Abstract
Introduction: The global incidence of diphtheria remained steady during 2007–2011 after a steady decline of over 95 % from 1980 to 2006. This was largely due to a resurgence of the disease in India, which alone accounted for 71–83 % of the total cases reported worldwide. Case presentation: This article describes the identification of an outbreak of diphtheria in two very remote villages of northern Karnataka in South India in May 2011 and detection of further cases in as many as seven nearby villages in the 6 months that followed, which resulted in at least three deaths. The ineffectiveness of the Universal Immunization Programme in its present form in reaching the remote villages is highlighted, and one case of diphtheria with a non‐toxigenic strain of Corynebacterium diphtheriae, which is very rare in India and has the potential to upset eradication strategies, is documented. Conclusion: This article should provide a wake‐up call for the health administrators for restructuring and strengthening immunization strategies and programmes.
Highlights
The global incidence of diphtheria remained steady during 2007–2011 after a steady decline of over 95 % from 1980 to 2006
India alone accounted for 71–83 % of these cases. This is despite a reported increase in the coverage of the DPT vaccination which is presently given at 6, 10 and 14 weeks and 16–24 months after birth followed by a booster dose at 5 years of age, as part of the expanded programme of immunization called the Universal Immunization Programme (UIP) in India
The National Health Profiles released by the Government of India reported 3812, 3977, 3529, 3123 and 3485 cases of diphtheria respectively from 2007 to 2011, detailed literature on the occurrence of the disease is limited to some studies reported from Delhi and adjoining states in North India, Assam in North East India, Mumbai and northern parts of Maharashtra in Western India, and Hyderabad and Pondicherry in South India (CBHI, 2011; Sharma et al, 2007; Dravid & Joshi, 2008; Nath & Mahanta, 2010; Sashikala et al, 2011)
Summary
After a progressive decline that continued until the year 2006, the incidence of diphtheria reached a plateau and has remained at 4000 to 5000 cases per year globally to date (WHO, 2012). The recent report of National Health Profiles released by the Government of India (CBHI, 2012) in 2012 showed that the number of Abbreviations: Abbreviations: ICMR, Indian Council of Medical Research; RMRC, Regional Medical Research Centre. Apart from one case report, the only information available on diphtheria from Karnataka, one of the largest states in South India, is from the National Health Profiles, whereby two, five, five and zero cases of diphtheria were reported from 2007 to 2010, respectively, with no death (CBHI, 2011). The region identified another eight suspects from seven more villages in the district before 2 December 2011 Five of these yielded toxigenic C. diphtheriae and the remaining three were culture-negative. Prompt reporting and epidemic preparedness, coupled with the availability of anti-diphtheritic serum and well informed health workers, helped identify cases quickly and prevent more deaths
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