Cases Of Diphtheria Research Articles

Hubungan Dukungan Keluarga dengan Kelengkapan Imunisasi Dasar Balita di Desa Mumbulsari

Immunization has proven to be one of the most important public health efforts. Immunization programs shown remarkable success funds are a very cost-effective effort in preventing infectious diseases. Immunization is influenced by several factors, including knowledge level, mother’s age, education level, occupation, number of children and family support. This aims to analyze the Relationship of Family Support with the completeness of Basic Immunization Balita in Village Mumbulsari of Sub-districts Mumbulsari - Jember. In 2015, East Java accounted for the largest diphtheria cases (63%) and has not met the target of SPM (Minimum Service Standards). According to the health profile of jember district 2014 Of 49 health centers, there are 4 other health centers that have not reached the target of UCI are Kalisat health center (92%), Pakusari (86%), Bangsalsari (86%) and Mumbulsari (75%). This research design use correctional with Cross Sectional approach.Population 90 mothers who have children under the age of two years.After slovin formula obtained 73 respondents as sample by using simple random sampling technique. The result showed Basic Immunization of complete 53 (73%) and Basic Immunization of incomplete 20(27%), good family support 58(79,5%), less family support 15 (20,5%). Data analysis test using Spearman Rank with p-value 0,000 <α 0,05 which means there is a Family Support Relationship with Basic Immunization Equipment Balita. It is recommended that the next community who have a child under two years give family good support to basic immunization for granting mothers complete.

RELATIONSHIP OF WORK STATUS WITH COMPLETENESS OF BASIC IMMUNIZATION IN INFANTS IN THE WORKING AREA OF THE PUSKESMAS BOTANIA

Background :In Indonesia experienced a very worrying Extraordinary Event (KLB), namely the incidence of Diphtheria. Diphtheria incidence in Indonesia has always fluctuated since the 1980s. In 2007 there were 183 cases of diphtheria which increased to 1,192 cases in 2012 and decreased incidence of diphtheria in 2013-2016 (Sariadji, 2017). And according to the Indonesian Pediatrician Association (IDAI), the diphtheria outbreak in Indonesia is the highest in the world. Diphtheria outbreaks occurred in 28 provinces and 142 districts / cities. So there has never been the most in the world and the coverage is 28 Provinces, "said the Chairman of the Indonesian Pediatrician Association, Aman Bhakti Pulungan, during a press conference at the IDI office Jalan Sam Ratulangi, Central Jakarta (Nugraha, 2017). As of November 2017, there were 20. provinces that have reported diphtheria with 593 cases and 32 deaths. Director General of Disease Prevention and Control Ministry of Health, Mohamad Subuh said, 66 percent of the total prevalence did not immunize. Then, 31 percent did immunization, but not until the final stage. To be free from diphtheria, at least the individual must get three times the immunization. Meanwhile, the remaining 3 percent has received complete immunization (Putra, 2017). The purpose of this study is the relationship between work status and completeness of basic immunization in infants. Method : quantitative with cross sectional approach. Research location Pus public health Botania. The population in this study were all live births in the Botania Community Health Center working area, namely 2184 people. This sampling technique uses purposive sampling method, data analysis uses bivariate data analysis with statistical tests, namely the Chi Square test using the SPSS program. Result : shows that out of 96 respondents the majority have a working status of work as many as 54 people (56.2%), majority were incomplete as many as 56 people (58.3%). Chi-square analysis results obtained p-value 0.000, which means p-value <0.05 so that Ho is rejected

Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study.

BackgroundUnrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox’s Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population.Methods and findingsData were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2–4.7) during the exponential growth phase. The median age was 10 years (range 0–85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown.ConclusionsTo our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.

