Comunicação de risco: caso suspeito de difteria / Risk communication: suspected case of diphtheria

A comunicação de risco tem como objetivo apoiar na divulgação rápida e eficaz de conhecimento às populações, parceiros e partes intervenientes possibilitando o acesso às informações fidedignas que possam apoiar nos diálogos para tomada de medidas de proteção e controle em situações de emergência em saúde pública. Em Goiás na SE 16/2022, foi notificado 01 caso suspeito de difteria, sexo feminino, 16 anos, do município de Santa Helena de Goiás, com histórico de 03 doses da vacina DTP+HIB (08/2010), não foi identificada doses de reforço, conforme preconizados pelo PNI

Risk communication aims to support the rapid and effective dissemination of knowledge to populations, partners and stakeholders, enabling access to reliable information that can support dialogues for taking protection and control measures in emergency situations in public health. In Goiás on SE 16/2022, 01 suspected case of diphtheria was reported, female, 16 years old, from the municipality of Santa Helena de Goiás, with a history of 03 doses of the DTP+HIB vaccine (08/2010), no doses were identified reinforcement, as recommended by the PNI

A Review of Traditional Vaccine-Preventable Diseases and the Potential Impact on the Otolaryngologist

Abstract Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines. Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases. Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States. Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.

Disease outbreaks in Eastern Mediterranean Region [EMR], January to June 2018

Since beginning of the year 2018, the WHO Eastern Mediterranean Region [EMR] has experienced ongoing and new outbreaks of emerging and re-emerging infectious disease in many countries. A number of these outbreaks are continuing from the previous year

Informe especial: Actualización epidemiológica de difteria / Special report: Epidemiological update of diphtheria

La difteria es una enfermedad infecciosa grave, con potencial epidémico, para la que existe una vacuna eficaz. Es una infección bacteriana aguda causada por la liberación de una exotoxina específica, producida por el bacilo gram positivo, Corynebacterium diphtheriae. Sólo las cepas toxigénicas causan enfermedad. La enfermedad se presenta principalmente en menores de 15 años de edad sin vacunación o con vacunación incompleta; no obstante puede presentarse en adultos en áreas con baja cobertura de vacunación. En este informe se presentan distintos aspectos de la enfermedad y la situación epidemiológica en las Américas y en Argentina: definiciones de caso, medidas de prevención y de control

Diphtheria in the Dominican Republic: reduction of cases following a large outbreak / Difteria en la República Dominicana: reducción de casos tras un extenso brote epidémico

OBJECTIVE: To describe the most recent outbreak of diphtheria in the Dominican Republic and the disease's occurrence and vaccination coverage in 2004-2013. METHODS: Clinical data of diphtheria cases that occurred in 2004 and that met the study's case definition were reviewed along with socioeconomic and epidemiological information from the cases' families. Univariate and multivariate analyses were performed to assess risk factors for fatal diphtheria. Routine surveillance and vaccination coverage data are presented. RESULTS: From January 2004-April 2005, a total of 145 diphtheria cases were reported; 80 (66%) of the 122 cases reported in 2004 met the case definition; 26 were fatal (case-fatality rate: 32.5%). Incidence was highest in the group 1-4 years of age at 5.3 per 100 000; 62.5% were male. Of the 80 cases, 61 (76%) where hospitalized in Hospital A, 17 in Hospital B, and 2 in two other hospitals. Earlier onset (first half of 2004), birth order, and tracheotomy were associated with fatal diphtheria (P < 0.05); cases in Hospital A were also more likely to be fatal (P = 0.066). The average annual diphtheria incidence was 4.91 cases/1 million people in 2000-2003, climbed to 8.8 cases per million in 2004-2005, and dropped to 0.38 in 2006-2014; no diphtheria cases have been reported since 2011. DTP3 vaccination coverage ranged from 72%-81% in 2000-2004 and from 81%-89% in 2005-2013. CONCLUSIONS: The 2004-2005 diphtheria outbreak in the Dominican Republic resulted in important and avoidable morbidity and mortality. Annual cases declined and no cases have been reported in recent years. Maintaining high vaccination coverage and diligent surveillance are crucial to preventing diphtheria outbreaks and controlling the disease.

