Diphtheria - Paraguay (Central)

DIPHTHERIA - PARAGUAY (CENTRAL) ************************** A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> Date: Wed, 15 May 2002 23:35:46 -0300 From: Dr. Antonio Arbo Sosa <msearbo@conexion.com.py> In Paraguay 3 weeks ago an outbreak of Diphtheria began. Through today [15 May 2002] 10 cases have been identified (the most recent was identified 11 May 2002). The majority of the cases were between 5 and 10 years of age. The outbreak is occurring in a rural city, Jose Augusto Saldivar, located 35 km from Asuncion, the capital of Paraguay [in the Central Department]. None of the cases had received three doses of vaccine (DPT). All cases presented as a respiratory infection with membranous pharyngitis or obstructive laryngotracheitis. Three of the cases died (case fatality rate of 30 percent). Vaccination histories of the patients were provided [to Dr. Sosa] by Dr. Gualberto Piñanez, Chief of Department of Epidemiology of the Health Secretary of Paraguay, since only 3 of the cases were hospitalized in our institution. Of the 10 patients, 6 had never received any doses of DPT, 3 had received only 1 dose of DPT and in the remaining case, the mother said that the child had received 3 doses but there was no documentation of this. -- Antonio Arbo, MD, MSc Chief of Pediatric Department Tropical Medicine Institute <msearbo@conexion.com.py> [Thanks to Dr. Arbo for sending in this first hand report on the current outbreak. According to GIDEON (Global Infectious Disease and Epidemiology Network) <http://www.GideonOnline.com> routine immunization (DTP) in Paraguay is administered at ages 2, 4, 6 and 18 months; and 4 years. Year / Vaccine coverage (percent) / Cases reported 1980 / 17 / 14 1990 / 79 / 10 1991 / 79 / 4 1992 / 85 / 6 1993 / 79 / 6 1994 / 84 / 1 1995 / 79 / 1 1996 / 80 / 0 1997 / 82 / 0 1998 / 84 / 0 1999 / 77 / 0 2000 / 80 / 0 Since 1980 there have been major increases in vaccination coverages with decreases in the numbers of cases reported, so that during the period 1996 through 2000, no cases were reported. The occurrence of 10 cases in the preceding 3 weeks, none of whom have a history of adequate vaccination, serves as a reminder of the vulnerability of the population to diphtheria if not vaccinated. In reviewing the prior ProMED-mail postings on diphtheria, the majority of cases and outbreaks covered have been associated with the Russian Federation, either with reports of outbreaks from the Russian Federation, or imported cases from the Russian Federation. This outbreak in Paraguay is one of the first outbreaks reported in Latin America in recent years. The WHO Vaccines and Immunizations website has an excellent background review of diphtheria at: <http://www.who.int/vaccines-diseases/diseases/diphtheria_dis.shtml>. In the discussion on the epidemiology of the disease, it states: "In the face of rising immunization levels in all countries throughout the world what was once a cyclical epidemic disease is now charcterized by sporadic cases and intermittent outbreaks of low intensity. This shift occurred in the 1940s and 1950s in most industrialized countries as use of Diphteria, Tetanus/Pertussis (DTP) vaccine increased... Developing countries, however, are much less prone to faucial (throat) diphtheria outbreaks, and their shift has been less dramatic. But recent large epidemics of diphtheria in several eastern European countries have again drawn attention to this forgotten disease. Reports from developing countries suggest different epidemiological patterns of the disease occur in populations with different immunization histories. In the NIS [Newly Independent States], the outbreaks had high-case fatality rates and a large proportion of patients with complications." Follow-up information on this outbreak would be appreciated, including age distribution of the cases and control efforts implemented. - Mod.MPP] [see also: Diphtheria, imported - Finland, UK 20020126.3400 2000 ------ Diphtheria - India (North) 20000118.0076 1998 ------- Diphtheria - New Zealand 19980817.1633 1997 ------ Diphtheria, imported - UK 19970616.1272 1996 ------- Diphtheria - Rep. of Georgia 19960615.1112 Diphtheria - Russia 19960627.1175 1995 ------ Diphtheria - Central Asian Republics 19951114.1067 Diphtheria - Sweden threatened 19950707.0504 19950717.0547] ...............................................mpp/pg/mpp *##########################################################* ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by ProMED-mail. 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