Diphtheria outbreak in Jakarta and Tangerang, Indonesia: Epidemiological and clinical predictor factors for death

Abstract

Background In 2017, a diphtheria outbreak occurred in several provinces in Indonesia. The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria. Methods A retrospective cohort study was conducted using patient medical records at five referral hospitals in the Province of Jakarta and one in Tangerang District, Banten Province during January 2017 to 31 August 2018. All children in the age group of 1–18 years old discharged with diagnosis of clinical diphtheria formed the study group. All anonymized patient data were evaluated for demographic issues, clinical features, immunization status, complication, laboratory profiles and outcome. Results A total of 283 patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. All mortal patients had the complication of myocarditis. Regression analyses revealed factors for predicting mortality. Incomplete primary diphtheria toxoid immunization, stridor, bull neck, leukocytosis ≥15 x109 cells/L and thrombocytopenia ≤150 x109 cells/L in each combination for 2 predictors modeling were correlated with death. Conclusions We report key predictors of mortality in pediatric patients with clinical diphtheria. The presence of these features when admitted to the hospital must be taken into account, because they can lead to fatal outcome.

Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis

“…Our findings showed a notable rise in the number of diphtheria cases during the months between October 2017 and January 2018, which are considered winter months. This finding is consistent with the findings of previous studies in Yemen and Indonesia [ 11 , 13 , 14 ]. A decline in the cases after the peak started in February and continued until August 2018.…”

“…Diphtheria outbreaks often occur because of low childhood vaccination, as well as lack of booster vaccinations for older children and adults [ 17 ]. This supports our findings that most affected cases were unvaccinated, which is consistent with the findings of previous studies in India and Indonesia reporting that mortality occurred in more than 70% of patients who did not receive complete immunization [ 14 , 18 ]. Our study confirms that raising immunity levels in the population through vaccination remains a critical tool for diphtheria control.…”

Microbiological and Clinical Aspects of Diphtheria-Confirmed Cases from Capital City of Indonesia, Jakarta, and Surrounding Areas in 2017

“…On the other hand, as an alarming symptom, almost 50% of the cases exhibited bull neck as a toxic sign affecting prognosis (29). Furthermore, although only three cases (7.5%) had myocarditis, awareness is required since it is correlated with fatal cases (7,30). All cases with myocarditis complications passed away in this study.…”

“…Some studies have presented a microbiological and clinical overview of diphtheria (7,13); however, an analysis of laboratory-confirmed cases is rare. Some previous studies have also illustrated diphtheria-confirmed cases with small sample sizes; however, some others have presented a partial overview in separated aspects (12,14).…”

“…Moreover, the clinical aspects of cases contribute to updating the clinical manifestation, management, and prognosis of the disease, which may not sometimes fit the theory (3,5). Several previous studies have addressed the microbiological and clinical aspects of diphtheria cases in Indonesia (7,8). However, the microbiological aspects are generally limited to subtype, toxigenicity, and susceptibility.…”