OBJETIVO: Describir el brote epidémico más reciente de difteria en la República Dominicana, la incidencia de la enfermedad y la cobertura de la vacunación del 2004 al 2013. MÉTODOS: Se analizaron los datos clínicos de los casos de difteria acaecidos en el 2004 y que cumplieron con la definición de caso del estudio, junto con la información socioeconómica y epidemiológica de las familias en las que aparecieron los casos. Se llevaron a cabo análisis de una sola variable y de múltiples variables para evaluar los factores de riesgo de difteria mortal. Se presentan los datos de vigilancia ordinaria y cobertura vacunal. RESULTADOS: De enero del 2004 a abril del 2005, se notificaron un total de 145 casos de difteria; 80 (66%) de los 122 casos notificados en el 2004 cumplieron con la definición de caso; 26 fueron mortales (tasa de letalidad por caso: 32,5%). La incidencia más alta (5,3 por 100 000) se produjo en el grupo de 1 a 4 años de edad; 62,5% fueron varones. De los 80 casos, 61 (76%) se hospitalizaron en el Hospital A, 17 en el Hospital B, y 2 en otros dos hospitales. La aparición más temprana (primera mitad del 2004), el orden de nacimiento y la traqueotomía se asociaron con difteria mortal (P < 0 ,05); la probabilidad de evolución mortal fue mayor en los casos ingresados en el Hospital A (P = 0,066). La incidencia promedio anual de difteria fue de 4,91 casos por millón de personas del 2000 al 2003, ascendió a 8,8 casos por millón durante los años 2004 y 2005, y descendió a 0,38 del 2006 al 2014; no se han notificado casos de difteria desde el 2011. La cobertura de la vacunación con DTP3 varió de 72 a 81% del 2000 al 2004 y de 81 a 89% del 2005 al 2013. CONCLUSIONES: El brote epidémico de difteria de los años 2004 y 2005 en la República Dominicana ocasionó una importante morbimortalidad prevenible. Se produjo un descenso en la incidencia de casos y no se han notificado nuevos casos en los últimos años. El mantenimiento de una alta cobertura vacunal y de una vigilancia eficiente es crucial para la prevención de los brotes epidémicos de difteria y el control de la enfermedad.

Study of Immunization Status and Outcome of Diphtheria Patients.

Background: With advent of EPI and UIP, most of the vaccine preventable diseases have shown a decline; however, Diphtheria continues to remain an endemic disease and has also shown resurgence nationally as well as internationally. Aims and Objectives: To study Diphtheria morbidity and mortality trends. To note variation with respect to age, sex, immunization status, seasonal variation and outcome. Materials and Method: A retrospective analysis of hospital records over the period of 3 years from Jan/2008 to Dec/2010 obtained with permission of hospital superintendent Dr. Jhala from infectious disease hospital in Ahmedabad, Gujarat. Details of 247 cases regarding age, sex, immunization status were taken as per the hospital case records. Results: Of 247 cases, 114 were male (46%), 133 (54%) Females, 71 (29%) were under 5 Years, 103 (42%) were in 6 – 12 years and 35 (14%) were in 13- 20yrs, 38 patients (15%) were noted within 21-60yrs group, a total of 73 (29.5%) patients were observed in adult and adolescent group. Mortality was 0.47%. Incidence was more in months of September to March. In the present study, 85 (34.4%) were completely immunized, 31 (12.55%) were partially immunized and for 18 (7.3%) vaccination status was unknown. 113 (45.75%) were not immunized. Conclusion: Diphtheria continues to remain a major public health concern in spite of being a vaccine preventable disease, though common in pediatric age it is increasingly common in adoloscent and adults. High level of clinical suspicion needed to keep the mortality rates on lower side. A strict implementation of vaccination programmes with follow up booster dose is necessary which will increase the herd immunity, leading to decrease in diphtheria prevalence.

