Wednesday, September 26, 2018

Diphtheria death toll in Delhi rises to 20: Anticipation and preparedness key to avert any outbreak

As many as 19 children have died of diphtheria at the North Corporation-run Maharishi Valmiki Infectious Diseases Hospital, one child died at the Delhi government-run Lok Nayak Hospital, taking the death toll due to diphtheria in the city to 20.  “From September 6-24, there have been 157 admissions, of which 128 were from UP. Rest of the cases are from Haryana and Delhi,” a senior North civic body official said. (HT, Sept. 25, 2018).

Diphtheria is a vaccine-preventable disease and is included in the Universal Immunisation Programme (UIP) in India as DPT vaccine. In 2014, the Health Ministry launched Mission Indradhanush as a special drive to vaccinate all unvaccinated and partially vaccinated children under UIP. Mission Indradhanush aims to increase full immunization coverage in India to at least 90% children by December 2018.

The very fact that there has been an increase in the number of diphtheria cases in the capital, this indicates the failure of the primary immunization program. This should be investigated and the unvaccinated children and those who have received incomplete vaccination, in both urban and rural areas, should be identified and covered under the Mission Indradhanush, as was its aim.

There is a shortage of antidiphtheria serum (ADS). We have been told that the facility to produce DPT group of vaccines at the Central Research Institute in Kasauli is undergoing renovation. This shows no anticipation and lack of preparedness on the part of the government.

The government should reimburse all those who have procured ADS from private sector or it should itself procure the same from local sources.

The overall case-fatality rate for diphtheria is 5-10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. These 20 deaths should not have occurred.

There is clearly a gap in immunization coverage rates as well as lack of preparedness of the government. As a result, the concerned authorities failed to mount the level of response needed to contain a probable outbreak of diphtheria, in this case, with 160 reported cases.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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