Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India (original) (raw)
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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.
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.
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.
Persistence of Diphtheria, Hyderabad, India, 2003–2006
Emerging Infectious Diseases, 2008
During 2003-2006, diphtheria rates in Hyderabad, India, were higher among persons 5-19 years of age, women, and Muslims than among other groups. Vaccine was effi cacious among those who received >4 doses. The proportion of the population receiving boosters was low, especially among Muslims. We recommend increasing booster dose coverage.
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 ...
Resurgence of diphtheria in rural north Karnataka: Clinical profile and outcome
IP innovative publication pvt. ltd, 2019
Introduction: Although, diphtheria is eliminated in many developed countries by effective immunization, diphtheria still continues to be endemic in India and is the leading cause of morbidity and mortality, especially in rural parts of North Karnataka. The objective of the present study is to recognize the clinical profile, morbidity and mortality pattern of diphtheria and to study their immunization status as a hospital based observational study performed in paediatric intensive care unit. Materials and Methods: This study is a hospital based observational study from April 2018 to August 2018 at a tertiary care referral PICU, S.Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka. The cases were analysed with respect to demographic details, clinical features, immunization status, complications and mortality. Results: The study consisted of 22 children who presented with features suggestive of diphtheria, 90% were >5years of age with male to female ratio of 1.2:1. Of the 22 children 4 (18.2%) children were completely immunized, and 18(81.8%) were partially immunized/not immunized. All patients presented with fever, membrane in throat and throat pain (100%) followed by bull neck 54.5%, dysphagia 36.36%, epistaxis 9% and Airway obstruction 4.54%. Alberts stain was positive in 18 cases (81.8%) and throat swab culture positive in 16 cases (72.7%). Myocarditis was the commonest complication (63.6%) followed by palatal palsy (13.63%), shock (4.5%) and stroke (4.5%). Case fatality rate was 18.18%. Conclusion: Shifting of occurrence of diphtheria in the age group of >5 years suggest the need to improve and strengthen the immunization program specially the booster doses.
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 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.
Sporadic Outbreaks of Diphtheria: A Three Year Study from a Tertiary Care Centre of Northeast India
Diphtheria is an acute toxin mediated contagious febrile illness, predominantly in children, caused by the locally invasive Gram positive bacillus Corynebacterium diphtheriae. In developing countries, with increasing coverage of immunization, the incidence of the disease has declined. This study was carried out to know the incidence of diphtheria among 99 patients from suspected sporadic diphtheria outbreaks, admitted in a tertiary care centre of Assam in Northeast India, over a period of three years from January, 2013 to December, 2015. Throat swabs were collected and subjected to direct smear microscopy by Gram's and Albert stains, and culture on Blood agar, Loeffler's seum and Tellurite Blood agar media. C. diphtheriae was isolated in 26 cases. The highest culture positivity of 40% each was in age groups 5-9 and 10-14 years. Culture positivity was highest (62.5%) in non-immunized patients, and surprisingly, it was 31.57% in fully immunized patients. The study signifies re-emergence of diphtheria in this State calling for intensive monitoring and review of Universal Immunization Programme, and quality, storage and transport conditions of vaccines in the State.
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...