Describing the burden of diphtheria in Canada from 2006 to 2017, using hospital administrative data and reportable disease data

Lin, Dolly; Fane, Brigitte Ho Mi; Squires, Susan G; Dickson, Catherine

doi:10.14745/ccdr.v47i10a03

Cited by 3 publications

References 11 publications

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Over a Century of Infectious Disease Surveillance in Canada: Introducing the Canadian Disease Incidence Dataset (CANDID)

Earn,

MacKinnon,

Manzin

et al. 2024

Preprint

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BackgroundCanadian notifiable disease surveillance provides data on the incidence of communicable diseases, dating back to the late 19th century. The Public Health Agency of Canada offers summaries of these data (from 1924–2022) through an online portal. These summaries provide historical context for Canadian health researchers, but lack information on intra-annual and inter-provincial patterns. Sub-annual and sub-national data can be found in published documents, or requested from archives of government agencies, but are only available in typewritten or handwritten hard copies. We digitized and collated these data sources to create a resource for epidemiology and public health.MethodsWe manually entered data from scans of hard copies into spreadsheets resembling the originals, facilitating accurate transcription through easier cross-checking. We developed open-source pipelines to harmonize these spreadsheets into CSV files that blend data across sources.ResultsWe assembled and processed 1,631,380 incidence values from 1903–2021. Focusing on sub-annual and sub-national data and removing redundancy yielded 934,009 weekly, monthly, or quarterly incidence values broken down by province/territory, containing 139 diseases. We give two examples of sub-annual and sub-national patterns: strong annual cycles of poliomyelitis that peaked simultaneously across provinces, and spatially heterogeneous resurgence of whooping cough in the 1990s.InterpretationCanada’s history of infectious disease surveillance has produced a detailed record of sub-annual and sub-national disease incidence patterns that remains largely unexplored. This important record is now available as the Canadian Disease Incidence Dataset (CANDID), hosted on a publicly accessible website along with the pipelines used to create it and scans of the original sources.

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Over a Century of Infectious Disease Surveillance in Canada: Introducing the Canadian Disease Incidence Dataset (CANDID)

Earn,

MacKinnon,

Manzin

et al. 2024

Preprint

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Epidemiology of Diphtheria and Predictors of Outcome in Nigeria: A Single-Center Study from July 2023 to April 2024

Alege,

Ibrahim,

Ibraheem

et al. 2024

Preprint

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Background: Despite recurrent outbreaks of diphtheria in Nigeria, there is a lack of in-depth analysis of hospitalization outcomes. Herein, we describe the sociodemographic, clinical, and laboratory features that were associated with hospitalization outcomes (defined as death or discharge) during the recent diphtheria outbreak in Nigeria. Methods This prospective observational study included 246 diphtheria cases managed in a dedicated isolation ward of a health facility in northwestern Nigeria from July 1, 2023, to April 30, 2024. We adopted the case definition for diphtheria from the Nigeria Center for Disease Control and Prevention (NCDC). Results The median age (interquartile range) was 7.00 (4–10) years, and half of the patients were aged 5–10 years (49.6%). The common clinical features were fever (95.9%), sore throat (91.9%), painful swallowing (90.7%), pseudomembrane (93.1%), and cervical-submandibular lymphadenopathy (91.5%). Most children were unvaccinated (158; 64.2%), and 199 (80.9%) received diphtheria antitoxin. Of the 246 cases of diphtheria, 58 in-hospital deaths occurred, with a crude mortality rate of 23.6%. After adjusting for confounders, the variables that predicted hospitalization deaths were neck swelling with an adjusted odds ratio (AOR) of 9.8 (95% CI 1.686–56.469), abnormal respiratory findings (AOR, 149.987 [95% CI, 15.600–1442.023] ), hypoxemia (AOR, 37.785 [95% CI, 4.255–331.962] ), and elevated serum creatinine above 1.5 mg/dL (AOR 107.783, 95% CI, 7.944–1462.376). Conclusions Diphtheria, a re-emerging disease, constitutes a significant burden in Nigeria, especially among children. Neck swelling, hypoxemia, abnormal respiratory findings and impaired renal function are predictive of hospitalized death.

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Toxinogene Corynebacterium diphtheriae-surinfectie van een chronisch ulcus

Massa¹,

Boret²,

Vogelaers³

et al. 2023

Tijdschr Geneesk

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Toxigenic Corynebacterium diphtheriae superinfection of a chronic ulcer This article describes the medical history of a 92-year-old Congolese woman with a chronic ulcer on the right inner ankle, present since childhood after scratching small bumps. After returning from a holiday in Congo, the patient had a swollen right lower leg and the ulcer had become remarkably painful. Corynebacterium diphtheriae was cultured from a wound culture and toxin production was demonstrated by a PCR and an immunoprecipitation test (Elek test). Cutaneous diphtheria, usually caused by C. diphtheriae or C. ulcerans, has been on the rise in recent years, primarily due to frequent travelling to endemic areas and migration. The patient was initially treated with azithromycin for 2 weeks, whereafter a control culture showed no evidence of C. diphtheriae. Given the persistent pain symptoms, azithromycin was continued for 2 more weeks. The patient had received only 1 documented vaccine and was thus incompletely vaccinated against diphtheria. A nasopharyngeal carrier status could not be demonstrated. Contact isolation is strongly recommended in patients with toxigenic skin diphtheria since they form a reservoir for secondary transmission with the risk of respiratory diphtheria. Unprotected contacts with the wound exudate should be treated prophylactically with azithromycin 500 mg once a day for 3 days or a single intramuscular administration of 1.2 million units of benzathine-penicillin. Despite large-scale vaccination programs against diphtheria, a physician should include cutaneous diphtheria in the differential diagnosis in case of a non-healing ulcer with a grayish attachment.

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Describing the burden of diphtheria in Canada from 2006 to 2017, using hospital administrative data and reportable disease data

Cited by 3 publications

References 11 publications

Over a Century of Infectious Disease Surveillance in Canada: Introducing the Canadian Disease Incidence Dataset (CANDID)

Over a Century of Infectious Disease Surveillance in Canada: Introducing the Canadian Disease Incidence Dataset (CANDID)

Epidemiology of Diphtheria and Predictors of Outcome in Nigeria: A Single-Center Study from July 2023 to April 2024

Toxinogene Corynebacterium diphtheriae-surinfectie van een chronisch ulcus

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