clove and Diphtheria

Diphtheria is a potentially devastating disease whose epidemiology remains poorly described in many settings, including Madagascar. Diphtheria vaccination is delivered in combination with pertussis and tetanus antigens and coverage of this vaccine is often used as a core measure of health system functioning. However, coverage is challenging to estimate due to the difficulty in translating numbers of doses delivered into numbers of children effectively immunised. Serology provides an alternative lens onto immunisation, but is complicated by challenges in discriminating between natural and vaccine-derived seropositivity. Here, we leverage known features of the serological profile of diphtheria to bound expectations for vaccine coverage for diphtheria, and further refine these using serology for pertussis. We measured diphtheria antibody titres in 185 children aged 6-11 months and 362 children aged 8-15 years and analysed them with pertussis antibody titres previously measured for each individual. Levels of diphtheria seronegativity varied among age groups (18.9% of children aged 6-11 months old and 11.3% of children aged 8-15 years old were seronegative) and also among the districts. We also find surprisingly elevated levels of individuals seropositive to diphtheria but not pertussis in the 6-11 month old age group suggesting that vaccination coverage or efficacy of the pertussis component of the DTP vaccine remains low or that natural infection of diphtheria may be playing a significant role in seropositivity in Madagascar.

Topics: Adolescent; Antibodies, Bacterial; Bordetella pertussis; Child; Corynebacterium diphtheriae; Diphtheria; Diphtheria-Tetanus-Pertussis Vaccine; Female; Humans; Immunization Programs; Immunoglobulin G; Infant; Madagascar; Male; Seroepidemiologic Studies; Vaccination Coverage; Whooping Cough

Diphtheria is an infection that has been unreported for more than two decades in Mahajanga. A child, aged 4, presented with a pseudomembranous pharyngitis was associated with a dysphagia. He was from a rural municipality of Ambato Boeny at Mahajanga province and was admitted to the Pediatric Unit of the University Hospital Center. The child was not immunized against diphtheria. A throat swab was performed and cultured, from which Corynebacterium diphtheriae was identified. The strain, of biovar Mitis, was confirmed as diphtheria toxin (DT)-gene positive and produced DT (Elek test). Unfortunately, the child developed cardiac and neurological complications and died of respiratory and heart failure.

Topics: Child; Child, Preschool; Corynebacterium diphtheriae; Diphtheria; Family; Humans; Madagascar; Male; Pharyngitis

Diphtheria is re-emerging in Europe. A total of 36 cases were reported in Europe in 2015 versus 53 cases between 2000 and 2009.. We report two cases of Corynebacterium diphtheriae infection in a French hospital in 2016: a cutaneous infection with negative toxin testing in a French traveller, and a respiratory diphtheria carriage with positive toxin testing in an Afghan refugee diagnosed with pulmonary tuberculosis. The vaccination history of the Afghan patient could not be retrieved.

Topics: Adult; Afghanistan; Communicable Diseases, Emerging; Corynebacterium diphtheriae; Diphtheria; Emigrants and Immigrants; France; Humans; Madagascar; Male; Refugees; Skin Ulcer; Travel-Related Illness; Young Adult

Topics: Asthma; Child, Preschool; Contraindications; Diphtheria; Diphtheria Toxoid; Fatal Outcome; Humans; Madagascar; Male; Medical Errors