|Credit CDC PHIL|
Once a leading cause of childhood death in the United States, and around the world, Diphtheria is become so well controlled by vaccines in Western countries over the past 50 years that many doctors can now go their entire career without seeing a case.
As recently as 30 years ago, 100,000 cases were reported globally each year, but over the last decade that number has dropped to about 5,000. According to UNICEF:
In 2015, forty countries reported 4,700 cases of diphtheria, of which India and Madagascar accounted for 84% of the cases. Over the past five years, outbreaks have been reported in Brazil (2013), Haiti (at present), India (endemic), Indonesia (2011-3), Laos (2013, and at present), Nepal (endemic), Pakistan (2015), South Africa (2015), Thailand (2012-3), Venezuela (2016) and Vietnam (2015).5We've looked at several reported outbreaks in recent years, including Reports Of A Growing Diphtheria Outbreak in Venezuela earlier this year, and in 2016 at an ECDC Rapid Risk Assessment: Fatal Case Of Diphtheria In Belgium.
There have been recent reports of Diphtheria in war-torn Yemen (see WHO delivers medicines as diphtheria spreads in Yemen), where, like in Venezuela, public health services have largely collapsed.
Although the diphtheria vaccine is highly protective against the disease, vaccinated individuals can still can be asymptomatic carriers of toxigenic C. diphtheriae. It doesn't take very long into a societal collapse before unvaccinated children start coming down with this highly contagious disease.
Making matters worse, Diphtheria antitoxin (DAT) has been in short supply for several years, even in the EU (see ECDC RRA A case of diphtheria in Spain), and is difficult to get, or in some cases completely unavailable, in much of the developing world.Escaping religious persecution and reported ethnic cleansing in Myanmar, over the past 3 months more than 600,000 Rohingya refugees have flooded across the border into Cox's Bazar, Bangladesh where they are being housed in cramped resettlement camps.
A perfect environment for infectious diseases, including Diphtheria, to spread.According to the following WHO news release, more than 100 cases have already been reported, and this may represent just the `tip of the iceberg'.
Diphtheria is spreading fast in Cox’s Bazar, Bangladesh
6 December 2017 | Geneva - Diphtheria is rapidly spreading among Rohingya refugees in Cox’s Bazar, Bangladesh, WHO warned today.
More than 110 suspected cases, including 6 deaths, have been clinically diagnosed by health partners, including Médecins Sans Frontières (MSF) and the International Federation of the Red Cross (IFRC).
"These cases could be just the tip of the iceberg. This is an extremely vulnerable population with low vaccination coverage, living in conditions that could be a breeding ground for infectious diseases like cholera, measles, rubella, and diphtheria," said Dr Navaratnasamy Paranietharan, WHO Representative to Bangladesh.
"This is why we have protected more than 700,000 people with the oral cholera vaccine, as well as more than 350,000 children with measles-rubella vaccine in a campaign that ended yesterday. Now we have to deal with diphtheria."
Since August 2017, more than 624,000 people fleeing violence in neighbouring Myanmar have gathered in densely populated temporary settlements with poor access to clean water, sanitation and health services – and the numbers continue to swell.
WHO is working with the Bangladesh Ministry of Health and Family Welfare, UNICEF and partners to contain the spread of the highly infectious respiratory disease through effective treatment and adequate prevention.
Together, they are supporting patient diagnosis and treatment, ensuring adequate supplies of medicines, and preparing a vaccination campaign targeting all children up to 6 years with pentavalent (DPT-HepB-Hib) and pneumococcal vaccines, which protect against diphtheria and other diseases. Training is already underway for vaccinators.
WHO has procured an initial 1,000 vials of diphtheria antitoxins that are due to arrive in Bangladesh by the weekend. Combined with antibiotics, the antitoxins can save the lives of people already infected with diphtheria, by neutralizing the toxins produced by the deadly bacteria.
"We are working with partners to ensure that clinical guidance is available to health workers, and that there are enough beds and medicines for those who get sick. But the only way to control this outbreak is to protect people, particularly children, through vaccination," said Dr Paranietharan.
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