Incidence Of Diphtheria Research Articles

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

DYNAMICS OF DIPHTHERIA INCIDENCE IN THE TRANSCARPATHIAN REGION OF UKRAINE IN THE VACCINATION ERA

The aim: Was to study the dynamics of the incidence of diphtheria in the Transcarpathian region of Ukraine. Materials and methods: A retrospective analysis of the data of the state statistical reporting of the Transcarpathian region on the incidence of diphtheria, the carriage of infection, vaccination coverage and the severity of diphtheria immunity was carried out. Conclusions: Low coverage of the population with vaccination against diphtheria, registration of an outbreak of diphtheria among international students of the region, and other regions of Ukraine in conditions of increased population migration, are alarming prognostic signs of the possible development of another significant epidemic rise of diphtheria morbidity in Transcarpathia.

Status Kelengkapan Imunisasi Difteri Pada Kejadian Difteri Di Wilayah Surabaya

One of the diseases of Extraordinary Events in East Java Province is diphtheria disease. Diphtheria is an acute infectious disease of the upper respiratory tract in the system caused by the bacterium Corynebacterium Diphtheria. One of the factors that may affect the incidence of diphtheria is an incomplete immunization status. The purpose of this research is to analyze the relationship status of the completeness of immunization with diphtheria incidence in the region of Surabaya. Design research Analytic approach with Cross-Sectional Correlation. The independent variable complete immunization status of diphtheria and dependent variable is diphtheria occurrence. The population of the research was as many as 29 people who suffered from diphtheria in 2017 and sample as many as 27 people who suffered from diphtheria in 2017in the city of Surabaya. Using a technique Simple Random sampling. The instruments of research using questionnaires, observation secondary data: laboratory results and sheet book KMSfor incomplete immunization status data and diphtheria incidence, tested use the spearman rho correlation. Statistical results with Spearman Rho Correlations test obtained ρ = 0.03 with ρ ≤ 0.05. It states that H0 is rejected H1 accepted as well as the result of correlation coefficient – 0.411. This shows the existence of the relationship between complete immunization status of diphtheria with diphtheria occurrence in the region of Surabaya. The implications of this research show that the diphtheria immunization incompleteness affects the incidence of diphtheria. Expected health workers can better do health promotion about the importance of immunization and prevention of diphtheria transmission, registration, and grant of immunization in the community.Keywords: Diphtheria, Immunization, Surabaya

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.

Spatial distribution of vaccine-preventable diseases in central Iran in 2015–2018: A GIS-based study

Vaccination is the second most effective health measure to maintain public health and prevent diseases after providing safe drinking water. This study aimed to determine the geographical distribution of vaccine-preventable diseases (VPDs) in Qom Province in four years (2015–2018) using Geographic Information System (GIS). In this cross-sectional study, the indicators of VPDs surveillance were extracted from the VPDs surveillance system at the Centers for Disease Control and Prevention (CDC) in Qom University of Medical Sciences. They were further evaluated, and the incidences of VPDs in the study years were investigated. Finally, the spatial distribution map of VPDs was provided for surveillance quality in each Qom district by Arc GIS 10.3 software. The annual incidence rate (AIR) was estimated to be 18.47 for hepatitis B, 0.29 for measles, 0.13 for rubella, 0.09 for pertussis, 0.29 for diphtheria and 0.91 for acute flaccid paralysis (AFP). The highest incidences of AFP, rubella and measles were observed in Markazi district. Salafchegan was a district with the highest incidence of diphtheria, and the highest incidence rate of hepatitis B was observed in Khalajestan district. In addition, all pertussis cases were reported from Qom city. According to thematic maps of GIS, the annual incidence rate of VPDs in Qom Province was lower than the mean rate in Iran. Nevertheless, it is highly recommended that a high immunization coverage should be done in the childhood and good surveillance indicators such as non-disease discarded rate, and the proportion of suspected cases with an adequate investigation should be used to monitor VPDs.