Diphtheria: a re-emerging infectious disease

<p class="abstract"><strong>Background: </strong>Diphtheria is a fatal bacterial infection which affects the mucous membranes of oropharyngeal and nasal cavity, caused by aerobic gram-positive bacteria Corynebacterium diphtheriae. Clinical diphtheria is on the increase worldwide, mainly affecting developing countries and leading cause of morbidity and mortality. We sought to understand its presentation among patients and also early intervention of the disease. The objective of the study was to study the clinico-demographic profile of cases, the relationship between immunization status and clinical disease, the role of microbiological investigations and to identify complications in diphtheria cases.</p><p class="abstract"><strong>Methods:</strong> This study is a hospital based observational study from September 2019 - September 2020 at a tertiary care centre, S.Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka. The cases were analysed with respect to demographic details, clinical features, immunization status, microbiological confirmation and complications of diphtheria cases.</p><p class="abstract"><strong>Results: </strong>32 cases were suspected to have diphtheria on clinical examination. The mean age of presentation was 15 years. Fever, sore throat, difficulty in swallowing, neck swelling and pseudomembrane in oral cavity were the common signs and symptoms. Airway compromise, myocarditis and neurological complications were noted. Antidiphtheritic serum (ADS) was tried in all 32 cases and 8 cases had adverse reactions. Case fatality rate was 12.5%.</p><p class="abstract"><strong>Conclusions: </strong>Shifting of occurrence of diphtheria in the age group of >5 years suggest the need to improve and strengthen the immunization program specially the booster doses.</p>

Spatial Mapping of Diphtheria Vulnerability Level in East Java, Indonesia, using Analytical Hierarchy Process – Natural Break Classification

Diphtheria is a serious infectious disease induced by the Corynebacterium Diphtheriae bacteria and often causes outbreaks (extraordinary events) in various regions. Based on data from the Ministry of Health, East Java is the biggest benefactor to diphtheria cases in Indonesia. Diphtheria cases in East Java tend to increase, especially in 2018 there were 753 diphtheria cases in 38 districts. Efforts made to prevent, treat, and control diphtheria outbreaks by the government are to analyze the level of susceptibility to diphtheria. This paper proposes a new approach to analyze the level of diphtheria susceptibility using the analytical hierarchy process (AHP) and natural breaks classification in East Java Province, Indonesia. AHP method is used to obtain diphtheria susceptibility values based on seven criteria, such as the number of sufferers, number of deaths, DPT 1, DPT 2, DPT 3 immunization, population density, and humidity. Natural break classification is used to classify the vulnerability values from AHP into three levels of vulnerability, consisting of low, medium, and high. The results of the grouping are displayed in the form of spatial mapping in the form of a web-based geographic information system (web-GIS) on the determination of the diphtheria vulnerability level using the AHP-natural breaks classification. The GVF evaluation for 2016, 2017, and 2018 are respectively 0.66, 0.67, and 0.65 (more than 0.5), which means that the proposed method achieved accurate and significant classification. Spatial-temporal analysis for 2013-2018 also achieves accurate and significant with a GVF value of 0.77. The spatial-temporal analysis can predict the high potential for vulnerability.

Immunity against diphtheria among children aged 5–17 years in India, 2017–18: a cross-sectional, population-based serosurvey

Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India. We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural). 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035). The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine. Indian Council of Medical Research.

Diphtheria in an Adult: A Paradigm of Waning Immunity

In the past 10 years, there have been several reported cases of the existence of a vaccine-preventable disease from several Indian states. Diphtheria, re-emerge as a major public health problem as this fatal infection used to be noticed in toddlers and school-going has now been stated to occur amongst adults also despite the fully functional Universal Immunisation Program (UIP) in India. India contributed about 53.9% of diphtheria cases globally in the year 2016. In cases, the reason for the upsurge could be attributed to lack of proper immunisation or waning of vaccine-induced immunity with increasing age. Here, a case of a 24-year-old adult male was reported who presented with acute membranous tonsillitis, a preliminary diagnosis made on physical examination. Corynaebacterium diphtheriae was isolated. Finally, the isolate was confirmed as C. diphtheriae using Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) system.

