire that had questions eliciting details such as socio-demographic characteristics, clinical history, examination findings, and vaccination history. The case fatality rate was calculated. Means and proportions were also measured, and the significance level was set at P <0.05. The meanSD age of the participants was 94.4 years. Laryngeal involvement was found in 10 (11%) participants. Complete diphtheria vaccination doses were taken by 6 (6.4%) participants. The case fatality rate was 13%, and complications such as neuropathy were found in 21 (22%) cases, cardiac problems in 12 (13%), and respiratory problems in 13 (14%). Longer duration of the illness, delayed presentation, and complications were associated with poor clinical outcomes (P<0.05). The majority of diphtheria cases were 6-10 years old and had a low socioeconomic status. Most of them had a partial vaccination against diphtheria. Around one-third of the patients had complications related to diphtheria, and the case fatality rate was also high. Key preventive measures for controlling the deadly diphtheria disease include specialized immunization programs for areas with poor immunization coverage, as well as the early detection and treatment of suspected cases.
Diphtheria in the current era of universal vaccination
Journal of the Royal College of Physicians of Edinburgh
A 16-year-old male resident of a remote village in Haryana was referred to our medical emergency for progressive dyspnoea of one day. He presented with complaints of fever with chills, progressive neck swelling and drooling of saliva for three days duration. The parents could not recall vaccination history, BCG scar was also absent suggesting unvaccinated status. Examination of the oral cavity revealed an off whitish raised membrane, adherent to the posterior pharyngeal wall with surrounding redness and edema [Figure-1A]. On general physical examination he had; tachycardia, tachypnoea and neck swelling [Figure-1B]. He was suspected of having diphtheria and a throat swab was sent immediately for albert/ gram staining in the emergency laboratory. Investigations showed Hb-11.8gm/dl (12-18gm/dl), TLC-13300/µL (4000-11000/ µL), neutrophils-76% (40-75%), lymphocytes-12% (20-45%), monocytes-10% (2-10%) and eosinophils-2% (1-6%) with borderline (27 U/L) raised Creatine kinase-MB enzyme (CK-MB) (5-25 U/L). Throat swab gram stain [Figure 2A] and albert stain [Figure 2B] were positive for diphtheriae like bacteria; confi rming the diagnosis of diphtheria. This case brings out the importance of recognising the re-emergence of diphtheria in older age groups. Lacunae in the universal immunisation process, rumours on vaccination effects and poor living conditions for refugee population are likely reasons in Asia and Europe. Universal immunisation, early diagnosis, prophylaxis and adequate supportive care are measures to prevent it.
Diphtheria in Children-Are we even close to control the menace
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Despite the success of mass immunization in many countries worldwide, diphtheria continues to play a major role as a lethal resurgent infectious disease. The case reports of resurgence/persistence of diphtheria in India represent only the tip of the iceberg. Aims and Objectives: To study the epidemiology, clinical profile, complications and outcome of diphtheria in children. Materials and Method: A retrospective observational study conducted at a teaching hospital. Review of case notes of all children aged 1 month – 14 years, clinically/microbiologically diagnosed and managed as diphtheria was done. Demographic, clinical & immunization status details, complications and outcome were recorded. Results: A total of 149 cases were reviewed. Male to female ratio was 1.26:1. Maximum (65.77%) cases were reported from regions of Karnataka. Incidence of diphtheria was 0.4%. Highest incidence (46.98%) was seen in children of 5-10 years age group. Majority (69.80%) were unimmunized. Difficulty swallowing (89.93%) and bull neck (81.21%) were common presentations. A total of 79 complications were seen of which myocarditis was the commonest (41.77%). Of 149, 98 (65.77%) recovered and were successfully discharged. CFR was 29.53%. Maximum deaths (50%) were seen in 1-5 year age group. Most children (88.63%) died within 5 days of hospitalisation. Conclusion: Even after more than 3 decades of UIP implementation, diphtheria is still not a lost entity. A shift in age incidence was observed. Occurrence in completely immunized children points towards waning immunity with age or flaws in immunization. Uniformity and improvement in vaccine coverage, adolescent/adult immunization and early diagnosis and treatment might take us closer to achieve control.
