Persistence of Diphtheria, Hyderabad, India, 2003–2006 (original) (raw)
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A Case–control Study of Diphtheria in the High Incidence City of Hyderabad, India
The Pediatric Infectious Disease Journal, 2016
Background: India accounts for approximately 72% of reported diphtheria cases globally, the majority of which occur in the state of Andhra Pradesh. The aim of this study is to better understand lack of knowledge on diphtheria vaccination and to determine factors associated with diphtheria and low knowledge and negative attitudes. Methods: We performed a 1:1 case–control study of hospitalized diphtheria cases in Hyderabad. Eligible case patients were 10 years of age or older, resided within the city of Hyderabad and were diagnosed with diphtheria per the case definition. Patients admitted to the hospital for nonrespiratory communicable diseases and residing in the same geographic region as that of cases were eligible for enrolment as controls Results: There were no statistical differences in disease outcome by gender, education, economic status and mean room per person sleeping in the house in case and control subjects. Not having heard of diphtheria (adjusted odds ratio: 3.56; 95% c...
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Diphtheria is an infectious disease caused by a gram-positive facultatively anaerobic bacilli, Corynebacterium (C.) diphtheriae. The present health statistics and data from the few studies that have been carried out suggest that our war with this disease is still going on and is far from being over in spite of the vaccine that’s freely available. Aim: To study clinical profile, complications, and outcome of diphtheria in karnataka population and to correlate with immunisation status. Materials and Methods: This was a hospital-based prospective cross-sectional observational study done in the Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, from January 2018 to November 2018. Patients admitted with history suggestive of diphtheria were enrolled and categorised into probable and confirmed cases. The age, sex, area of residence, religion, immunisation status, mean time of presentation to hospital from onset of illness, use of ...
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.
A Case Series of Diphtheria in Western India: Time to Revisit Vaccination Coverage and Policy?
2021
INTRODUCTION: Diphtheria is a significant child health problem in countries with low immunization coverage. Reports of diphtheria in the adult population are also increasing. Here we describe case series of diphtheria in western India for 6 months. OBJECTIVE: To identify and isolate Corynebacterium species, demonstrate the isolates for toxigenicity and examine the immune status of the patients by estimating antibody titers in sera (antidiphtheria toxoid IgG). METHODS: Twelve patients admitted with clinical suspicion of oropharyngeal diphtheria for six months. In each case, two throat swabs were collected and primary identification of Corynebacterium diphtheriae was done by direct microscopy (Gram's and Albert's stains), bacteriological culture and biochemical tests as per the standard procedure. Culture isolates were tested for toxigenicity by Elek's gel precipitation and were sent to a reference laboratory for tox A gene detection by polymerase chain reaction. Anti-diphtheria toxoid IgG antibody levels were determined in patient's sera using a commercial Anti-Diphtheria Toxoid IgG Enzyme-Linked Immunosorbent Assay (EUROIMMUN, Germany) at a reference laboratory. RESULTS: All 12 patients presented with oropharyngeal diphtheria with the formation of pseudomembrane in the oropharynx. Eleven patients were of the pediatric age group and one was an adult. The microbiological diagnosis was achieved for 11 patients and one was diagnosed clinically. Based on vaccination history, microbiological findings and distribution of anti-diphtheria toxoid IgG antibodies titers, the results showed persistence of toxigenic strain of Corynebacterium diphtheriae circulating in our region. CONCLUSIONS: The present study demonstrated that toxigenic strains of C. diphtheriae are circulating in this geographical location which indicates the need for constant epidemiological surveillance ensuring early detection of diphtheria and review the efficacy of the immunization programme.
International Journal of Contemporary Pediatrics, 2019
Background: Considered as a rare clinical entity in immediate post-vaccination era, diphtheria has now started gaining surface in India for last few years, with an epidemiological shift involving older children owing to poor immunization coverage and waning immunity. Thus, it is imperative to quantify disease burden, analyses the clinical profile and factors affecting the outcome of diphtheria in children.Methods: A prospective observational study conducted in the Pediatric department of a teaching hospital where all children admitted with clinical diagnosis of diphtheria during the study period were included. Demographic data and clinically relevant information along with complications and outcome were recorded. Cases were managed as per standard treatment protocol providing intensive care support wherever required. Complications and factors affecting the outcome in all diphtheria cases were analysed.Results: Total 53 children were enrolled into study, and the mean age of study pop...