Analisis Perilaku Ibu Berstatus Mahasiswi Pasca Sarjana Kesehatan Masyarakat Universitas Indonesia (Fkmui) Terhadap Pemberian Imunisasi Anak

Imunisasi merupakan salah satu pencapaian terbesar dalam program kesehatan masyarakat yang terbukti signifikan menurunkan insiden penyakit. Tujuan penelitian untuk mengetahui analisis perilaku ibu berstatus Mahasiswi Pasca Sarjana Kesehatan Masyarakat Universitas Indonesia (FKMUI) terhadap pemberian imunisasi anak. Metode kualitatif pendekatan Rapid Assessment Procedure (RAP) berlokasi di FKMUI. Pemilihan informan menggunakan purposive sampling dengan prinsip kesesuaian (appropriateness) dan kecukupan (adequacy). Pengumpulan data dengan Focus Group Discussion (FGD) 2 kelompok masing-masing terdiri dari 6 mahasiswi pascasarjana FKM UI yang memiliki balita yang diimunisasi lengkap. Wawancara mendalam oleh mahasiswi pascasarjana yang memberikan imunisasi tidak lengkap, dan yang tidak memberikan imunisasi serta Pegawai Kementerian Kesehatan Subdit Imunisasi Ditjen P2P sebagai triangulasi sumber. Hasil penelitian menyebutkan sebagian besar informan mempunyai pengetahuan yang baik, sikap yang positif. Seluruh informan sepakat media informasi penting untuk keberhasilan program imunisasi terutama untuk menangkis isu ataupun hoax seputar imunisasi. Sebagian besar informan mendapatkan dukungan dari keluarga untuk memberikan imunisasi anaknya sehingga status imunisasi anak lengkap, namun ada informan yang tidak mendapatkan dukungan keluarga terdekat yaitu suami, hal ini membuat status imunisasi anaknya tidak lengkap. Dukungan keluarga dan media elektronik memiliki pengaruh besar dalam memotivasi ibu untuk memberi imunnisasi kepada anaknya. Disarankan untuk lebih berhati hati dalam memilah informasi yang masuk agar kesehatan anak dan lingkungan tetap terjaga dengan baik

Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules.

The World Health Organization (WHO) does not recommend routine adult booster vaccination for tetanus and diphtheria after completion of the childhood vaccination series. However, many countries continue to implement adult booster vaccinations, leading to the question of whether this is necessary to reduce the incidence of these 2 rare diseases. We conducted an observational cohort study based on WHO case reports from 2001 through 2016. We compared the incidence of tetanus and diphtheria in 31 North American and European countries that either do or do not recommend adult booster vaccination. Countries that vaccinate adults every 5-20 years (group 1) were compared with countries that do not routinely vaccinate adults for tetanus or diphtheria (group 2). Comparison of group 1 vs group 2 revealed no significant decline in tetanus incidence rates among countries that vaccinate adults (P = .52; risk ratio [RR] = 0.78; 95% confidence interval [CI], .36 to 1.70). The risk of contracting diphtheria was increased among countries that vaccinate adults due to inclusion of Latvia, a country that had poor vaccination coverage (P < .001). However, if Latvia is excluded, there is no difference in diphtheria incidence between countries that do or do not routinely vaccinate adults (P = .26; RR = 2.46; 95% CI, .54 to 11.23). Review of >11 billion person-years of incidence data revealed no benefit associated with performing adult booster vaccinations against tetanus or diphtheria. Similar to other vaccines, this analysis supports the WHO position on adult booster vaccination and, if approved by governing health authorities, this may allow more countries to focus healthcare resources on vulnerable and undervaccinated populations.