Difteria pelo Corynebacterium ulcerans: uma zoonose emergente no Brasil e no mundo / Corynebacterium ulcerans diphtheria: an emerging zoonosis in Brazil and worldwide / Difteria por Corynebacterium ulcerans: una zoonosis emergente en Brasil y en el mundo

O artigo revisa a literatura sobre a emergência de infecções humanas causadas por Corynebacterium ulcerans em diversos países, incluindo o Brasil. Foi realizada análise de artigos publicados entre 1926 e 2011 nas bases Medline/PubMed e SciELO, bem como artigos e informes do Ministério da Saúde. Apresenta-se um esquema de triagem, rápido, econômico e de fácil execução, capaz de permitir a realização do diagnóstico presuntivo de C. ulcerans e C. diphtheriae na maioria dos laboratórios brasileiros públicos e privados. A circulação de C. ulcerans em vários países, aliada aos recentes casos de isolamento do patógeno no Rio de Janeiro, é um alerta a clínicos, veterinários e microbiologistas sobre a ocorrência de difteria zoonótica e a circulação do C. ulcerans em regiões urbanas e rurais do território nacional e/ou da América Latina.

The article is a literature review on the emergence of human infections caused by Corynebacterium ulcerans in many countries including Brazil. Articles in Medline/PubMed and SciELO databases published between 1926 and 2011 were reviewed, as well as articles and reports of the Brazilian Ministry of Health. It is presented a fast, cost-effective and easy to perform screening test for the presumptive diagnosis of C. ulcerans and C. diphtheriae infections in most Brazilian public and private laboratories. C. ulcerans spread in many countries and recent isolation of this pathogen in Rio de Janeiro, southeastern Brazil, is a warning to clinicians, veterinarians, and microbiologists on the occurrence of zoonotic diphtheria and C. ulcerans dissemination in urban and rural areas of Brazil and/or Latin America.

El articulo revisa la literatura sobre la emergencia de infecciones humanas causadas por Corynebacterium ulcerans en diversos países, incluyendo Brasil. Se realizó análisis de artículos publicados entre 1926 y 2011 en las bases Medline/Pubmed y SciELO, así como artículos e informes del Ministerio Brasileño de la Salud. Se presenta un esquema de selección, rápido, económico y de fácil ejecución, capaz de permitir la realización del diagnóstico presuntivo de C. ulcerans y C. diphtheriae en la mayoría de los laboratorios brasileños públicos y privados. La circulación de C. ulcerans en varios países, aliada a los recientes casos de aislamiento del patógeno en Rio de Janeiro (Sureste de Brasil), es un alerta a clínicos, veterinarios y microbiólogos sobre la ocurrencia de difteria zoológica y la circulación de C. ulcerans en regiones urbanas y rurales del territorio nacional y/o de América Latina.

Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital.

Background: Diphtheria is a fatal disease and may cause serious complications if not recognized early and treated properly. Objectives:To study the epidemiology, clinical features, complications, and outcomes in respiratory diphtheria. Materials and Methods:Diphtheria cases admitted in the infectious disease hospital, Beliaghata, Kolkata, India between January 2009 to January 2011 were evaluated in respect to demographic profile, immunization status, clinical features, complications, and outcomes. Results: 200 diphtheria cases were studied. 150 (75%) patients had history of an adequate immunization, and 100 (50%) patients were from lower socio-economic groups. Common clinical features observed were throat pain in 148 (74%) cases and fever in 112 (56%) cases. Complications observed were myocarditis in 136 (68%) cases, neuropathy in 30 (15%) cases, and respiratory compromise in 14 (7%) cases. Death occurred in 5 (2.5%) patients. Conclusions:diphtheria is still a public health problem in many developing countries. Strict public health measures like an increased immunization coverage, improvement of socio-economic status, easy availability of anti-diphtheritic serum (ADS), early recognition and effective treatment-all may reduce the incidence and mortality.