Study of Diphtheria and Its Complications: A Retrospective Study from a Tertiary Care Hospital
Pediatric Infectious Disease
Aim and objective: To study clinical presentation and complication in diphtheria in pediatric age-group. Materials and methods: Retrospectively 33 clinical diphtheria cases who got admitted to the isolation unit of Niloufer hospital from August 2019 to July 2020 were taken for this study. The epidemiological details, vaccination status, clinical profile, routine blood investigations along with SGOT, ECG, treatment given, and interventions done with outcome were studied. Results: The common symptoms observed were throat pain seen in 26 cases (79%), fever seen in 25 cases (76%), dysphagia seen in 24 cases (75%), bull neck seen in 18 cases (55%), and palpitations seen in 06 cases (18%). Of the 33 patients, 4 (12%) patients had completed vaccination, 29 (88%) cases were either unimmunized or partially immunized as per their age. The complications observed were cardiac involvement evident through elevated serum transaminase and ECG changes seen in 06 cases (18%), neurological involvement seen in 05 cases (15%), renal failure seen in 04 cases (12%), thrombocytopenia seen in 02 cases (6%), and bleeding seen in 01 case (3%). Tracheostomy due to airway compromise required in six cases. A total number of nine (29%) patients died with complications. Conclusion: Diphtheria incidence is relatively more in the age-group >5 years. The common symptoms are throat pain followed by fever, dysphagia, and bull neck. Common complications observed are myocarditis associated with high mortality, palatal palsy, renal failure, and thrombocytopenia. An increase in vaccination coverage is an effective preventive measure to reduce the incidence of diphtheria.
Epidemiological investigation of a case of diphtheria
Indian Journal of Medical Specialities, 2010
A five year old female child presented with fever, throat pain and swelling in neck region and was clinically diagnosed as a case of diphtheria and confirmed microbiologically. An epidemiological investigation was conducted, which revealed that the child had received no vaccine against diphtheria. She was managed with antibiotics, anti-diphtheritic anti-sera, DPT and other necessary vaccines as required under UIP. Five other children from the same school were also identified to be sufferring from similar complaints during the same period. All the children were tracked and rapid search for any other similar cases was conducted. History of partial/incomplete immunisation among the close contacts was also obtained and their chemoprophylaxis with oral erythromycin was ensured through government functionaries. No other case of diphtheria has since been reported from this area. This report highlights the steps that need to be adopted for prompt epidemiological investigation of infectious diseases in collaboration with public health authorities to achieve the optimum desired results.
Diphtheria remains a threat to health in the developing world: an overview
Memórias do Instituto Oswaldo Cruz, 2003
Changes in the epidemiology of diphtheria are occurring worldwide. A large proportion of adults in many industrialized and developing countries are now susceptible to diphtheria. Vaccine-induced immunity wanes over time unless periodic booster is given or exposure to toxigenic Corynebacterium diphtheriae occurs. Immunity gap in adults coupled with large numbers of susceptible children creates the potential for new extensive epidemics. Epidemic emergencies may not be long in coming in countries experiencing rapid industrialization or undergoing sociopolitical instability where many of the factors thought to be important in producing epidemic such as mass population movements and difficult hygienic and economic conditions are present. The continuous circulation of toxigenic C. diphtheriae emphasizes the need to be aware of epidemiological features, clinical signs, and symptoms of diphtheria in vaccine era so that cases can be promptly diagnosed and treated, and further public health measures can be taken to contain this serious disease. This overview focused on worldwide data obtained from diphtheria with particular emphasis to main factors leading to recent epidemics, new clinical forms of C. diphtheriae infections, expression of virulence factors, other than toxin production, control strategies, and laboratory diagnosis procedures.
Global Epidemiology of Diphtheria, 2000–20171
Emerging Infectious Diseases, 2019
In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria-tetanus-pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.