Hubungan Tingkat Pengetahuan Ibu Tentang Imunisasi DPT Dengan Status Imunisasi Bayi Dalam Program Imunisasi DPT Di Desa Labulia Kecamatan Jonggat Kabupaten Lombok Tengah Tahun 2018

Imunisasi DPT adalah salah satu vaksinasi yang wajib diberikan kepada balita. Menurut World Health Organization (WHO), tercatat ada 7.097 kasus difteri yang dilaporkan di seluruh dunia pada tahun 2016. Diantara angka tersebut, Indonesia menempati urutan ke 2 setelah India dengan jumlah kasus difteri terbanyak. Untuk mengetahui hubungan tingkat pengetahuan ibu tentang imunisasi DPT dengan status imunisasi bayi dalam program imunisasi DPT di Desa Labulia Kecamatan Jonggat Kabupaten Lombok Tengah tahun 2018. Penelitian ini menggunakan Observasi Analitik dengan menggunakan pendekatan Cross Sectional. Populasi pada penelitian ini berjumlah 49 orang dan sampel menggunakan seluruh populasi. Penelitian ini menggunakan uji statistik Chi Square dan diperoleh nilai signifikan sebesar 0,000 (r < 0,05) yang berarti Ho ditolak dan H1 diterima. Terdapat hubungan yang signifikan antara tingkat pengetahuan ibu tentang imunisasi DPT dengan status imunisasi bayi dalam program imunisasi DPT di Desa Labulia Kecamatan Jonggat Kabupaten Lombok Tengah Tahun 2018. Supaya melakukan penelitian lebih lanjut dengan mempertimbangkan faktor-faktor lain yang dapat mempengaruhi status imunisasi dalam program imunisasi DPT secara kompleks dan menyeluruh.

Clinico epidemiological study of measles, pertussis, diphtheria and tetanus cases in a tertiary care hospital of western Rajasthan

Introduction: Vaccine preventable infectious diseases like measles, whooping cough, tetanus and diphtheria are very important causes of morbidity and mortality in the younger infants and children in developing countries. The present study was therefore planned to evaluate and elaborate the factors responsible for this scenario. Materials and Methods: The current study was carried out in the Department of Pediatrics, Umaid Hospital, Dr. S.N. Medical College, Jodhpur, over a period of 12 months. During this period admitted cases of measles, whooping cough, diphtheria and tetanus were included in the present study. The diagnosis of vaccine preventable disease was made on clinical ground and supportive laboratory evidence & complications of these diseases were also studied. Results: The incidence of vaccine preventable diseases was 1.63% amongst hospitalized cases during the study period. Incidences of measles, pertussis, tetanus and diphtheria were 0.85%, 0.47%, 0.15% and 0.14% respectively. Measles cases (52.40%) were highest in number amongst all vaccine preventable diseases. Pneumonia was the main respiratory complication in measles (82.44%) and pertussis cases (78.07%). The mortality rates of measles, pertussis & diphtheria were 6.8%, 2.73% and 13.63% respectively. Conclusion: There is still a very high incidence of vaccine preventable diseases despite multiple national programmes and ongoing stress on these and associated programmes. Reappraisal of immunization programs and strategies including effective control measures will ultimately help to eradicate the vaccine preventable diseases. Keywords: Infectious diseases, Preventable disease, Immunization and vaccination.

