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Year : 2007  |  Volume : 25  |  Issue : 4  |  Page : 434-

Resurgence of diphtheria in the vaccination era

N Khan1, J Shastri1, U Aigal2, B Doctor2,  
1 Department of Microbiology, TN Medical College and BYL Nair Children Hospital, Mumbai, India
2 Department of Microbiology, Kasturba Hospital for Infectious Diseases, Mumbai - 400 008, India

Correspondence Address:
J Shastri
Department of Microbiology, TN Medical College and BYL Nair Children Hospital, Mumbai

How to cite this article:
Khan N, Shastri J, Aigal U, Doctor B. Resurgence of diphtheria in the vaccination era.Indian J Med Microbiol 2007;25:434-434

How to cite this URL:
Khan N, Shastri J, Aigal U, Doctor B. Resurgence of diphtheria in the vaccination era. Indian J Med Microbiol [serial online] 2007 [cited 2021 Mar 8 ];25:434-434
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Full Text

Dear Editor,

With the advent of expanded programme on immunisation (EPI) in 1978 and universal immunisation programme (UIP) in 1985, most of the vaccine preventable diseases have shown a decline but diphtheria is still endemic in our country. [1] The reported incidence of diphtheria in India during 1980 was about 39,231, it reduced to 3094 cases in 2000 and increased to 5725 cases in 2005. [2] Hence, this retrospective analysis was carried out at Kasturba Hospital for Infectious Diseases, Mumbai to study the trends of diphtheria cases over a period of 6 years (2000-2005).

A total of 30 suspected diphtheria cases were recorded over a period of 6 years. There was a steady increase in the number of cases from the year 2000 to 2005 [Table 1]. A similar increase in the number of diphtheria cases was also noticed at major tertiary care hospital of North India in 2000. [3] Of the 30 cases, 12 (40%) were males and 18 (60%) females. Typical clinical features of diphtheria were seen in more than 90% of the patients. Pharyngeal swabs showed that 7 (25%) patients were smear positive and 11 (39%) were culture positive. Antidiphtheric serum was given to a total of 27 (90%) patients. Mortality was seen in 22 (73%) patients and was maximum in the age group from 3 to 5 years.

In the present study, approximately 36% of cases did not receive any dose of DPT vaccine and 16% could not complete their DPT immunization schedule. This probably indicates unsatisfactory immunization coverage with DPT vaccine. As per a report of WHO/UNICEF, 2004 the estimated DPT-3 coverage among children in India has dropped from 71% in 1990-1995 to 64% every year from 2000 to 2004. [4] This drop in immunization coverage could be attributed to lack of awareness, misconception, avoiding immunization for trivial reasons, migration, declining enthusiasm regarding routine immunization due to repetition of pulse polio immunization campaign. In addition, although not documented, many families may accept pulse polio immunization as a substitute for routine immunization. [1] In the present study, microbiological confirmation was available only in 36.7% of cases. Ray et al , in their study also observed the low microbiological confirmation rate and giving reasons for the same stated that clinical diagnosis of diphtheria should be given due consideration. [5] Low microbiological positivity may be due to lack of expertise in sample collection and administration of antibiotics to the patients in the private sector before admission in the hospital. Overall mortality was seen in 73% of patients, which may be due to late or missed diagnosis, non-availability of antidiphtheritic serum and low index of clinical suspicion.

Therefore, a high index of suspicion for diphtheria, ensuring continuous availability of anti-diphtheritic serum, sustained DPT-3 vaccination coverage are some of the essential measures to keep diphtheria under control. At the same time, it is also essential to establish a good surveillance system to detect possible outbreak of diphtheria as early as possible.


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2WHO. Immunization surveillance, assessment and monitoring. Immunization Profile - India. 2006.
3Singhal T, Lodha R, Kapil A, Jain Y, Kabra SK. Diphtheria - down but not out. Indian Pediatr 2000; 37 :728-38.
4WHO/UNICEF Joint Reporting Form (JRF), India EPI Fact Sheet , 2004.
5Ray SK, Gupta SD, Saha I. A report of diphtheria surveillance from a Rural Medical College, Hospital. J Indian Med Assoc 1998; 96 :236-8.