Diphtheria resurgence in India: A case study from south Karnataka

Abstract

Corynebacterium diphtheriae is a gram-positive bacillus with characteristic polar metachromatic granules. It was a significant public health problem, infecting the throat and upper airways and producing a highly potent exotoxin but with the advent of diphtheria vaccine, cases have rapidly decreased. Now over the last decade, the reemergence of this infection has been noted and case reports from India have been documented. India represents 78% of globally reported cases with significant mortality despite national immunization programs in place. This case study indicates the severity of an improperly managed case, the importance of microbiological diagnosis with a special interest in molecular detection, and reinforces a resurgence of diphtheria infection.

Case Report: Pharyngeal Diphtheria in a Pregnant Woman from South India

“…Complete clinical recovery after DAT administration and confirmed microbiological investigations such as MALDI-TOF identification and molecular toxin gene detection helped to confirm a definitive diagnosis of diphtheria. 4,10,11 The patient will be closely followed because there are reports of fetal complications after DAT administration. 8 However, in our follow-up, the patient's 18-week fetal anomaly scan was unremarkable.…”

“…However, the average diphtheria-tetanus-pertussis (DPT) vaccine coverage in India remains at only 84%. 4,5 Several case reports have been published in recent years, and this resurgence of cases may be attributed to poor immunization coverage in a few geographic locations, failure to receive booster doses, and absence of data regarding coverage of booster doses of DPT vaccine. 3,4,6,7 Also, several research articles suggest waning immunity against diphtheria in adults who completed childhood immunization.…”

“…4,5 Several case reports have been published in recent years, and this resurgence of cases may be attributed to poor immunization coverage in a few geographic locations, failure to receive booster doses, and absence of data regarding coverage of booster doses of DPT vaccine. 3,4,6,7 Also, several research articles suggest waning immunity against diphtheria in adults who completed childhood immunization. [7][8][9][10][11] Thus, larger sero-surveillance studies are needed to understand the cause of rising diphtheria cases.…”

Divergent evolution of Corynebacterium diphtheriae in India: An update from National Diphtheria Surveillance network

“…Outbreaks associated with displaced population, socioeconomic conditions of the people and vaccination rates emphasize the continued threat posed by diphtheria. Sporadic outbreaks of diphtheria have continued to be reported from different parts of India among both vaccinated and non-vaccinated individuals [ 2 , 4 , 5 ]. Information on the clonality of C .…”