RECOMMENDATION OF DIPHTHERIA ANTITOXIN TO DIFFERENT SUSPECTS DURING THE DIPHTHERIA OUTBREAKS,LUMAJANG DISTRICT IN 2018

The number of diphtheria suspects in Lumajang district was the second highest in East Java province during the diphtheria outbreaks in 2018. The number of diphtheria cases was more than 500% in 2018 compared to 2017. To give diphtheria antitoxin (DAT), the provincial diphtheria expert team consider various suspects’ characteristics for DAT recommendation as DAT supplies are limited. This case report aimed to explore and describe the relationship between diphtheria suspects’ characteristics, including age, gender, symptoms, immunization status, duration of disease, and contact status with other suspects according to the DAT recommendations from the expert team. This case report was descriptive and used a cross-sectional approach. It was conductedduring the diphtheria outbreaks and involved total samples of all suspects. Based on age, the majority of the suspects (92%)were under 19 years old. Suspects at this age were the target of an outbreak response immunization (ORI) program. Those who were not targetted to receive ORI (aged over 19 years) began to appear in November and mostly in December. The trend of non-ORI targetted age increased after the third round of ORI implementation. According to the report form parents, most suspects (46.7%) had complete immunization status, and only 6.7% of their immunization records were reported on growth chart cards. All suspects with positive diphtheria never had and know routine immunization records. The laboratory tests show only 5% were suspected with positive diphtheria with a cultural type of mitis toxigenic. As many as 32% of the total suspects were recommended for DAT treatment. The use of controlled DAT could save 1,640,000 iU. Keywords: Diphtheria, outbreak response immunization, diphtheria antitoxin.

New decade, new response: Altering the public health response to toxigenic cutaneous diphtheria

Abstract Background Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population. Methods Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed. Results In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases. Conclusions This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease. Key messages Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.

Triage in the Time of Diphtheria.

IntroductionA diphtheria outbreak occurred in 2017 in Jakarta, Indonesia, during which our hospital was appointed as a referral hospital where patients with upper respiratory tract symptoms were sent for confirmation of the diagnosis and medical intervention. In this study we review the implementation of the emergency department (ED) triage process and patient flow management during the diphtheria outbreak. No previous study in Indonesia has provided a detailed report on the triage process during infectious disease outbreaks.MethodWe modified our pre-existing hospital triage method according to the “identify, isolate, and inform” principle. We developed novel criteria for triage to identify triage-suspected cases and also a diphtheria package to simplify the diagnostic process. Four separate rooms were modified to isolation spaces to enable medical staff to observe these patients. We obtained data from the ED outbreak registry and electronic health records.ResultsOf 60 cases of triage-suspected diphtheria, six were classified as suspected diphtheria. The mean time from “identify” to “isolate” was 3.5 minutes, and from “isolate” to “inform” was 10 minutes. Mean ED length of stay for probable diphtheria was 24.46 hours. No medical personnel in the ED showed any signs of diphtheria 30 days after the outbreak had abated.ConclusionThe modified criteria can help triage officers detect suspected diphtheria cases and measure the triage response time. Use of the diphtheria package and four separate rooms in the ED could act as an infection control procedure and facilitate the improvement of the diagnostic process.

Respiratory Illness Caused by Corynebacterium diphtheriae and C. ulcerans, and Use of Diphtheria Antitoxin in the United States, 1996–2018

Respiratory diphtheria is a toxin-mediated disease caused by Corynebacterium diphtheriae. Diphtheria-like illness, clinically indistinguishable from diphtheria, is caused by Corynebacterium ulcerans, a zoonotic bacterium that can also produce diphtheria toxin. In the United States, respiratory diphtheria is nationally notifiable: specimens from suspected cases are submitted to the Centers for Disease Control and Prevention (CDC) for species and toxin confirmation, and diphtheria antitoxin (DAT) is obtained from CDC for treatment. We summarize the epidemiology of respiratory diphtheria and diphtheria-like illness and describe DAT use during 1996-2018 in the United States. We described respiratory diphtheria cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and C. ulcerans-related diphtheria-like illness identified through specimen submissions to CDC during 1996-2018. We reviewed DAT requests from 1997 to 2018. From 1996 to 2018, 14 respiratory diphtheria cases were reported to NNDSS. Among these 14 cases, 1 was toxigenic and 3 were nontoxigenic C. diphtheriae by culture and Elek, 6 were culture-negative but polymerase chain reaction (PCR)-positive for diphtheria toxin gene, 1 was culture-positive without further testing, and the remaining 3 were either not tested or tested negative. Five cases of respiratory diphtheria-like illness caused by toxigenic C. ulcerans were identified. DAT was requested by healthcare providers for 151 suspected diphtheria cases between 1997 and 2018, with an average of 11 requests per year from 1997 to 2007, and 3 per year from 2008 to 2018. Respiratory diphtheria remains rare in the United States, and requests for DAT have declined. Incidental identification of C. ulcerans-related diphtheria-like illness suggests surveillance of this condition might be warranted.