National Journal of Community Medicine, 2011
As outbreak of diphtheria reflects the impact of immunization outbreak investigation was carried out to assess the diphtheria outbreak pattern and case fatality rate in Dabela Village of Amirgagh Taluka and CHC, District, Banaskantha, Gujarat in 2007. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future. Vaccine was efficacious among those who received >4 doses. The proportion of the population receiving boosters was low, especially among Muslims. We recommend increasing booster dose coverage. We investigated epidemic to 1) describe the epidemiology of diphtheria in terms of time, place, and person; 2) estimate vaccine coverage; and 3) to do SWOT analysis in Immunization services.4) To suggest successful vaccination.
An Epidemiological Investigation of the Diphtheria Outbreaks Reported in a District of Gujarat
Healthline
Introduction: Mortality and morbidity due to infectious disease have got reduced in the last couple of decades. Diphtheria is one of the infectious diseases which can be preventable with a complete immunization. Objective: To understand trends and identify factors affecting the outbreak of diphtheria in Banaskantha district of Gujarat. Method: A retrospective study based on the available case records for the years 2019, 2020 and 2021(till June). The study was conducted after the reported diphtheria cases in a district. The study was a public health response and intended to provide specific geographical recommendations to the district. The data was recorded from the reported case record and immunization registers. The data were analyzed for defined variables. Results: Out of the 366 cases identified during years 2019-2021.Almost 74% cases have occurred during 2019, with a 7.7% mortality rate. Total 48% of cases were among the age group of 5-10 years, with an increasing number of case...
Diphtheria outbreak in a district in Meghalaya, India: an overview
International Journal of Community Medicine and Public Health, 2016
Diphtheria is an infectious disease which has continued to cause illness and death in children even after the advent of vaccine and diphtheria anti-toxin. Since, immunization is an important tool against this disease, countries with poor immunization coverage still continue to experience several outbreaks of diphtheria, both reported and unreported. India is one of the worst affected counties of diphtheria and here mortality remains to be high as well due to unavailability of diphtheria anti-toxin. The present article aims to highlight one such outbreak in the remote part of Northeastern region of the country wherein diphtheria anti-toxin is not available in the entire region making the chances of fatality higher. A total of 7 cases of diphtherias were found in the present outbreak. Case fatality rate was 28.6%.6 out of the 7 cases were unvaccinated. Low immunization coverage along with poor living conditions as well as ignorance of community was found to be the major risk factors leading to this outbreak.
Re-emergence of diphtheria in Kerala: the need for change in vaccination policy
International Journal Of Community Medicine And Public Health, 2019
Background Diphtheria cases continue to occur in India despite a national vaccination program targeting the disease. Outbreaks of diphtheria have been known to occur in areas of low immunization coverage. An age shift has been noted to older children and adults in recent outbreaks from the Indian states of Andhra Pradesh, Karnataka, Delhi and Assam. Kerala witnessed its largest outbreak of Diphtheria in recent times from 2015 to 2017.Methods: Surveillance data from the Regional PEID Cell during the outbreak period was analysed and epidemiological data generated.Results: A total of 734 cases of diphtheria were reported during this period with eight deaths (Case fatality rate=1.08%). The mean age of the cases was 17.4 years (±13.9). More than 72% of the cases occurred in children above 10 year of age and 68% of the cases were either unimmunized or partially immunized. 32% of the cases were immunized for age. Of these, immunized children, 88% were above 10 years of age, indicating wani...
BMC Public Health, 2013
Background: Epidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years. Methods: This study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non-clinical variable using Microsoft™ Excel W 2010. Results: Our findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district. Conclusions: The outbreak raises several concerns regarding the epidemiology of diphtheria in Dhule. The reason for shift in the median age despite consistently poor immunization coverage (below 50%) remains unclear. Concomitant efforts should now focus on improving and monitoring primary immunization and booster coverages across all age groups. Gradually introducing adult immunization at ten year intervals may become necessary to prevent future vulnerabilities. Laboratory networks for genotyping and toxigenicity testing are urgently mandated at district level given the endemicity of the disease in the surrounding region and its recent introduction in remote Dhule. Contingency funds with pre-agreements to obtain ADS and DT/Td vaccines at short notice and developing standard case management protocols at district level are necessary. Monitoring the disease, emerging strains and mutations, alongside drug resistance through robust and effective surveillance is a pragmatic way forward.