Diphtheria, an infection that can be easily prevented and treated, is taking on a more threatening global status. Data indicates an increasing number of cases, both globally and specifically in India, contributing to its evolving threat.
Global Rise in Diphtheria
The global rate of diphtheria cases has been slowly but consistently climbing. In 2018, there were 16,651 reported cases, which is over double the yearly average of 8,105 cases recorded between 1996 and 2017.
Diphtheria in India
As per the World Health Organization (WHO), India’s encounter with diphtheria has escalated over the years. In 2015, there were 2,365 reported cases, but the numbers rose successively to 3,380, 5,293, and finally 8,788 in 2016, 2017, and 2018 respectively. The WHO also reported that India was responsible for 60% of all global diphtheria cases in 2017. Over 50 children succumbed to Diphtheria in Delhi in 2018.
Why the Increase?
Several reasons can account for this increase. A significant cause is the emerging Antimicrobial Resistance (AMR) where diphtheria is becoming resistant to multiple classes of antibiotics. AMR happens when microorganisms such as bacteria, viruses, fungi, and parasites develop resistance against antimicrobial drugs used to treat infections.
The Covid-19 pandemic has also played its part by severely disrupting vaccination schedules worldwide. Suspension of immunization campaigns could potentially setback efforts to eliminate various diseases.
Frequently, diphtheria is misunderstood as a common cough or cold by parents, leading to misdiagnosis. Diphtheria can go untreated if the infected individual has not received the necessary vaccinations, the harmful toxin released from the bacteria then begins to affect the function of the kidney, heart, and nervous system.
Vaccine hesitancy has also been identified as a contributing factor. This term refers to the delay or refusal of vaccines despite their availability.
Diphtheria: Understanding the Disease
Diphtheria is a disease caused primarily by the bacterium Corynebacterium diphtheriae. Symptoms include common cold, fever, chills, swollen gland in neck, sore throat, and bluish skin. The infection initially affects the throat and upper airways; however, it can produce toxins that impact other organs. It mainly spreads through coughs, sneezes, or close contact with an infected person, affecting particularly children aged 1 to 5 years.
The occurrence of diphtheria cases in under-five children reflects low coverage of primary diphtheria vaccination. The fatality rate is 5-10% of those diagnosed with the disease.
Treatment and Prevention
Treatment involves administering diphtheria antitoxin to neutralize the effects of the toxin as well as antibiotics to kill the bacteria. Prevention is feasible with the use of antibiotics and vaccines.
Vaccination Programmes in India
The diphtheria vaccine is one of the oldest in India’s Universal Immunisation Programme. According to data from the National Family Health Survey-4, the coverage of the diphtheria vaccine is 78.4%. In 1978, India launched the Expanded Programme on Immunisation which originally included vaccines for BCG (against TB), DPT (diphtheria, pertussis, tetanus), and cholera. This evolved into the Universal Immunisation Programme (UIP) in 1985, which now includes 12 vaccines.
Presently, the diphtheria vaccine is part of a pentavalent vaccine, designed to protect against diphtheria, pertussis, tetanus, Hepatitis B, and Haemophilus influenzae type B. It is one of the eight vaccines administered in the first year of life under the full immunisation programme. Recently, the Intensified Mission Indradhanush (IMI) 3.0 scheme was rolled out to cover children and pregnant women who missed their routine immunisation during the Covid-19 pandemic.