Abstract
BackgroundDiphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. As a consequence of war and collapse of the health system, a fatal epidemic occurred at the end of 2017. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children.MethodsA study was conducted in Sada'a governorate by using accumulative line list of diphtheria from November 2017 to September 2020 at electronic Integrated Disease Early Warning System (eIDEWS). The case definition of WHO was adopted. Data was analyzed by Microsoft Excel and Epi info- version 7.2 and multivariable logistic analysis used for identifying significant associated factors.Results747 cases were met of WHO case definition. The annual peak of cases started during week 31 and weak 49. Males were slightly more than females (51% vs 49%) and about 35% of cases involved children aged 10 to < 15 years. The overall incidence of diphtheria and case fatality rate (CFR) were 69/ 100,000 and 6.4%, respectively. The highest CFR was among age groups under 5 years 11% (P < 0.001) and among females was 8%. Dysphagia and swollen lymph nodes were the predominant symptoms 98%, 92%, respectively. Based on the Vaccination status, the percentage of unvaccinated and unknown were 53% and 41% respectively, with CFR 11% among cases who received one dose. Furthermore, the most case were from Sahar 40% with case fatality rate 8% and the highest CFR was significantly higher among cases in border and ongoing conflict district (P < 0.05).ConclusionsThe findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada'a that is rising with the low diphtheria immunization coverage. Therefore, concomitant efforts should now focus on improving and monitoring routine immunization across all age groups and healthcare services, especially in borders and continuing conflict districts.
Highlights
Diphtheria is a highly contagious bacterial disease of upper respiratory tract and caused by Corynebacterium diphtheriae
The findings highlight that diphtheria is still an ongoing cause of morbidity and mortality among under 5 children in Sada’a that is rising with the low diphtheria immunization coverage
This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children
Summary
Diphtheria is a highly contagious bacterial disease of upper respiratory tract and caused by Corynebacterium diphtheriae. It is a vaccine-preventable disease which transmitted by direct contact with droplets from an. Diphtheria remains a health problem in different countries with weak vaccination coverage or pockets of unimmunized. A number of diphtheria outbreaks have been reported from different regions in Europe [3], Southeast Asia, America [4], and Africa [5] and the risk increases among children who are unvaccinated or partially vaccinated [6]. Diphtheria is a contagious vaccine-preventable disease that contributes to the high morbidity and mortality among under 5 children, especially in Yemen. This study aims to describe the epidemiology of diphtheria by time, place, and person and vaccination status of affected children
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