Diphtheria in Children- Are we even close to control the menace?

Introduction: Despite the success of mass immunization in many countries worldwide, diphtheria continues to play a major role as a lethal resurgent infectious disease. The case reports of resurgence/persistence of diphtheria in India represent only the tip of the iceberg. Aims and Objectives: To study the epidemiology, clinical profile, complications and outcome of diphtheria in children. Materials and Method: A retrospective observational study conducted at a teaching hospital. Review of case notes of all children aged 1 month – 14 years, clinically/microbiologically diagnosed and managed as diphtheria was done. Demographic, clinical & immunization status details, complications and outcome were recorded. Results: A total of 149 cases were reviewed. Male to female ratio was 1.26:1. Maximum (65.77%) cases were reported from regions of Karnataka. Incidence of diphtheria was 0.4%. Highest incidence (46.98%) was seen in children of 5-10 years age group. Majority (69.80%) were unimmunized. Difficulty swallowing (89.93%) and bull neck (81.21%) were common presentations. A total of 79 complications were seen of which myocarditis was the commonest (41.77%). Of 149, 98 (65.77%) recovered and were successfully discharged. CFR was 29.53%. Maximum deaths (50%) were seen in 1-5 year age group. Most children (88.63%) died within 5 days of hospitalisation. Conclusion: Even after more than 3 decades of UIP implementation, diphtheria is still not a lost entity. A shift in age incidence was observed. Occurrence in completely immunized children points towards waning immunity with age or flaws in immunization. Uniformity and improvement in vaccine coverage, adolescent/adult immunization and early diagnosis and treatment might take us closer to achieve control.