Understanding COVID-19 Vaccines and Their Development.

Understanding COVID-19 Vaccines and Their Development.

Impact of a three-dose diphtheria outbreak response immunization in East Java, Indonesia, 6 months after completion

ABSTRACT Several outbreaks of diphtheria have occured in the East Java Province of Indonesia since 2011. The last effort to stop the outbreak in the province was a three round outbreak response immunization (ORI) in 2018.The aim of the this study was to evaluate the impact of the 2018 ORI in East Java province – 6 months following the completion of the program. Surveillance data was collected for 6 month period, from January to June 2019. The source of data was the district health offices, hospitals, community health centers, and private physician and paramedic practices. The data included demographic characteristics, involved health facilities, patient immunization history, clinical signs and symptoms, some laboratory test results and other additional examinations. All cases were evaluated by the East Java Provincial Diphtheria Expert Committee and not based on the individual physician decision. During the 6 month period, there were 97 diphtheria cases which approved by the Diphtheria Expert Committee. The reports came from 36 of 38 districts. One patient died, denoting a case fatality rate of 1%. The majority were 19 years of age or less, with uncomplete immunization. Patients above 19 years were 24%. Compared with 2017 (438 cases) and 2018 (310), 2019 saw a significant reduction in the number of reported cases. Only 4 positive culture results were collected (positivity rate 4,13%). Two patients had Mitis subtype and the other two had Gravis subtype. Diphtheria ORI in East Java had a significant impact during the first 6 months of 2019.

Factors Analysis Related to the Completeness of Providing Basic Immunization in Infant Aged 12 Months

Background: The highest number of children with incomplete immunizations in Indonesia is five provinces in Java. During 2015, diphtheria cases in Blitar District, East Java reached 44 cases. However, in 2016, there was an increase with the discovery of 49 infants affected by diphtheria and spread in several districts and obtained the number of 12-month-old infants who did not get complete immunizations of 47 infants. Aim: The purpose of this study analyzed the factors related to the completeness of basic immunization for 12-month-old infants. Method: This study was a quantitative study with cross sectional approach. The study was conducted on mothers who have 12-month-old infants by filling out the questionnaires about the relationship of independent variables, namely knowledge and attitudes of the mother, family support and health workers support as well as the dependent variable, namely the completeness of basic immunization. Total respondents were 46 people. Data were analyzed using the Chi Square test to determine the relationship between independent and dependent variables and logistic regression statistical tests to find out the dominant variables related to the completeness of basic immunization. Results: There was a relationship between maternal knowledge (p = 0,000), maternal attitudes (p = 0,000), family support (p = 0,000), and health workers support (p = 0,000) and the completion of basic immunization. The dominant factor related to the completeness of basic immunization was knowledge. Conclusion: Knowledge, attitude, family support, and health workers support have a significant relationship with the completion of basic immunization.

Cutaneous ulcers revealing diphtheria: A re-emerging disease imported from Indian Ocean countries?