The Effect of Diphtheria AntiToxin (DAT) to Decrease Degrees of Diphtheria Severity

Background: Diphtheria incidence and mortality in Indonesia continue to increase from 2014-2017. DAT is critical to reduce the severity of diphtheria. The study aimed to determine the effect of DAT on reducing severity in diphtheria patients. Method: Analytical research with a case-control design. The research was conducted at RSPI Prof. Dr. Sulianti Saroso. The sample in this study was patients diagnosed with suspected diphtheria and diphtheria who received inpatient care at RSPI SS within a period of four years from 2014 to 2017. The cases in this study were 86 diphtheria-treated patients who were treated for 86 days, controls were 86 diphtheria-treated patients who were treated for &lt;10 days. Data were collected from medical records. Results: the variable associated with a decrease in severity of diphtheria sufferers was DAT (OR = 4,063; 95% CI: 1,354- 12,195, p = 0.012), corticosteroid administration (OR = 3,653, 95% CI 1.568-8,513, p = 0.003) and culture (OR = 0.170; 95% CI: 0.054-0,547), myocarditis is a confounding variable (OR = 1,690; 95% CI: 0.565- 5,052, p = 0.348). Conclusion: Provision of DAT has been shown to affect decreasing the severity of diphtheria.

Incidence of Diphtheria among Clinically Probable Cases in a Tertiary Care Centre- A Prospective Study

Introduction: Diphtheria is a vaccine preventable communicable acute infectious disease of upper respiratory tract caused by Corynebacterium diphtheriae (C. diphtheria) which is endemic in India. Delayed diagnosis of the disease leads to spread of infection in the community and causes increased morbidity and mortality in the affected individuals. To reduce the delay, an early attempt for microbiological diagnosis of diphtheria should be done as it is crucial and complimentary to clinical diagnosis. Aim: To know the prevalent toxin producing biotypes of Corynebacterium among the clinically probable cases of diphtheria. Materials and Methods: Throat swab samples from 300 clinical cases of diphtheria were processed by direct microscopy and culture. Microscopic examination was done by direct throat swab and samples were inoculated in Loeffler’s Serum Slope (LSS). Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method. Results were analysed using MS Excel. Results: Out of 300 samples, presumptive diagnosis of diphtheria by microscopic examination of direct throat swab was 3% and swab inoculated in LSS was 10%. Confirmed cases of diphtheria by culture were 48 (16%). A 100% sensitivity was seen for all antibiotics tested for all 48 isolates in antimicrobial susceptibility testing. Conclusion: A shift in the age wise incidence of the disease from pre-school to school age has been observed with more cases reported. C. diphtheriae gravis was the highly prevalent strain isolated. Culture should be considered as confirmatory method for diagnosis.

Epidemiological Investigation in Diphtheria Control in Banda Aceh, Indonesia

Background: Extraordinary events (KLB) diph­theria are still found in the city of Banda Aceh. An action is needed to break the chain of diph­theria cases and reduce the number of diphtheria mor­bidity or mortality, one of which is by con­ducting an epidemiological investiga-tion of diph­theria. This study aims to see how the implementation of diphtheria epidemiology investigations in the city of Banda Aceh and how it relates to the presence of diphtheria cases in the city of Banda Aceh. Subjects and Method: This was a qua­­li­ta­tive multiplecase study. Data were collect­ed by con­ducting interviews with doctors in five sample com­munity health center in Ban­da Aceh City. Community health centers were se­lect­­ed by pur­posive sampling based on primary data regard­ing the distribution of diphthe­ria during 2017 and 2018 in Banda Aceh City. This study combined source tri-angulation. The source triangulation infor­mant is surveil­lance who serv­ed in the Banda Aceh City Health Service. Results: The epidemiological investigation effort at the puskesmas began by immediately send­ing a diphtheria fast-moving team to carry out a chronological-related survey of cases and collect data on close contacts in the case envi­ron­ment. In close contact data collection there are com­munity health center that do not record com­plete close contact so prophylaxis cannot cover all close contacts. The stage of exa­mi­na­tion of throat or nose specimens for close con­tact is also not carried out in some com­munity health center. Conclusion: Epidemiological investigations play an important role in breaking the chain of diph­­theria distribution. Skipping stages in epidemiological investigations can provide a gap for the development of diphtheria in the case envi­ronment. Puskesmas that carry out a com­­plete stage of epidemiological investigation are proven to be able to eradicate the incidence of diphtheria in their working area. Keyword s : diphtheria, surveillance, epidemio­logy investigation Correspondence: Zahratul Aini. Masters Program in Family Medi­cine, Universitas Sebelas Maret, Jl. Ir. Su­tami 36A, Surakarta 57126, Central Java. E­mail: dr.­zahratulaini@gmail.com. Mobile: +62­8­­1360003­747. Journal of Epidemiology and Public Health (2020), 05(02): 141-149 https://doi.org/10.26911/jepublichealth.2020.05.02.02