Diphtheria toxin IgG levels in military and civilian blood donors in Rio de Janeiro, Brazil

Serologic data on diseases that are preventable by vaccines are necessary to evaluate the success of immunization programs and to identify susceptible subgroups. In the present study, we determined serum IgG levels against diphtheria toxin of military and civilian blood donors (N = 75; 69.3 percent males and 30.7 percent females) aged 18-64 years, from the Brazilian Army Biology Institute, Rio de Janeiro, using a commercial diphtheria kit (Diphtheria IgG ELISA; IBL, Germany). Most (63 percent) unprotected military donors were from the older age group of 41 to 64 years. In contrast, the majority (71 percent) of young military donors (18 to 30 years) were fully protected. About half of the military donors aged 31 to 40 years were protected against diphtheria. Among the civilians, about 50 percent of persons aged 18 to 30 years and 31 to 40 years had protective antibody levels against diphtheria as also did 64 percent of individuals aged 41 to 64 years. All civilians had a similar antibody response (geometric mean = 0.55 IU/mL) independent of age group. Military donors aged 18-30 years had higher IgG levels (geometric mean = 0.82 IU/mL) than military donors of 41-64 years (geometric mean = 0.51 IU/mL; P > 0.05). In conclusion, the existence of a considerable proportion of susceptible adults supports the position that reliable data on the immune status of the population should be maintained routinely and emphasizes the importance of adequate immunization during adulthood.

Bacteriological & epidemiological characteristics of diphtheria cases in & around Delhi -a retrospective study.

BACKGROUND & OBJECTIVE: Diphtheria infections caused by the different toxigenic biotypes of Corynebacterium diphtheriae are endemic in Delhi. Information on biochemical identification, toxigenicity and antimicrobial susceptibility to this bacterium is scanty. This retrospective study was carried out to identify isolated Corynebacteria biochemically, determine their toxigenicity, drug sensitivity and some epidemiological characteristics of diphtheria cases from Delhi and adjoining States for the period 1998-2004. METHODS: A total of 1118 throat and 585 nasal swabs were used to detect human pathogenic corynebacteria. WHO recommended methods were used for the detection, screening, toxigenicity and antibiogram pattern of the isolates. RESULTS: Among 493 (44.1%) cases detected positive for corynebacteria 71.8 per cent were pharyngeal, 20.9 per cent nasopharyngeal and rest 7.3 per cent nasal diphtheria cases. Biochemical identification revealed two species i.e., C. diphtheriae and C. pseudodiphtheriticum. In C. diphtheriae three biotypes were detected viz., intermedius (95.5%), gravis (3.4%) and mitis (1.1%). Toxin was expressed by 96 per cent isolates of C. diphtheriae. Cases were recorded from Delhi and four adjoining States. Sex ratio among male to female was 1.6:1. Prime victims were less than 9 yr old children (93.3%). Unvaccinated children (70.2%) were the main sufferers. Fatality rate was highest in Delhi cases (16.8%) followed by UP (14.6%) and Haryana (5.9%). INTERPRETATION & CONCLUSION: Standard methods revealed the replacement of C. diphtheriae var mitis with var intermedius and occurrence of diphtheria infections due to other human pathogenic corynebacteria. It is imperative to have good bacteriological facilities to have better surveillance with regular monitoring in the endemic areas to keep the disease under control.

Actualización de la situación epidemiológica de difteria, tétanos y tétanos neonatal / Update of the epidemiological situation in diphtheria, tetanus and neonatal tetanus

La difteria es una enfermedad producida por el bacilo Corynebacterium diphtheriae, gram positivo aerobio no esporulado, no encapsulado e inmóvil. Es de distribución mundial y con brotes epidémicos en algunos países. Es una enfermedad bacteriana, inmunoprevenible y de notificación universal, obligatoria e inmediata en Chile. En nuestro país la historia natural de la enfermedad cambió drásticamente con la introducción de las vacunas pertussis toxoide diftérico (D.T) en el año 1955 y posteriormente la incorporación de toxoide tetánico en el año 1974 (D.P.T.). El inicio de la disminución en la curva epidemiológica se presenta aproximadamente desde 1961, pero el marcado decrecimiento se registra en el año 1967 (7,4 casos por 100.000 hab.). El año 1996 registra el último caso en una niña de 1 año. Sin duda los avances en la salud pública chilena, particularmente las coberturas de vacunación óptimas, deben ser sostenidos en el tiempo. El tétanos es una enfermedad aguda inmunoprevenible inducida por una exotoxina del bacilo Clostridium tetani, bacilo gram positivo, anaerobio y formador de esporas. Es de notificación universal, obligatoria y diaria en Chile. Es de distribución mundial y con brotes epidémicos en algunos países. En Chile la historia natural de la enfermedad cambió drásticamente con la introducción de las vacunas pertussis y toxoide diftérico (D.T.) y pertussis, toxoide diftérico, toxoide tetánico (D.P.T.). Se comenzó a aplicar la vacuna D.T en el año 1955, y el año 1974 la D.P.T. El inicio de la disminución en la curva epidemiológica se presenta aproximadamente desde 1964, pero el marcado decrecimiento se registra en el año 1966 (0,5 casos por 100.000 hab.). El año 2006 registra una tasa de 0,04 casos por 100.000 hab., con una tendencia a la concentración de casos a nivel de las regiones de Los Lagos, Coquimbo y Araucania. No se han registrado casos de tétanos neonatal desde el año 1996.

