Diphtheria positive cases account for 20% of sample tested 

Former Director of Public Health and Preventive Medicine Dr K Kolandaswamy said that the disease majorly affects children and in some cases, young adults aged till 25.
Representational Image.
Representational Image.

MADURAI: Diphtheria, a respiratory infectious disease caused by the bacterium Corynebacterium diphtheriae, was a leading cause of death in children worldwide in the early 20th Century. With the introduction of a vaccine in the 1940s and 50s, diphtheria was believed to be a disease of the past for many. In an RTI reply obtained by the TNIE, it was revealed that out of the total samples tested in the three-year period -- January 2018 till March 2021 -- 16 people were found infected with the disease, accounting for the 20 per cent of the samples tested.

Former Director of Public Health and Preventive Medicine Dr K Kolandaswamy said that the disease majorly affects children and in some cases, young adults aged till 25. The infection, which has a fatality rate of about 20 per cent, re-surfaced in Tamil Nadu in the year 2017, he added. Health Department on the other hand said that since the re-emergence of the disease, it not only affects the children but also young adults.

Decoding the Data

In response to the data sought by TNIE through RTI, the District Health Department said that out of the 84 people tested for diphtheria in the district from January 2018 to March 22, 2021, as many as 16 people tested positive for the bacterial infection that is diagnosed through culture test. The highest number of diphtheria cases were reported in the district in 2019 when 11 people were found to be infected.

While only two persons tested positive in 2018, none were found to be infected in 2020. However, three persons were diagnosed with diphtheria this year, in the last 81 days alone. Official sources said that all diphtheria patients in the district are treated only at the Government Rajaji Hospital (GRH).

The data also showed that out of the 85 cases of suspected diphtheria reported in the district in the three-year-period, 44 hailed from rural parts of the district, while 41 people hailed from the city. While 22 children in the age group of 10-15 years were the highest among those with suspected diphtheria, 20 children in the age group 5-10 years were treated for suspected diphtheria and 18 children aged between 0-5 years were treated for suspected diphtheria. Notably, out of the 85 cases of suspected diphtheria, 16 people were aged above 25 years.

Further, the district has recorded four suspected diphtheria deaths since 2018, including one death this year. Of them, three patients were aged between 0-5 years while one was aged above 40 years.

Treatment

Any suspected diphtheria patient who shows symptoms of the disease is immediately isolated and treated akin to a diphtheria-infected patient, not waiting until the arrival of culture test results that takes about a couple of days. Firstly, he or she is soon administered a single dose of 10 vials of injectable anti-diphtheria serum at one go, irrespective of age. Simultaneously, four vials of injectable crystalline Penicillin are administered every day, for a minimum period of 10 days. Thus, each patient requires a minimum of 40 vials of crystalline Penicillin. Besides, erythromycin - an antibiotic oral pill is also given.

Filling the gaps

Dr Kolandaswamy who closely monitored the re-emergence since 2017 mentioned, "When diphtheria began to resurface after decades, the bacteria was found to jump from one age group to another when the focus is thrust upon vaccinating a particular age group of children, say 0-5 years. As a result, middle-aged adults who might have missed the booster shots of DPT or Tt vaccine between 5-16 years are now being infected."

Listing the possible reasons for the re-emergence of diphtheria, Dr Kolandaswamy said that partial immunisation coverage, children in private schools missing out on the second booster of DPT (at the age of five) and the increased travel of migrants may have caused the bacteria to thrive. These gaps have to be filled to contain the infection spread, he stressed.

Symptoms

*Mild fever
*Sore throat
*Formation of a greyish-white membrane in the pharynx and over tonsils
*Swollen glands in the neck

Effects

*Difficulty in breathing
*Difficulty in swallowing food
*Difficulty in speech Primarily affects the heart and central nervous system (causing paralysis)
*Affects kidneys
*Brings about multiple-organ failure
*Fatality

Vaccination

*Every infant must be administered a pentavalent vaccine (protects from five life-threatening diseases namely diphtheria, pertussis also known as whopping cough, tetanus, Hepatitis B and type b Haemophilus influenzae) at the sixth, 10th and 14th week since birth.

*Subsequently, the first booster of DPT (diphtheria, pertussis and tetanus) has to be administered between 16-24 months of age while the second booster has to be given at five years of age.

*Also, one dose of tetanus toxide (Tt) was administered twice - at the age of 10 and 16 until 2018, only to be replaced with Tetanus-Diphtheria (Td) vaccine due to the re-emergence of diphtheria cases after a three-decade gap. Further, pregnant women are now being administered the Td vaccine during the first and second trimester. All patients of injury and those who undergo surgery are now being administered the Td vaccine across Tamil Nadu. 

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