Corynebacterium Diphtheriae: A Case Report of Some Isolates in National Ear Care Centre Kaduna

This is a case study of the incidence of diphtheria in National Ear Care Centre Kaduna. Samples included all patients presented with diphtheria symptoms referred to the hospital from October to December; 2018. A total of 8 patients were referred and several samples taken for laboratory investigations. 8 throat swabs were collected for organism isolation by inoculation on some certain agars, incubation, secondary gram and microscopy; colonies appeared to be biconcave, large and whitish. Microscopy revealed characteristic Chinese lettered, pleomorphic bacillus which are features of Corynebacterium diphtheriae. Blood samples were used for urea and creatinine estimation which yielded abnormal high values in all except the creatinine of one of the samples indicating kidney impairment which could be attributed to presence of the tox gene. To further confirm the incidence of the disease; one throat swab was saved at 4°C for molecular confirmation and characterisation of the gene. It was then transported to Molecular laboratory and the DNA extracted using the phenol/chloroform extraction method. Both the A and B subunits of the tox gene were amplified from the DNA extract at 248bp and 297bp respectively. Sanger’s Dye Terminator Cycle Sequencing (DTCS) of both the subunits of the tox gene was carried out and the sequences were obtained and converted to the fasta format using a Finch TV for bioinformatics analyses using the NCBI blast tool. The A and B subunits showed a percentage identity of 99.59% and 95.57% to Corynebacterium diphtheriae mitis strain NCTC 3529 genome assembly, chromosome: 1 respectively. The A subunit also showed 99.59% identity to Corynebacterium diphtheriae strain BQ11 chromosome; complete genome while the B subunit also showed 95.57% identity to Corynebacterium diphtheriae mitis strain NCTC 7838 genome assembly chromosome: 1. A mutation was also discovered in the tox genes as indicated by the E-value of 3e-84 and 2e-121 for A and B subunits respectively which are values that are less than 1. This is also confirmed by 5 gaps noticed from the blast results (4 gaps from A and 1 from B) indicating the presence of indels. In conclusion; there are confirmed incidences and sporadic cases of diphtheria in Kaduna State and the organism is said to have mutated.

Global Epidemiology of Diphtheria, 2000-20171.

In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria–tetanus–pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.

EPIDEMIOLOGY CHARACTERISTICS AND IMMUNIZATION STATUS OF DIPHTHERIA PATIENTS IN EAST JAVA PROVINCE IN 2018

Background: East Java Province is the region with the highest incidence of diphtheria in Indonesia. In the past three years, the number of diphtheria cases amounted to 758 cases and resulted in three mortalities. Objective: This study aims to describe the epidemiological characteristics and diphtheria immunization status of patients in East Java province in 2018. Methods: This study employed descriptive research with cross-sectional design. This study utilized secondary data of publication profiles from the East Java Provincial Health Office in 2018. The population was the entire diphtheria patients in East Java province, 2018. The samples were taken by using the total population sampling technique. The variables in this study were epidemiological characteristic and immunization status of diphtheria patients. The data analysis employed a univariate analysis by providing the frequency table. Results: Based on the records, diphtheria infected the children more often but, in 2018, it was also found in adults. This circumstance is proven by the findings that the patients were aged ≥19 years (33.11%) and were males (50.60%). In 2018, diphtheria patients number experienced an increase and decrease fluctuatingly as well as quite prevalence in some areas in the province of East Java. Diphtheria patients were predominanted by incomplete immunization status and unimmunized patients. Conclusion: The completeness status of diphtheria immunization has a very important role in the incidence of diphtheria cases in East Java Province in 2018, particularly the status of patients who is not complete and unimmunized.

