Diphtheria outbreak in Lao People’s Democratic Republic, 2012–2013

Sein, Carolyn; Tiwari, Tejpratap; MacNeil, Adam; Wannemuehler, Kathleen; Soulaphy, Chanthavy; Souliphone, Phouthone; Reyburn, Rita; Gonzalez, Alejandro Ramirez; Watkins, Margaret; Goodson, James L.

doi:10.1016/j.vaccine.2016.06.074

Cited by 35 publications

(21 citation statements)

References 10 publications

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“…In our study, 46% of diphtheria cases and 69% of deaths were among the unvaccinated group. This corresponds to findings from a case-control study in Laos where approximately 34% of the people with diphtheria had not received any DPT doses [29, 31].…”

Section: Discussionsupporting

confidence: 83%

“…Children under 15 years were the most affected during this diphtheria outbreak (65%) compared to those in older age groups. For comparison, a similar study in Lao People’s Democratic Republic (Laos), in 2016, revealed that 69% of diphtheria cases were among children under 15 years [29]. The overall diphtheria CFR in Yemen has been 5.6%, and was highest among under-five children (11%).…”

Section: Discussionmentioning

confidence: 99%

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Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

et al. 2019

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Background War 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. Methods This 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. Results The 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. Conclusion The 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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

et al. 2019

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“…The administration of DAT contributes to reducing mortality [21]. Early administration is critical because DAT is not able to neutralize the toxin once the toxin has entered host cells (particularly myocardial cells) [22]. DAT had not been reliably available in this hospital for the past 10 years.…”

Section: Discussionmentioning

confidence: 99%

Diphtheria in Metro Manila, the Philippines 2006–2017: A Clinical, Molecular, and Spatial Characterization

Saito

Dimapilis²,

Fujii

et al. 2020

Clinical Infectious Diseases

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Background Diphtheria is a vaccine-preventable disease that persists as a global health problem. An understanding of the pattern of disease is lacking in low- and middle-income countries such as the Philippines. Methods We conducted a retrospective review of the clinical, microbiological, and epidemiological features of patients admitted with a clinical diagnosis of diphtheria to an infectious disease referral hospital in Metro Manila, the Philippines, between 2006 and 2017. Cases were mapped and the distribution was compared with population density. Corynebacterium diphtheriae isolates from between 2015 and 2017 were examined by multilocus sequence typing (MLST). Results We studied 267 patients (range:12−54 cases/year) admitted between 2006 and 2017. The case fatality rate (CFR) was 43.8% (95% confidence interval, 37.8−50.0%). A higher number of cases and CFR was observed among children <10 years. Mortality was associated with a delayed admission to hospital and a lack of diphtheria antitoxin. Between 2015 and 2017 there were 42 laboratory-confirmed cases. We identified 6 multilocus sequence types (STs). ST-302 was the most common (17/34, 48.6%), followed by ST67 (7/34, 20%) and ST458 (5/34, 14%). Case mapping showed a wide distribution of diphtheria patients in Metro Manila. Higher case numbers were found in densely populated areas but with no apparent clustering of ST types. Conclusions Our analysis indicates that diphtheria remains endemic in Metro Manila and that the infection is frequently fatal in young children. Improved vaccine coverage and a sustainable supply of diphtheria antitoxin should be prioritized.

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“…Lack of access to vaccination services was experienced by Lao PDR, Nigeria, Dominican Republic, and South Africa. 11,13,14,16 In Lao, site with diphtheria outbreak were mountainous. Vaccination services were delivered by mobile outreach unit.…”

Section: Health Care Systemmentioning

confidence: 99%

“…Suboptimal DTP3 coverage likely caused the outbreak. 11 While in India, the world"s highest rates of diphtheria, the outbreak also reported in two very remote villages of northern Karnataka in South India in 2011. Ten confirmed cases infected with toxigenic strains of C. diphtheriae with 2 people killed, and the majority of confirmed cases were either unimmunized or immune drop-outs.…”

Section: Introductionmentioning

confidence: 99%

Faktor-Faktor Risiko Yang Berhubungan Dengan Kejadian Luar Biasa Difteri Di Negara Berkembang

Rintani

Mintarsih

Muliawan³

et al. 2018

JIKM

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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

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Diphtheria outbreak in Lao People’s Democratic Republic, 2012–2013

Cited by 35 publications

References 10 publications

Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system

Diphtheria in Metro Manila, the Philippines 2006–2017: A Clinical, Molecular, and Spatial Characterization

Faktor-Faktor Risiko Yang Berhubungan Dengan Kejadian Luar Biasa Difteri Di Negara Berkembang

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