Persistence of Diphtheria, Hyderabad, India, 2003–2006

Bitragunta, Sailaja; Murhekar, Manoj; Hutin, Yvan; Penumur, Padmanabha P.; Gupte, M. D.

doi:10.3201/eid1407.071167

Cited by 45 publications

(20 citation statements)

References 4 publications

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“…Ray et al reported a shift in the median age of diphtheria in Calcutta, in as early as 1998 and attributed the shift to good primary immunization [3]. Age shift was reported from Karnataka in 1992 [13] and Andhra Pradesh between 2003–2006 [12]. A recent outbreak in Assam reported over 70% of the cases between 15- 45 years of age confirming the upward trend for disease incidence in all regions of the country [20].…”

Section: Discussionmentioning

confidence: 97%

“…Although this is partly accounted for by disproportionate size of the Indian birth cohort and influenced by variable reporting efficiency of diphtheria cases between countries, the disease remains largely neglected and widely prevalent with periodic intermittent outbreaks in over 12 states of the country [1-4,9,12-24]. Given the persistence of multiple foci in all regions of the country there is indeed a heightened risk of re-emergence of the disease in epidemic forms.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…A study by Sanou et al showed that in rural areas, children from Muslim families had lower immunisation coverage rates compared to others and that religion was not significantly related to lower immunisation coverage in urban areas [20]. Similarly, a study in India by Nath et al showed that Muslim religion was a significant independent predictor of partial immunisation status of the child and that Muslim religion was associated with the unimmunised status of the child [21,22].…”

Section: Introductionmentioning

confidence: 99%

Identifying households with low immunisation completion in Bangladesh

Andrews-Chavez¹,

Biswas²,

Gifford³

et al. 2012

Health

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The objective of this study was to investigate if the mothers' demographics and household characteristics-including type of use of cooking fuel, energy and toilet facilities-have any implication for complete immunisation rates among their children. A cross-sectional data analysis of a nationally representative sample of 4925 women with at least one child was performed. Chi-squared tests and multivariate logistic regression analyses were used. Immunisation coverage was positively associated with the mother's education and with household characteristics such as toilet facility, electricity and involvement in a microfinance group. These findings indicate the need for further advocacy for increased knowledge on the importance of vaccination and affordable public immunisation programs focusing on higher risk households such as those with pit facilities, lack of electricity and no participation in a microfinance group. Such households warrant further attention and can be targeted for immunisation coverage.

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“…Initially the disease was common among under-five children but is now affecting older children (5-19 years) and adults. 8 …”

Section: Introductionmentioning

confidence: 99%