Diphtheria outbreak in Lao People's Democratic Republic, 2012-2013.

BACKGROUND: Diphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country. METHODS: We reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed. RESULTS: Sixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were <15years old, five (8%) reported receiving three DTP doses (DTP3), 21 (34%) had received no DTP doses, and 35 (56%) had unknown vaccination status. For the case-control study, 42 of 52 diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services. CONCLUSION: Suboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces.

Emergence of chikungunya in Moonlapamok and Khong Districts, Champassak Province,the Lao People's Democratic Republic, May to September 2012.

INTRODUCTION: Chikungunya is a vector-borne disease transmitted to humans by Aedes mosquitoes, which are widespread in the Lao People's Democratic Republic. However, chikungunya virus (CHIKV) had not been detected in the country before outbreaks reported in July 2012. The first outbreaks were detected through health care worker event-based surveillance. METHODS: The case definition for the outbreaks was defined as a person with acute onset of fever (≥ 38 °C) and severe arthralgia (joint pain) or arthritis from 1 May 2012 in Champassak Province. Rapid response teams conducted active case finding, performed an environmental assessment including an entomological survey and implemented control measures. Descriptive analysis was undertaken in Microsoft Excel. RESULTS: There were 197 cases (attack rate 3.4%) of suspected chikungunya reported from 10 villages in Moonlapamok and Khong Districts of Champassak Province. All age groups (age range: seven months-74 years) were affected with slightly more female (56%) than male cases. Thirty-one per cent (16 of 52) of serum samples tested positive for CHIKV by polymerase chain reaction. The environmental assessment found poor water storage practices and high entomological indices. DISCUSSION: These outbreaks show the effectiveness of health care worker event-based surveillance and the importance of sharing of information across borders for detecting emerging diseases. Public health education is an important measure to prevent epidemics of chikungunya. Information about chikungunya should be supplied to health care workers in the region so they are alert to the potential spread and are able to implement control measures for this disease.

Emergence of chikungunya in Moonlapamok and Khong Districts, Champassak Province,the Lao People's Democratic Republic, May to September 2012

Introduction: Chikungunya is a vector-borne disease transmitted to humans by Aedes mosquitoes, which are widespread in the Lao People’s Democratic Republic. However, chikungunya virus (CHIKV) had not been detected in the country before outbreaks reported in July 2012. The first outbreaks were detected through health care worker event-based surveillance. Methods: The case definition for the outbreaks was defined as a person with acute onset of fever (> 38 °C) and severe arthralgia (joint pain) or arthritis from 1 May 2012 in Champassak Province. Rapid response teams conducted active case finding, performed an environmental assessment including an entomological survey and implemented control measures. Descriptive analysis was undertaken in Microsoft Excel. Results: There were 197 cases (attack rate 3.4%) of suspected chikungunya reported from 10 villages in Moonlapamok and Khong Districts of Champassak Province. All age groups (age range: seven months–74 years) were affected with slightly more female (56%) than male cases. Thirty-one per cent (16 of 52) of serum samples tested positive for CHIKV by polymerase chain reaction. The environmental assessment found poor water storage practices and high entomological indices. Discussion: These outbreaks show the effectiveness of health care worker event-based surveillance and the importance of sharing of information across borders for detecting emerging diseases. Public health education is an important measure to prevent epidemics of chikungunya. Information about chikungunya should be supplied to health care workers in the region so they are alert to the potential spread and are able to implement control measures for this disease.