Abstract
BackgroundWar in Yemen started three years ago, and continues unabated with a steadily rising number of direct and indirect victims thus leaving the majority of Yemen’s population in dire need of humanitarian assistance. The conflict adversely affects basic socioeconomic and health conditions across the country.MethodsThis study analyzed the recent ongoing diphtheria outbreak in Yemen and in particular, the health system’s failure to ensure immunization coverage and respond to this outbreak. Data from the weekly bulletins of the national electronic Disease Early Warning System’s (eDEWS) daily diphtheria reports and district immunization coverage were analyzed. The number of diphtheria cases and deaths, and immunization coverage (DPT) were reviewed by district including the degree to which a district was affected by conflict using a simple scoring system. A logistic regression and bivariate correlation were applied using the annual immunization coverage per district to determine if there was an association between diphtheria, immunization coverage and conflict.ResultsThe study results confirm the association between the increasing cases of diphtheria, immunization coverage and ongoing conflict. A total of 1294 probable cases of diphtheria were reported from 177 districts with an overall case fatality rate of 5.6%. Approximately 65% of the patients were children under 15 years, and 46% of the cases had never been vaccinated against diphtheria. The risk of an outbreak increased by 11-fold if the district was experiencing ongoing conflict p < 0.05. In the presence of conflict (whether past or ongoing), the risk of an outbreak decreased by 0.98 if immunization coverage was high p > 0.05.ConclusionThe conflict is continuously devastating the health system in Yemen with serious consequences on morbidity and mortality. Therefore, the humanitarian response should focus on strengthening health services including routine immunization procedures to avoid further outbreaks of life-threatening infectious diseases, such as diphtheria.
Highlights
Diphtheria is a life-threatening bacterial disease caused by Corynebacterium diphtheria, a non-encapsulated gram-positive bacillus
A diphtheria outbreak was announced on 29 October 2017 by the Ministry of public Health and population and World Health Organization (WHO) in Yemen
A total of 73 deaths were reported in all governorates, which resulted in an overall case fatality rate (CFR) of 5.6%
Summary
Diphtheria is a life-threatening bacterial disease caused by Corynebacterium diphtheria, a non-encapsulated gram-positive bacillus. It is transmitted through close respiratory contact, causes airway obstruction due to nasopharyngeal infection, and may spread to other organs [1,2,3]. Diphtheria is a vaccine-preventable disease, which was largely eliminated in industrialized countries decades. Diphtheria remains a problem in a number of low-income countries with poor immunization coverage. Bangladesh experienced recently an outbreak in a large refugee camp for the Rohinga in 2017 [7]. Dureab et al Conflict and Health (2019) 13:19. The conflict adversely affects basic socioeconomic and health conditions across the country
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