Diphtheria in Belgium: 2010-2017.

In Western Europe, the incidence of both respiratory and cutaneous diphtheria, caused by toxin-producing Corynebacterium diphtheriae, Corynebacterium ulcerans or Corynebacterium pseudotuberculosis, has been low over the past few decades thanks to the use of an effective vaccine and a high level of vaccination coverage. However, the disease has still not been eradicated and continues to occur in all of Europe. In order to prevent sequelae or a fatal outcome, diphtheria antitoxin (DAT) should be administered to suspected diphtheria patients as soon as possible, but economic factors and issues concerning regulations have led to poor availability of DAT in many countries. The European Centre for Disease Prevention and Control and World Health Organization have called for European Union-wide solutions to this DAT-shortage. In order to illustrate the importance of these efforts and underline the need for continued diphtheria surveillance, we present data on all registered cases of toxigenic and non-toxigenic C. diphtheriae, C. ulcerans and C. pseudotuberculosis in Belgium during the past decade, up to and including 2017.

Association for Percentage of DPT Immunization Against Incidence of Diphtheria in West Java province 2017 with spatial analysis

Association for Percentage of DPT Immunization Against Incidence of Diphtheria in West Java province 2017 with spatial analysis

ANALISIS PERILAKU IBU BERSTATUS MAHASISWI PASCA SARJANA KESEHATAN MASYARAKAT UNIVERSITAS INDONESIA (FKMUI) TERHADAP PEMBERIAN IMUNISASI ANAK

ABSTRACTImmunization has been considered one of the greatest achievements in public health programs and with immunization a number of diseases can be reduced such as eradicating smallpox, eradicating polio, and significant progress in reducing the incidence of diphtheria, tetanus, whooping cough and measles (1). Right now immunization at the global level is stagnant at 86%. It is estimated that around 19.5 million children worldwide do not receive basic immunization (2). In Indonesia, an estimated 1.9 million children under 1 year were not fully immunized in 2015 (3) and as many as 242135 children were not immunized in 2016. To find out the Mother’s Behavior As A Public Health Postgraduate Student Of University Of Indonesia On Giving Children’s Immunization. This study used a qualitative method using the Rapid Assessment Procedure (RAP) approach located in the University of Indonesia's Public Health Faculty . The informant selection technique uses purposive sampling with the principle of appropriateness and adequacy. Data collection method is with Focus Group Discussion (FGD) 2 groups with each consisting of 6 postgraduate students from University of Indonesia's Public Health Faculty who have fully immunized. As triangulation source, interview conducted with postgraduate students who provide incomplete immunizations, postgraduate students who do not provide immunizations, and staff of the Ministry of Health, Immunization Directorate General of P2P. Nearly all informants had good knowledge, positive attitudes towards immunization is that only a small percentage of informants refused immunization. All informants agreed that media information is important for the success of immunization programs, especially to prevent issues or hoaxes about immunization. Most of the informants received support from their families to give their children immunizations so that the status of immunization for children was complete, but there were informants who did not get the support of their closest family wich is the husband, which made their child's immunization status incomplete. But family support and electronic media have a big influence in motivating mothers to immunize their children. It is recommended to be more careful in sorting the information so that children's and the environment health are maintained properly.Keywords : Immunization behavior, child immunization, mother's education

Analysis of dynamics of intensity of community immunity to diphtheria in different age groups of vaccinated population of the ryazan region in 2015-2017

