Publication:

Obstinate diphtheria needs innovation in immunization

Background Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur in our country with the phenomenon of age shifting. It is pertinent to study the epidemiological determinants of diphtheria. The objective of the study was to profile of diphtheria patients admitted in ID and BG, hospital, Kolkata, Bengal, India.

Methods A descriptive cross-sectional study was done in September, 2010 involving the diphtheria patients admitted in ID and BG hospital, Kolkata from July, 2009 to June, 2010. Data were collected from BHT of the patients kept in the MRD of ID and BG hospital and telephonic enquiry for those patients whose BHT were found missing of some information, specially immunization.

Results Almost 90% cases were diagnosed clinically. Majority (47.23%) belonged to 12-29 years age group with clear age shifting. There was rural and female predominance. Almost 2/3rd was unimmunized and more than 3/4th belonged to below poverty level. Patch in throat was the most common clinical feature detected at the time of admission and difficulty in swallowing was the most frequent symptoms. Referral source was unknown for higher proportion of female in ≥12 year who also had higher duration of hospital stay and required significantly higher dose of Anti-Diphtheria Serum. Myocarditis was noted as most frequent complication (41%) and case fatality rate was 3.97%. Peak occurrence was noted during August to November.

Conclusions Diphtheria seems to be obstinate with age shifting indicating rethinking in our control strategy by universal immunization.