Diphtheria mortality in Nigeria: the need to stock diphtheria antitoxin

Sadoh, AE; Sadoh, WE

doi:10.4314/ajcem.v12i2.64323

Cited by 8 publications

(13 citation statements)

References 7 publications

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“…In 2005, seven deaths (CFR 10%) were reported from Dhule and Malegaon districts due to the non-availability of ADS [9,54]. A CFR of nine per cent in our study despite availability of ADS is unacceptable although we do report difficulty in obtaining ADS at short notice.…”

Section: Discussioncontrasting

confidence: 55%

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

et al. 2013

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BackgroundEpidemic 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.MethodsThis 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® 2010.ResultsOur 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.ConclusionsThe 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.

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Section: Discussioncontrasting

confidence: 55%

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

et al. 2013

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“…This is strongly correlated to the action of the exotoxin in their system and the unavailability of the antitoxin in the hospital leading to the incomplete treatment of the disease. A similar case was reported in Benin City; Edo state; Nigeria where 9 cases were seen and 3 deaths recorded due to unavailable antitoxin to counteract the effect of the DTx which lead to persistence of symptoms and death [18].…”

Section: Discussion Of Resultssupporting

confidence: 69%

Corynebacterium Diphtheriae: A Case Report of Some Isolates in National Ear Care Centre Kaduna

Rimi

Agyigraa

Nkwazema

et al. 2019

AJRID

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This is a case study of the incidence of diphtheria in National Ear Care Centre Kaduna. Samples included all patients presented with diphtheria symptoms referred to the hospital from October to December; 2018. A total of 8 patients were referred and several samples taken for laboratory investigations. 8 throat swabs were collected for organism isolation by inoculation on some certain agars, incubation, secondary gram and microscopy; colonies appeared to be biconcave, large and whitish. Microscopy revealed characteristic Chinese lettered, pleomorphic bacillus which are features of Corynebacterium diphtheriae. Blood samples were used for urea and creatinine estimation which yielded abnormal high values in all except the creatinine of one of the samples indicating kidney impairment which could be attributed to presence of the tox gene. To further confirm the incidence of the disease; one throat swab was saved at 4°C for molecular confirmation and characterisation of the gene. It was then transported to Molecular laboratory and the DNA extracted using the phenol/chloroform extraction method. Both the A and B subunits of the tox gene were amplified from the DNA extract at 248bp and 297bp respectively. Sanger’s Dye Terminator Cycle Sequencing (DTCS) of both the subunits of the tox gene was carried out and the sequences were obtained and converted to the fasta format using a Finch TV for bioinformatics analyses using the NCBI blast tool. The A and B subunits showed a percentage identity of 99.59% and 95.57% to Corynebacterium diphtheriae mitis strain NCTC 3529 genome assembly, chromosome: 1 respectively. The A subunit also showed 99.59% identity to Corynebacterium diphtheriae strain BQ11 chromosome; complete genome while the B subunit also showed 95.57% identity to Corynebacterium diphtheriae mitis strain NCTC 7838 genome assembly chromosome: 1. A mutation was also discovered in the tox genes as indicated by the E-value of 3e-84 and 2e-121 for A and B subunits respectively which are values that are less than 1. This is also confirmed by 5 gaps noticed from the blast results (4 gaps from A and 1 from B) indicating the presence of indels. In conclusion; there are confirmed incidences and sporadic cases of diphtheria in Kaduna State and the organism is said to have mutated.

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“…Infantile diphtheria was also reported by various authors as well as we observed 2 unimmunized infants of 9 months and 11 months old from nearer state (Madhya Pradesh). 9,[12][13][14][15] As secondary attack rate is very high all cases needs to be isolate and their family members thoroughly examined and treated. We found two siblings were admitted 4 days duration apart and both were unimmunized.…”

Section: Resultsmentioning

confidence: 99%

Clinical profile and outcome of diphtheria in central India: a retrospective observational study

Meshram

Patil

2018

Int J Contemp Pediatr

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Background: Although, diphtheria is eliminated by many developed countries by effective immunization, still diphtheria continues to be endemic in India and leading cause of morbidity and mortality, especially in areas in the border of the two states. The objective of the present study was to recognize the clinical profile, morbidity and mortality pattern of diphtheria and to study their immunization status as a retrospective observational study performed in pediatric wards and paediatric intensive care unit.Methods: The medical records were recovered from the case files, searching for cases diagnosed as diphtheria from the Medical Record Section and Statistical Service of the institute. A pre-established protocol was formed after approval from institutional ethical committee. Case study included suspected, probable and confirmed cases of diphtheria as per the WHO definition guidelines. All the relevant data and information regarding age, gender, residence, socioeconomic status, immunization status, clinical details, laboratory investigation, complications, and treatment provided, and outcome were recorded.Results: Amongst 47 patients, 55.32% were >5years and mean age was 6.46±3.08 years with no difference in sex distribution. 2(4.25%) patients were completely immunized, 27(57.45%) were partially immunized and 18(38.30%) were not immunized. An immunization rate was less in females as compared to males. All patients presented with fever and membrane in throat followed by throat pain 95.74%, enlarged/congested tonsils 80.85%, respiratory difficulty 68.08%, dysphagia 59.57% bull neck 48.94% and voice change 36.17%. Myocarditis was the commonest (42.55%) complication followed by palatal palsy (14.89%), polyneuropathy (8.51%), acute renal failure (4.25%) and DIC & shock (4.25%) were observed. Case fatality rate was 21.28%. Maximum numbers of cases were noted during the rainy season.Conclusions: Shifting of occurrence of diphtheria in the age group of 5-15 years suggest the need to improve and strengthen the immunization activity specially booster doses in the border districts as most of the cases were from areas at the border of two states.

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Diphtheria mortality in Nigeria: the need to stock diphtheria antitoxin

Cited by 8 publications

References 7 publications

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

Corynebacterium Diphtheriae: A Case Report of Some Isolates in National Ear Care Centre Kaduna

Clinical profile and outcome of diphtheria in central India: a retrospective observational study

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