Caring for Rohingya Refugees With Diphtheria and Measles: On the Ethics of Humanity.

Hundreds of thousands of Rohingya refugees arrived in Bangladesh within weeks in fall 2017, quickly forming large settlements without any basic support. Humanitarian first responders provided basic necessities including food, shelter, water, sanitation, and health care. However, the challenge before them-a vast camp ravaged by diphtheria and measles superimposed on a myriad of common pathologies-was disproportionate to the resources. The needs were endless, resources finite, inadequacies abundant, and premature death inevitable. While such confines force unimaginable choices in resource allocation, they do not define the humanitarian purpose-to alleviate suffering and not allow such moral violations to become devoid of their horrifying meaning. As humanitarian workers, we maintain humanity when we care, commit, and respond to moral injustices. This refusal to abandon others in desperate situations is an attempt to rectify injustices through witnessing and solidarity. When people are left behind, we must not leave them alone.

Seroprevalence of antibodies for pertussis and diphtheria among people leaving or entering China: a cross-sectional study.

INTRODUCTION: Despite high population immunity, pertussis remains one of the leading causes of vaccine-preventable deaths worldwide. The aim of this study was to determine the seroprevalence of IgG antibodies to pertussis toxin (PT) and diphtheria among the adult male population leaving or entering China. METHODOLOGY: Blood samples were obtained from 240 Chinese and 207 African healthy adults that were leaving and entering China, respectively. Serum IgG antibodies against PT (anti-PT IgG) and diphtheria were determined. RESULTS: The mean concentration of anti-PT IgG antibodies was 13.82 IU/mL and 18.11 IU/mL for the leaving and entering populations, respectively. None of the studied Chinese leaving China were seropositive for pertussis. Of the 240 subjects leaving China, 209 (87.1%) had anti-diphtheria antibody concentrations of ≥ 0.1 IU/mL and 31 (12.9%) had antibody concentrations between 0.01 and 0.099 IU/mL. Eleven (5.31%) of the studied Africans entering China had anti-PT IgG antibodies higher than 30 IU/mL and thus were considered seropositive for pertussis. Of the 207 Africans entering China, antibody concentrations of ≥ 0.1 IU/mL were found in 164 subjects (79.2%) while 43 (20.8%) had antibody concentrations between 0.01 and 0.099 IU/mL. CONCLUSIONS: Almost all Chinese adult men leaving China and most African men entering China have very low serum antibody levels of pertussis. Furthermore, the antibody level of diphtheria among these two populations was low among adults. A larger population study is needed to determine whether booster vaccinations against pertussis and diphtheria should be considered for adults in China and also for Africans entering China.

East African immigrant children in Australia have poor immunisation coverage.

AIM: To provide data on the immunisation status of recently arrived East African children and adolescents in Australia. METHODS: A prospective audit was conducted at a hospital-based paediatric immigrant health clinic, in Melbourne, Australia, over the time period November 2000-January 2002. Study subjects were consecutive children and adolescents born in East Africa, arriving in Australia after January 1998. Vaccination status was ascertained by parent report and review of patient-held records where available, and by serological testing for immunity to hepatitis B, tetanus, diphtheria, rubella and measles. RESULTS: Among 136 participants, 132 (97%) had incomplete or unknown immunisation status based on parent report and vaccination records; written records were available for 5/136 (4%) of participants. Only 21/136 (15%) had serological immunity to all five of measles, rubella, tetanus, diphtheria and hepatitis B, despite a total of 395 visits to vaccine providers by participants since migration. A higher proportion of children had serological immunity to measles (90%) compared to the proportion with serological immunity to rubella (77%), tetanus (61%), diphtheria (45%) and hepatitis B (33%). The predictive value of parent-reported vaccination status for serological immunity was poor. CONCLUSIONS: Paediatric East African immigrants in Victoria are very likely to be inadequately immunised and parent-reported vaccination status does not predict serological immunity. Full catch-up immunisation is recommended where immunisation status is unknown and written records are unavailable. Consideration should be given to policy and program development to provide timely and complete immunisation coverage in this group after arrival in Australia.

Epidemiology of diphtheria in South Dakota.

Respiratory diphtheria was one of the most common causes of death among children in the pre-vaccine era. Since the introduction of diphtheria toxoid vaccine in 1920s, and its widespread use by the late 1940s, diphtheria became increasingly rare in the United States. However, through the 1970s diphtheria remained endemic in some states, with reported incidence rates > 1.0 per million population in six states (Alaska, Arizona, Montana, New Mexico, South Dakota, and Washington). Starting in 1980, less than five cases have been reported each year in the United States. The majority of culture-confirmed cases have been associated with importation from other countries. Toxigenic Corynebacterium diphtheriae, the organism causing diphtheria, was thought to have become rare or even have disappeared from previously endemic areas such as South Dakota. However, during four months in 1996, 11 persons (one index case, six patients and four household contacts) in an American Indian community in South Dakota were found to be infected by C. diphtheriae; six of these isolates were toxigenic. The findings in this report indicate that despite 20 years without reported respiratory diphtheria cases, toxigenic C. diphtheriae is still present in South Dakota. The continuous circulation of toxigenic strains of C. diphtheriae emphasizes the need for health care providers throughout South Dakota to promote timely vaccination against diphtheria among persons of all ages and ethnic groups, to be aware of the clinical signs and symptoms of diphtheria so that cases can be promptly diagnosed and treated, and further public health measures can be taken to contain this serious disease.

[Immunity to diphtheria of African guest workers and students]. / Diphtherieimmunität afrikanischer Gastarbeiter und Studenten.

This study investigated the immuno-protective diphtheria antitoxin titres of 38 guest workers from Mozambique and 44 students from Cameroon 18 to 35 years of age. Two methods were used to analyse the sera: the cell culture method and the indirect haemagglutination test. The results of both methods were comparable. Approximately 69% of the guest workers from Mozambique showed protective diphtheria antitoxin levels (> or = 0.1 IE/ml), 24% had a boosterrequiring basic immunity (> or = 0.01-0.09 IE/ml), whereas 7% showed no protective diphtheria antitoxin levels. This compared with 46, 35 and 19% respectively among the students from Cameroon.

The 1985 national immunisation survey: diphtheria, tetanus, and pertussis (whooping cough)

In April 1985 a national immunisation survey was conducted in which sera were collected from almost 3000 randomly selected children throughout New Zealand. The sera collected were from about 1000 new school entrants (mean age 5 years), 1000 standard 3 students (mean age 10 years), and 1000 form 4 students (mean age 15 years). The sera were tested for diphtheria and tetanus immunity and antibody to pertussis by enzyme-linked immunosorbent assay (ELISA) tests. The percentage of those immune to diphtheria decreased with age from 73.1% in the 5 year olds to 53.7% in the 15 year olds. The percentage of those immune to tetanus decreased with age from 66.9% in the 5 year olds to 54.6% in the 10 year olds but then increased to 64.0% in the 15 year olds. While more than 71.0% of the 10 and 15 year olds had measurable antibody to pertussis, only a low 54.4% of the 5 year olds did. The proportion immune to diphtheria and tetanus in both Maoris and Europeans was approximately similar in all three age groups. More Maoris (78.9%) than Europeans (66.1%) had antibody to pertussis. When the data had been standardised for age and ethnic group the percentage with antibody to pertussis and immunity to diphtheria was highest in the southern region, while for tetanus immunity the percentage immune was highest in the northern and southern regions. We conclude that a sizeable pool of new school entrants (mean age 5 years) without antibody to pertussis is accumulating at a time when pertussis still persists.(ABSTRACT TRUNCATED AT 250 WORDS)