Diagnóstico laboratorial da difteria e a prática da coleta de material de comunicantes como estratégia da vigilância epidemiológica - Grande São Paulo, 1987 a 1996 / Laboratorial diagnosis of difhteria and the practice of material collection from contacts as a strategy of epidemiological surveillance - Metropolitan area of São Paulo, 1987 a 1996

Difteria é uma doença aguda causada pelo Corynebacterium diphtheriae. Apesar do conhecimento sobre sua etiopatogenia, seus aspectos clínico, terapêutico e profilático, a difteria permanece endêmica no Brasil. A ampla utilização da vacina tríplice bacteriana há mais de 25 anos, ao lado de melhorias nas condições sanitárias da população, é responsável pela mudança na situação epidemiológica da difteria, particularmente no Estado de São Paulo, promovendo uma drástica redução no númerode casos e óbitos pela doença. Embora possa prescindir da confirmação laboratorial valendo-se dos dados clínicos, cada vez mais, a investigação laboratorial é fundamental para o aumento da especificidade do diagnóstico clínico e para que se conheça a freqüência da infecção, a participação de cepas toxigênicas e demais aracterísticas do agente etiológico. Foram analisados os dados laboratoriais referentes ao período de 1987 a 1996, para a Grande São Paulo, de pacientes suspeitos de difteria e de seus comunicantes, com o objetivo de avaliar a prática da coleta de material como estratégia da vigilância epidemiológica para o controle da doença e diagnóstico dos casos. Na análise do número de casos suspeitos, observou-se, a partir de 1992, significativa diminuição do número de casos, seguida da sua estabilidade em níveis mais baixos a partir de 1994. A análise da toxigenicidademostrou que eram toxigênicas 91,2% das cepas isoladas dos casos suspeitos e 63,3% das cepas isoladas dos comunicantes. Os resultados apresentados reforçam a norma vigente de que a coleta de material de comunicantes e demais medidas de prevenção da doença não podem aguardar os resultados laboratoriais. Os resultados negativos não devem interferir na decisão do número de amostras a serem coletadas em comunicantes...

Clinical features of diphtheria in thai children: a historic perspective.

To study the clinical and laboratory features of childhood diphtheria, the cases of 381 children with clinical and bacteriological diagnoses of diphtheria who were treated at the Children's Hospital between 1976 and 1985 were reviewed. Of these, 191 were males and 190 were females. The mean age was 4.6 years. Approximately 75% of the patients had no history of immunization. Common manifestations of diphtheria included patch (100%), fever (92.4%), upper respiratory tract infection (91.6%), upper airway obstruction (42.3%), hoarseness (36.7%), and bull neck (11.3%). The mean duration of fever prior to admission was 3.3 days with a range of 0-11 days. Patch sites included the tonsils (91.9%), the pharynx (55.9%), the larynx (27.8%) and others (24.4%). Complications included upper airway obstruction (42.3%), cardiac complications (10.0%) and neurological complications (4.7%). The mortality rate was 5.8%. There were significant associations between death and the presence of bull neck, laryngeal patch, airway obstruction and cardiac complications. Early recognition and prompt treatment will decrease complications and mortality in this group of patients.