Obstinate diphtheria needs innovation in immunization

Sardar, Jadab Chandra; Saren, Asit Baran; Haldar, Dibakar; Chatterjee, Kaushik; Biswas, Samar; Chatterjee, Tutul; Sarkar, Gautam Narayan

doi:10.18203/2349-3291.ijcp20162363

Int J Contemp Pediatr

2016

DOI: 10.18203/2349-3291.ijcp20162363

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Obstinate diphtheria needs innovation in immunization

Jadab Chandra Sardar

Asit Baran Saren

Dibakar Haldar

et al.

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Cited by 3 publications

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“…9 Many outbreaks of diphtheria have been reported in various states of India in recent times. [10][11][12][13][14] A diphtheria outbreak of 593 cases in Indonesia was documented by several provincial health offices between 1 January and 1 November 2017, many occurring in East Kalimantan in children aged 1-10 years. 15 Since there has been a lack of studies on childhood diphtheria in Wahidin Sudirohusodo Hospital, Makassar, we aimed to investigate the clinical spectrum and outcomes of childhood diphtheria in our facility.…”

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confidence: 99%

Clinical spectrum and outcomes of pediatric diphtheria

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Pelupessy

Alimadong

et al. 2019

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Background Although vaccination programs have succeeded in reducing the incidence of diphtheria, it remains a health problem in Asia, including Indonesia. Objective To investigate the clinical spectrum and outcomes of pediatric diphtheria in Wahidin Sudirohusodo Hospital. Methods This study was a retrospective review of childhood diphtheria medical records from January 2011 to December 2017 in Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Recorded data consisted of age, gender, nutritional and immunization statuses, signs and symptoms, throat swab culture results, complications, and outcomes. Results Of 28 subjects aged 9 months to 17.10 years, the majority were >5 years (57.1%) and male (60.7%). Subjects’ mean age was 6.15 years and 82.1% of cases were well nourished. Overall, 85.7% had received complete immunizations, while 14.3% were not immunized, having received neither basic nor booster vaccines. The presenting manifestations were fever, pseudomembranes, and sore throat in all subjects, enlarged tonsils (78.57%), dysphagia (67.86%), cough (57.14%), headache (57.14%), hoarseness (67.86%), bull neck (25%), and myocarditis (14.3%). Most subjects had hospital stays of >10 days (67.9%). Mortality was 14.3%, usually in those admitted with a late, deteriorating condition and dying before getting optimal treatment. Poor outcome was significantly associated with the lack of basic or booster immunizations, poor nourishment, bull neck, myocarditis, and hospital stays < 5 days (P<0.05 for all). Conclusion The clinical spectrum and outcomes of pediatric diphtheria in this study are relatively similar to reports from other hospitals. Mortality was mostly in patients who lack basic or booster immunizations, are poorly nourished, or have bull neck, myocarditis, or hospital stays < 5 days.

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confidence: 99%

Clinical spectrum and outcomes of pediatric diphtheria

Nawing

Pelupessy

Alimadong

et al. 2019

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“…So many outbreaks of diphtheria from various states in India have been reported in recent times. [5][6][7][8][9] Because of inadequate vaccine coverage, waning vaccine induced immunity, mass population movements, poor living standards, delay reporting to hospital and non-availability or delay in administering antitoxin appears to be main factors contributing to re-emerging of the disease and high mortality at border district areas of the states. Our institute is serving to population of Vidhrabh and nearby states and there is paucity of literature from central India.…”

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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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“…5 Recently, several outbreaks have been reported in developing countries, such as India, Indonesia, Nigeria, and Vietnam. [6][7][8] From 2016 to 2019, diphtheria outbreaks were reported in multiple countries, including Bangladesh, Venezuela, and Yemen. 7 The burden of the disease is especially high in countries experiencing conflict or social disruption, such as Bangladesh and Yemen.…”

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Clinical spectrum and outcomes of the 2019-2020 pediatric diphtheria outbreak in Yemen

Bawazir,

Binkroom,

Binghouth

2024

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Background Diphtheria is an acute bacterial infectious disease characterized by serious morbidity and mortality. Outbreaks continue to occur in developing countries despite national vaccination programs. Vaccination, early recognition the disease, and adequate intervention are needed to avoid devastating outcomes. Objective To describe the clinical spectrum of childhood diphtheria and its association to outcomes during the 2019-2020 diphtheria outberak in Yemen. Methods This was a retrospective study to assess the demographic, clinical features, and outcomes of paediatric respiratory diphtheria in patients with diphtheria during the outbreak from September 2019 until May 2020 admitted at Mukalla Maternity and Children Hospital. We used SPSS 22 version for data analysis. Results There were 34 culture-confirmed diphtheria cases included in this study, their age ranged from 13 months to 15 years old. Most of the cases (76.5%) happened to children at more than 5 years old. There was no gender difference. Of these 34-positive diphtheria, 79.4% from Hadramout and 17.6% from Shabwa governorate. Most of the cases (35.3%) were admitted in December. More than half of the patients (52.9%) were unimmunized. Fever, sore throat, and enlarged tonsils were presented in all patients, dysphagia (82.4 %), pseudomembrane (91.7%), bull neck (52.9%), and stridor (8.8%) were also found in some patients. Complications included acute renal failure (20.6%), disseminated intravascular coagulation (DIC), shock (17.6%), and myocarditis (8.8%). Significant poor outcome (P< 0.05) was associated with bull neck, myocarditis, acute renal failure, DIC, and shock. The case fatality rate (CFR) was 20.6%. Conclusion Fever, sore throat, tonsillitis, pseudomembrane, and bull neck are high index suspicion of diphtheria and anticipation of ominous outcome. The shifting of occurrence of diphtheria to older age group indicates the need for booster(s) diphtheria toxoid vaccine in addition to improving and strengthening the current immunization program.

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Obstinate diphtheria needs innovation in immunization

Cited by 3 publications

References 8 publications

Clinical spectrum and outcomes of pediatric diphtheria

Clinical spectrum and outcomes of pediatric diphtheria

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

Clinical spectrum and outcomes of the 2019-2020 pediatric diphtheria outbreak in Yemen

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