Aim. To study the level of anti-diphtheria antitoxic antibodies in blood serum of vaccinated individuals over the period of 2015-2017.&#x0D; Materials and Methods. The study was conducted on the base of the Center of Hygiene and Epidemiology of the Ryazan region. The evaluation of antitoxic immunity against diphtheria was performed on the basis of the results of annual serological examination of at least 100 samples of blood sera for the content of diphtheria antitoxin in each age indicator group. In the study reaction of passive hem agglutination was used with standardized erythrocyte diphtheria antigen. Blood serum samples of individuals of indicator groups of the population with a documented history of vaccination were investigated. On the basis of the results of serological monitoring, the analysis of the state of anti-diphtheria antitoxic immunity in children (3-4 years, n=300), teenagers (16-17 years, n=302) and adults (30-39 years, n=323; 40-49 years, n=305) of the Ryazan region in 2015-2017 was carried out.&#x0D; Results. The level of protection among children, teenagers and adults in the studied period was 97.0 and 95.6%. The intensity of anti-diphtheria immunity was also high: 93.3-95.6% of the examined persons had medium and high antibody titers. Protective level of anti-diphtheria antibodies in 2015 was revealed in 97.3%, in 2016 in 93.3% and in 2017 in 98.3% of the examined samples.&#x0D; Conclusion. Analysis of the results of serological monitoring showed a positive dynamics of growth of the number of seropositive individuals with intense anti-diphtheria immunity. The data of serological monitoring correspond to the official statistical data of Directorate of Rospotrebnadzor in the Ryazan region on the high level of coverage of the population with vaccination. According to previously published epidemiological studies, in such conditions the incidence of diphtheria in the population is sporadic.

Clinical spectrum and outcomes of pediatric diphtheria

Background Although vaccination programs have succeeded in reducing the incidence of diphtheria, it remains a health problem in Asia, including Indonesia.&#x0D; Objective To investigate the clinical spectrum and outcomes of pediatric diphtheria in Wahidin Sudirohusodo Hospital.&#x0D; Methods This study was a retrospective review of childhood diphtheria medical records from January 2011 to December 2017 in Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Recorded data consisted of age, gender, nutritional and immunization statuses, signs and symptoms, throat swab culture results, complications, and outcomes. &#x0D; Results Of 28 subjects aged 9 months to 17.10 years, the majority were &gt;5 years (57.1%) and male (60.7%). Subjects’ mean age was 6.15 years and 82.1% of cases were well nourished. Overall, 85.7% had received complete immunizations, while 14.3% were not immunized, having received neither basic nor booster vaccines. The presenting manifestations were fever, pseudomembranes, and sore throat in all subjects, enlarged tonsils (78.57%), dysphagia (67.86%), cough (57.14%), headache (57.14%), hoarseness (67.86%), bull neck (25%), and myocarditis (14.3%). Most subjects had hospital stays of &gt;10 days (67.9%). Mortality was 14.3%, usually in those admitted with a late, deteriorating condition and dying before getting optimal treatment. Poor outcome was significantly associated with the lack of basic or booster immunizations, poor nourishment, bull neck, myocarditis, and hospital stays &lt; 5 days (P&lt;0.05 for all). &#x0D; Conclusion The clinical spectrum and outcomes of pediatric diphtheria in this study are relatively similar to reports from other hospitals. Mortality was mostly in patients who lack basic or booster immunizations, are poorly nourished, or have bull neck, myocarditis, or hospital stays &lt; 5 days.

Epidemiology of diphtheria and antimicrobial resistance among diphtheria cases, Bijapur district, Karnataka, India, 2012 to 2015