IntroductionDiphtheria due to Corynebacteriumdiphtheriae (C. diphtheriae) has become rare in developed countries. In France only 10 cases of toxigenic diphtheria have been reported since 1989, in all cases causing pharyngitis and all emanating from endemic countries with exception of one contact case. We report herein 13 cases with cutaneous diphtheria, in 5 of which diphtheria toxin was produced, and all imported into France between 2015 and 2018. ObservationsThirteen patients aged 4 to 77 years presented painful and rapidly progressive round ulcerations of the legs, that were superficial and in some cases purulent, with an erythematous-purple border covered with greyish membrane. Bacteriological sampling of ulcers revealed the presence of C. diphtheriae. Only 6 patients had been properly immunized over the preceding 5 years. DiscussionThese cases underline the resurgence of cutaneous diphtheria and the circulation of toxigenic strains in France following importation from Indian Ocean countries. This may constitute an important reservoir for ongoing transmission of the disease. Re-emergence of this pathogen stems from the current migratory flow and decreased adult booster coverage. ConclusionCutaneous diphtheria should be considered in cases of rapidly developing painful skin ulcers with greyish membrane, especially among patients returning from endemic areas, regardless of their vaccination status. The clinician should order specific screening for C. diphtheriae from the bacteriologist, since with routine swabbing Corynebacteriaceae may be reported simply as normal skin flora. Vaccination protects against toxigenic manifestations but not against actual bacterial infection. Early recognition and treatment of cutaneous diphtheria and up-to-date vaccination are mandatory to avoid further transmission and spread of both cutaneous and pharyngeal diphtheria.

Toxigenic Corynebacterium ulcerans: re-emergence of a zoonotic infection

Diphtheria is a potentially life-threatening infection in humans. The three species capable of causing diphtheria are: Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis. Although UK cases are rare, recently there has been an increase in reported toxigenic C. ulceransassociated with companion animals. Potentially toxigenic corynebacteria are sent to the National Reference Laboratory, Public Health England (PHE), London, UK for species confirmation, determination of presence of the diphtheria toxin gene by real-time PCR, and confirmation of toxin expression by the Elek test. We reviewed submissions of C. ulcerans between January 2006 and November 2019. Fifty-three isolates of toxigenic C. ulcerans were received, 29 from humans and 24 from animals. The most common animal hosts were dogs (15) and cats (7), but isolates were also received from a horse and a captive rhinoceros. Multi-locus sequence typing (MLST) data were derived from whole genome sequencing. In three human cases, C. ulcerans was isolated from companion animals and in all three, typing data supported an epidemiological link between human and animal hosts. The sequence types (STs) for these linked isolates were ST331 (human and dog, human and cat) and ST551 (human and cat). Although MLST data are limited, the finding of the same ST (ST331) from canine and feline sources indicates that strains can be carried by both hosts. Management of diphtheria cases is an important public health issue. Typing data can support epidemiological linkage and identify possible sources, allowing the potential intervention and treatment of animals thus avoiding onward transmission.

Impact of COVID-19 pandemic on paediatric services at a referral centre in Pakistan: lessons from a low-income and middle-income country setting

The COVID-19 pandemic has disrupted health and health systems worldwide, and most countries have still not recovered from the immediate effects of the increased mortality and morbidity due to severe...

ESTIMASI PARAMETER REGRESI ZERO-INFLATED NEGATIVE BINOMIAL DENGAN METODE ALGORITMA EXPECTATION MAXIMIZATION (EM) (Studi Kasus: Penyakit Difteri di Jawa Barat Tahun 2016)

This study aims to determine the parameter estimation method of the ZINB model with the Expectation Maximization (EM) algorithm, and also to overcome the case of overdispersion caused by excess zeros in diphtheria cases in West Java in 2016 and to know the factors that significantly influence. Based on the results of the analysis, the factors that significantly influence the number of diphtheria cases in West Java Province in 2016 for the data count are the percentage of DPT immunization (X1), the percentage of residents who have access to safe drinking water (X3) and the percentage of TPM that meet sanitary hygiene requirements (X6). Whereas for zero-inflation data is the percentage of residents who have access to decent drinking water (X3), number of puskesmas (X5) and the percentage of TPM that meet sanitary hygiene requirements (X6).