Daily Times

Sir: Throat infection is now very common in Pakistan nowadays. I want to share some useful information regarding this.

Diphtheria is an infection of the upper respiratory tract caused by Corynebacterium diphtheria. The major virulence factor of diphtheria is the diphtheria toxin. Diphtheria is a communicable disease of global significance, and its outbreaks have to be reported to the world community under the International Health Regulations (IHR).

Corynebacterium diphtheria is an aerobic gram-positive bacillus. Toxin production (toxigenicity) occurs only when the bacillus is itself infected (lysogenised) by a specific virus (bacteriophage) carrying the genetic information for the toxin (tox gene). Only toxigenic strains can cause severe disease.

In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus pertussis (DTP3) after having received the first dose (DTP1).

A pilot seroepidemiological survey was conducted to assess immunity status of diphtheria among healthy individuals of Rawalpindi/Islamabad (Pakistan), who had been administered at least one dose of the vaccine against the disease, as part of childhood vaccination

Diphtheria is an acute, toxin-mediated disease caused by the bacteria, Corynebacterium diphtheria. The name of the disease is derived from the Greek diphtheria, meaning leather hide. The disease was described in the 5th century BCE by Hippocrates, and epidemics were described in the 6th century AD by Aetius. The bacterium was first observed in diphtheritic membranes by Klebs in 1883 and cultivated by Löffler in 1884. Antitoxin was invented in the late 19th century, and toxoid was developed in the 1920s. The incubation period of diphtheria is 2-5 days (range, 1-10 days).

The overall case-fatality rate for diphtheria is 5-10 percent, with higher death rates (up to 20 percent) among persons younger than five and older than 40 years of age.

Diphtheria antitoxin, produced in horses, was used for treatment of diphtheria in the United States since the 1890s. Since 1997, diphtheria antitoxin has been available only from CDC, through an Investigational New Drug (IND) protocol .

Pakistani literature on barriers to childhood immunization is mainly reported from cross-sectional studies .In these studies, child’s immunization status was primarily assessed by mother’s recall due to the unavailability of immunisation cards at the time of interview in the survey .In the absence of immunisation card, the assessment of child’s immunisation status is liable to misclassification. In Pakistan based on documented evidence of immunization status particularly interested in identifying the reasons why children fail to complete the three dose DTP3 series after having received the first dose of DTP (DTP1). Therefore, we enrolled and followed-up a cohort of children visiting EPI centres for DTP1 in rural areas for the improvement of DPT vaccine.

Several small serologic studies in the United States found that 19-77 percent of adults older than 20 years old were susceptible to diphtheria. Other studies suggest that circulating antitoxin levels of not more than 0.1 IU/mL are needed for protection. National Health and Nutrition Examination Survey conduct from 2013 to 2014 (CDC; unpublished data

The most effective way of preventing diphtheria is to maintain a high level of immunisation in the community. In most countries, diphtheria toxoid vaccine is given in combination with tetanus toxoid and pertussis vaccines (DTP vaccine). More recently, some countries have been using a combination vaccine that includes vaccines for diphtheria, tetanus, pertussis. My suggestion are:

People with diphtheria need to be kept in isolation until they are certified to be free of the disease by Communicable Disease Control Branch (CDCB).

Contacts of people with diphtheria need to be investigated for the disease.

Family or household contact with diphtheria should be excluded from childcare, preschool, school and work place.

Contacts whose work involves food handling or caring for unimmunized children are excluded from work.

Widespread immunization against diphtheria is the only effective control. The diphtheria vaccine is administered through the National Immunisation Program.

People travelling to countries where diphtheria is common should have received a full course of immunisation.

Immunisation policy should be integrated into national fiscal and health development policy and strategic plans.

Take advantage of new vaccine introduction to ensure that infrastructure development (such as cold chain) is sufficient to meet these needs.

Establish national budget lines for immunisation so that adequate funds are budgeted, allocated and actually disbursed for routine immunisation.

Leaders and communities should rally behind the goal of high immunization coverage in the African Region.

Engaging communities to increase demand for immunisation services.

Adequate numbers of staff with a range of disciplines and training, and appropriate institutional arrangements should be put in place. Adequate pre- and in -service training should be provided. Supportive supervision must be operationalised.

Promote and increase involvement in research for vaccine preventable and other priority diseases.

Training of peripheral health workers should include skills to enable them to function in an integrated way.

SAIMA NOREEN

Lahore

Published in Daily Times, December 7^th 2018.