Purpose: India contributes to 80% of diphtheria cases. There were 177 deaths due to diphtheria in 2010. Many diphtheria outbreaks were reported from Bijapur district of Karnataka state, India. Analysis of burden and drug sensitivity pattern might help to identify risk groups and to provide guidelines for treatment of diphtheria cases. Our objectives were to describe the epidemiology of diphtheria and drug susceptibility among diphtheria cases in Bijapur district. Methods & Materials: We did a cross-sectional study between 2012 and 2015. We defined a probable case as inflammation of upper respiratory tract with adherent membranes. We defined a confirmed case as a probable case that was laboratory confirmed by throat culture. We collected line list of probable and confirmed diphtheria cases, population details in Bijapur district and antibiotic sensitivity of culture reports. We calculated attack rates and case fatality rate by taluks of Bijapur district. We calculated proportion of antibiotic resistance among lab confirmed cases. Results: There were 229 probable cases and 26 confirmed cases of diphtheria. Attack rate was 110/ million and case fatality rate was 2% (5/255). Median age of males was 5 years (range: 3 months to 18 years) and females was 6 years (range: 1 year to 18 years). Highest attack rate (290/million) was in Bagewadi taluk, followed by Sindagi taluk (130/ million). Attack rate in Bijapur, Indi and Muddebihal were 80, 80 and 70 per million respectively. Incidence of diphtheria cases was 3/million in 2012, 15/million in 2013, 80/million in 2014 and 14/million in 2015. Penicillin resistance was found among 92% (24/26) of cases, cotrimaxozole resistance among 27% cases (7/26) and ampicillin resistance among 15% cases (4/26)}. Multidrug resistance for penicillin and cotrimoxazole was found among 23% (6/26) of cases. Multidrug resistance to penicillin and ampicillin was found among 15%(4/26) of cases). All cases were sensitive to azithromycin, erythromycin, doxycycline, clindamycin, ciprofloxacin, cefotaxime, gentamycin and tetracycline. Conclusion: Diphtheria incidence increased between 2012 and 2014, but reduced after 2014 in Bijapur. Penicillin resistance was common. We recommend sensitising health workers about penicillin resistance and educating them not to use penicillin. We recommend estimating vaccine coverage and vaccine effectiveness.

FAKTOR-FAKTOR RISIKO YANG BERHUBUNGAN DENGAN KEJADIAN LUAR BIASA DIFTERI DI NEGARA BERKEMBANG

Latar Belakang: Difteri adalah salah satu penyakit yang dapat dicegah oleh vaksin. Namun dalam sepuluhtahun terakhir dilaporkan terjadi peningkatan insiden difteri yang memicu terjadinya kejadian luar biasa dinegara berkembang. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengantingginya insiden difteri di negara berkembang.Metode: Metode penelitian yang digunakan yaitu Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA). Literatur yang sesuai ditelusuri dari database elektronik Pubmed, Proquest,Science Direct, Scopus, and EBSCO. Kriteria inklusi yang digunakan yaitu kasus terjadi di negaraberkembang, hasil penelitian berhubungan dengan faktor risiko terkait kejadian luar biasa difteri, dan desainstudi penelitian adalah studi observasional.Hasil Penelitian: Diperoleh 10 artikel penelitian yang berlokasi di India, Thailand, Lao PDR, Brazil,Dominican Republic, South Africa, dan Nigeria. Cakupan vaksinasi yang rendah, status vaksinasi tidaklengkap atau tidak di vaksinasi sama sekali serta akses yang buruk ke layanan perawatan kesehatan merupakanfaktor utama yang terkait langsung dengan terjadinya kejadian luar biasa difteri di sebagian besar negara.Faktor sistem pelayanan kesehatan seperti ketersediaan anti-toksin Difteri serta kemampuan tenaga kesehatandalam diagnosis dini dan penanganan segera juga memainkan peran penting dalam mengendalikan kejadianluar biasa Difteri. Hasil studi juga menyoroti peningkatan risiko infeksi pada orang dewasa karenamemudarnya tingkat antibodi di masa dewasa.Kesimpulan: Rendahnya cakupan imunisasi, sulitnya akses pada pelayanan imunisasi, dan rendahnya tingkatpendapatan merupakan faktor yang memicu timbulnya kejadian luar biasa difteri di negara berkembang.Penguatan surveilans dan sistem pelayanan kesehatan sangat diperlukan untuk mengatasi kejadian luar biasadifteri.Kata kunci: Kejadian luar biasa, difteri, vaksinasi, faktor risiko