Diphtheria in the current era of universal vaccination (original) (raw)
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Diphtheria: a re-emerging public health challenge
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019
Diphtheria is a highly contagious, potentially life threatening bacterial infection caused by Corynebacterium diphteriae. Diphtheria is transmitted from person to person, usually through respiratory droplets and can lead to severe breathing problems, heart failure, blood disorders and death. Diphtheria was basically eliminated after the introduction of the vaccine in the 1940-1950s. However there is presently global concern that diphtheria is reemerging. We herein report nine cases of diphtheria presenting within a period of six months. All cases presented with sore throat, fever, membrane in the oropharynx and bull neck. Eight of the cases had never been immunized against diphtheria. All cases progressed and developed various complications with 8 of the cases dying. None of the cases had diphtheria antitoxin. This cases present the potential for this highly fatal but preventable disease reemerging and the need to be aware of epidemiological features, clinical signs and symptoms of ...
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.
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.
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.
International Congress Series, 2003
This study analysed the number of patients admitted with diphtheria to a teaching hospital in the state of Assam in India over a period of ve years and compared the disease characteristics and management with outcomes and incidences of diphtheria reported in the literature. It was a retrospective analysis of data elicited from clinical records of patients admitted to hospital. A total of 101 admissions were recorded during a ve-year period between March 1997 to March 2002, mostly with pharyngeal diphtheria (90 per cent). The majority of patients had no history of immunization (70 per cent). Signi cant presenting features were a tonsillar patch, sore throat, respiratory distress and fever. All patients were treated with anti-diphtheritic serum and intravenous antibiotics. Steroids were given to 81 per cent of patients and tracheostomy was carried out in 10 per cent of cases. The mortality was 16 per cent. Diphtheria of the respiratory tract remains a potentially fatal disease commonly presenting with membranous pharyngitis. Early diagnosis and treatment with anti-diphtheritic serum and antibiotics remain the cornerstone of treatment. Inadequate immunization cover is deemed responsible for the continued menace of diphtheria.
Obstinate diphtheria needs innovation in immunization
International Journal of Contemporary Pediatrics, 2016
Background: Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur in our country with the phenomenon of age shifting. It is pertinent to study the epidemiological determinants of diphtheria. The objective of the study was to profile of diphtheria patients admitted in ID and BG, hospital, Kolkata, Bengal, India. Methods: A descriptive cross-sectional study was done in September, 2010 involving the diphtheria patients admitted in ID and BG hospital, Kolkata from July, 2009 to June, 2010. Data were collected from BHT of the patients kept in the MRD of ID and BG hospital and telephonic enquiry for those patients whose BHT were found missing of some information, specially immunization. Results: Almost 90% cases were diagnosed clinically. Majority (47.23%) belonged to 12-29 years age group with clear age shifting. There was rural and female predominance. Almost 2/3rd was unimmunized and more than 3/4th belonged to below poverty level. Patch in throat was the most common clinical feature detected at the time of admission and difficulty in swallowing was the most frequent symptoms. Referral source was unknown for higher proportion of female in ≥12 year who also had higher duration of hospital stay and required significantly higher dose of Anti-Diphtheria Serum. Myocarditis was noted as most frequent complication (41%) and case fatality rate was 3.97%. Peak occurrence was noted during August to November. Conclusions: Diphtheria seems to be obstinate with age shifting indicating rethinking in our control strategy by universal immunization.
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.
Resurgence of Diphtheria – A case report
Tropical Journal of Pathology and Microbiology, 2018
Diphtheria is a highly infectious and one of the most common causes for childhood mortality. In developed countries, diphtheria has been completely eradicated with the introduction of effective immunization program. In developing countries like India, the incidence of this disease has declined with immunization. But resurgence has been reported from many parts of India. Poor immunization coverage and failure to take booster doses is responsible for persistence of diphtheria. Here we report a case of diphtheria in a 6 year old boy from Chamarajanagar district.
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.