Obstinate diphtheria needs innovation in immunization


  • Jadab Chandra Sardar Department of Community Medicine, R G Kar Medical College, Kolkata, Bengal
  • Asit Baran Saren Department of Community Medicine, Bankura Sammilani Medical College, Bankura, Bengal
  • Dibakar Haldar Department of Community Medicine, Bankura Sammilani Medical College, Bankura, Bengal
  • Kaushik Chatterjee Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu
  • Samar Biswas Department of Neuromedicine, Bankura Sammilani Medical College, Bankura, Bengal
  • Tutul Chatterjee Department of Community Medicine, ID and BG Hospital, Kolkata, Bengal
  • Gautam Narayan Sarkar Department of Community Medicine, Bankura Sammilani Medical College, Bankura, Bengal




Diphtheria, Age shifting, Waning antibody titre, Adult diphtheria vaccine


Background: Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur in our country with the phenomenon of age shifting. It is pertinent to study the epidemiological determinants of diphtheria. The objective of the study was to profile of diphtheria patients admitted in ID and BG, hospital, Kolkata, Bengal, India.

Methods: A descriptive cross-sectional study was done in September, 2010 involving the diphtheria patients admitted in ID and BG hospital, Kolkata from July, 2009 to June, 2010. Data were collected from BHT of the patients kept in the MRD of ID and BG hospital and telephonic enquiry for those patients whose BHT were found missing of some information, specially immunization.

Results: Almost 90% cases were diagnosed clinically. Majority (47.23%) belonged to 12-29 years age group with clear age shifting. There was rural and female predominance. Almost 2/3rd was unimmunized and more than 3/4th belonged to below poverty level. Patch in throat was the most common clinical feature detected at the time of admission and difficulty in swallowing was the most frequent symptoms. Referral source was unknown for higher proportion of female in ≥12 year who also had higher duration of hospital stay and required significantly higher dose of Anti-Diphtheria Serum. Myocarditis was noted as most frequent complication (41%) and case fatality rate was 3.97%. Peak occurrence was noted during August to November.

Conclusions: Diphtheria seems to be obstinate with age shifting indicating rethinking in our control strategy by universal immunization.


Suryakantha AH. Community Medicine with Recent Advances: Jaypee Brothers: 2nd Edn. 2014. Pp. 322.

Vashistha VM, Kumar P. 50 years of Immunization in India: Progress and Future. Indian Pediatr. 2013;50:111-8.

Lahariya C. A brief history of vaccines and vaccination in India. Indian J Med Res. 2014;139:491-511.

United Nations International Children’s Fund. Coverage evaluation survey: all India report 2009. New Delhi: Government of India and UNICEF; 2010.

Park K. Text Book of Preventive and Social Medicine; 23th Edn, Jabalpur, Banarsidas Bhanot; 2015: p.160.

World Health Organization, Geneva. Vaccine-preventable diseases: monitoring system. 2015 global summary. Available at http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=IND&commit=OK, Last accessed on 29/3/2016.

Singhal T, Lodha R, Kapil A, Jain Y, Kabra S K. Diphtheria down but not out. Indian Pediatrics. 2000;37:728-38.

Eskola J, Lumio J, Vuopio-verkiola J. Resurgent Diphtheria-are we safe? British Medical Bulletin. 1998;54:636-45.

Immunization Hand Book for Health Worker. Ministry of Health & Family Welfare, Government of India, New Delhi, 2011:p.13.

Nath B, GoswamiMahanta T. Investigation of an outbreak of diphtheria in Borborooah block of Dibrugarh district, Assam. Ind journal of Community Medicine. 2010;35(3):436-8.

Bitragunta S, Murhekar MV, Hutin YJ, Penumur PP, Gupte MD. Persistence of diphtheria, Hyderabad, India, 2006. Emerg Infect Dis [serial on the Internet] 2008 Jul. Available from http://wwwnc.cdc.gov/eid/ article/14/7/07-1167. DOI: 10.3201/eid1407.071167.

Kole AK, Roy R, Kar SS, Chanda D. Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital. Indian J Med. Sci 2010;64:373-7.

Basavaraja GV, Chebbi PG, Joshi S. Resurgence of diphtheria: clinical profile and outcome - a retrospective observational study. Int J Contemp Pediatr. 2016;3(1):60-3.

Khan N, Shastri J, Aigal U, Doctor B. Resurgence of Diphtheria in the vaccinated era. Indian J Medical Microbiology. 2007;25:4

Sharma NC, Banavaliker JN, Ranjan R, Kumar R. Bacteriological and epidemiological characteristics of diphtheria cases in and around Delhi-a retrospective study. Indian J Med Res. 2007;126(6):545-52.

Maheriya KM, Pathak GH, Chauhan AV, Mehariya MK, Agrawal PC. Clinical and Epidemiological Profile of Diphtheria in Tertiary Care Hospital. Gujarat Medical Journal. 2014;69(2):105-8.

Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK. A retrospective study of diphtheria cases, Rajkot, Gujarat. IJCM. 2004;29:161.

Laha PN, Misra NP. Diphtheria. Indian J Pediatr. 1956;23:354-7.

Ray SK, DasGupta S, Saha I. A report of diphtheria surveillance from a rural medical college hospital. J Indian Med Assoc. 1998;96:236-8.

Vitek CR, Wharton M. Diphtheria in the former Soviet Union: reemergence of a pandemic disease. Emerg Infect Dis. 1998;4:539-50.






Original Research Articles