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1.
Artigo em Russo | MEDLINE | ID: mdl-34486871

RESUMO

The serologic epidemiological analysis of intensity of anti-diphtheria and anti-tetanus post-vaccination population immunity in the Republic of Kyrgyzstan was carried out. The presence of immune defense was determined in 453 residents by detecting IgG to diphtheria and tetanus by enzyme-linked immunosorbent assay using test system RIDASCREEN Diphtherie IgG and RIDASCREEN Tetanus IgG (Germany, R-Biopharm). It was established that the level of antibodies depends on the age of individuals. The highest immune defense against diphtheria is present in adult population aged 20-29 years (100%) and 30 years and older (100%). The lowest level is detected in the group of children of 1-4 years old and is up to 30.6%. The proportion of individuals with protective titer of antibodies ≥ 0.10 for diphtheria was 88.5%. The population intensity of post-vaccination tetanus immunity high antibody titers were established in age groups of 15-19 years (92.9%), 20-29 years (93.3%) and 30 years and older (94.8%). There is relationship between level of antibody titers and the age. Thus, in children age group of 5-9 years, high level of protection was established, that amounted up to 60.4%, in adolescents of 10-14 years old this indicator was 40%, and the lowest level in children aged of 1-4 years old was 39.6%.


Assuntos
Difteria , Tétano , Adolescente , Adulto , Anticorpos Antibacterianos , Criança , Pré-Escolar , Difteria/epidemiologia , Difteria/prevenção & controle , Humanos , Lactente , Quirguistão/epidemiologia , Tétano/prevenção & controle , Vacinação , Adulto Jovem
2.
BMC Infect Dis ; 21(1): 581, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34134646

RESUMO

BACKGROUND: Despite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population. METHODS: A total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (< 0.1 IU/mL) to C. diphtheriae infection. RESULTS: Among the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1-2 years old (0.59 IU/mL) and 6-7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4-6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p < 0.001)], gender [Adults: χ2 = 5.58(df = 1),p = 0.018] and ethnicity [Adults: χ2 = 21.49(df = 5),p = 0.001] with diphtheria toxoid IgG antibody level. CONCLUSIONS: About 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5-6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.


Assuntos
Anticorpos Antibacterianos/sangue , Toxoide Diftérico/imunologia , Difteria/epidemiologia , Imunoglobulina G/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Corynebacterium diphtheriae/metabolismo , Difteria/patologia , Ensaio de Imunoadsorção Enzimática , Humanos , Lactente , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Adulto Jovem
3.
Wiad Lek ; 74(4): 1019-1023, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156023

RESUMO

OBJECTIVE: The aim: Was to study the dynamics of the incidence of diphtheria in the Transcarpathian region of Ukraine. PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the data of the state statistical reporting of the Transcarpathian region on the incidence of diphtheria, the carriage of infection, vaccination coverage and the severity of diphtheria immunity was carried out. CONCLUSION: Conclusions: Low coverage of the population with vaccination against diphtheria, registration of an outbreak of diphtheria among international students of the region, and other regions of Ukraine in conditions of increased population migration, are alarming prognostic signs of the possible development of another significant epidemic rise of diphtheria morbidity in Transcarpathia.


Assuntos
Difteria , Difteria/epidemiologia , Difteria/prevenção & controle , Humanos , Incidência , Estudos Retrospectivos , Ucrânia/epidemiologia , Vacinação
4.
Nat Commun ; 12(1): 2871, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001895

RESUMO

Reported incidence of pertussis in the European Union (EU) and the European Economic Area (EEA) varies and may not reflect the real situation, while vaccine-induced protection against diphtheria and tetanus seems sufficient. We aimed to determine the seroprevalence of DTP antibodies in EU/EEA countries within the age groups of 40-49 and 50-59 years. Eighteen countries collected around 500 samples between 2015 and 2018 (N = 10,302) which were analysed for IgG-DTP specific antibodies. The proportion of sera with pertussis toxin antibody levels ≥100 IU/mL, indicative of recent exposure to pertussis was comparable for 13/18 countries, ranging between 2.7-5.8%. For diphtheria the proportion of sera lacking the protective level (<0.1 IU/mL) varied between 22.8-82.0%. For tetanus the protection was sufficient. Here, we report that the seroprevalence of pertussis in these age groups indicates circulation of B. pertussis across EU/EEA while the lack of vaccine-induced seroprotection against diphtheria is of concern and deserves further attention.


Assuntos
Difteria/epidemiologia , Tétano/epidemiologia , Coqueluche/epidemiologia , Adulto , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Bordetella pertussis/efeitos dos fármacos , Bordetella pertussis/imunologia , Bordetella pertussis/fisiologia , Difteria/imunologia , Difteria/prevenção & controle , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Europa (Continente)/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Tétano/imunologia , Tétano/prevenção & controle , Coqueluche/imunologia , Coqueluche/prevenção & controle
5.
Int J Infect Dis ; 107: 25-30, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33864919

RESUMO

BACKGROUND: Lao People's Democratic Republic has frequent outbreaks of vaccine-preventable diseases (VPD). This study aimed to determine susceptibility and exposure to VPD in Saravan, a rural province with high ethnic diversity and some of the poorest health indicators nationwide. METHODS: Patients from three district hospitals and one provincial hospital were enrolled. Serum was tested by ELISA for IgG against hepatitis B virus (HBV), tetanus, diphtheria, measles, and rubella. RESULTS: The study enrolled 2463 participants aged 5-90 years. Exposure to HBV was 33.2% and increased with age up to 62.4% of those aged >50 years. HBV surface antigen prevalence was 5.7% in males and 2.4% in females; 9.9% had serology compatible with vaccination. Seroprevalence of protective anti-tetanus antibodies was 46.3% overall. Protective anti-diphtheria seroprevalence was 40.5%. Anti-measles seroprevalence increased from 16.7% in those aged 5-10 years to 97.7% in those aged >50 years. Anti-rubella seroprevalence was 93.0% overall. There were differences in seroprevalences between sex, districts and ethnicity. CONCLUSIONS: Routine infant vaccination needs strengthening in order to close the immunity gaps. High burden of HBV infection should be addressed by increasing birth dose vaccine coverage. Regional and ethnic differences need to be investigated to enable a targeted approach to vaccination.


Assuntos
População Rural/estatística & dados numéricos , Doenças Preveníveis por Vacina/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Difteria/epidemiologia , Feminino , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Humanos , Imunoglobulina G/sangue , Laos/epidemiologia , Masculino , Sarampo/epidemiologia , Pessoa de Meia-Idade , Rubéola (Sarampo Alemão)/epidemiologia , Estudos Soroepidemiológicos , Tétano/epidemiologia , Vacinação , Doenças Preveníveis por Vacina/sangue , Adulto Jovem
6.
PLoS Med ; 18(4): e1003587, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33793554

RESUMO

BACKGROUND: Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS: Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. CONCLUSIONS: To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.


Assuntos
Difteria/epidemiologia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Saúde Pública , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Campos de Refugiados , Refugiados , Estudos Retrospectivos , Adulto Jovem
7.
Curr Opin Neurol ; 34(3): 432-438, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33840775

RESUMO

PURPOSE OF REVIEW: The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. RECENT FINDINGS: Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers. SUMMARY: Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient's history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.


Assuntos
Botulismo , Doenças Transmissíveis , Difteria , Tétano , Botulismo/diagnóstico , Botulismo/epidemiologia , Botulismo/terapia , Difteria/diagnóstico , Difteria/epidemiologia , Humanos , Tétano/diagnóstico , Tétano/epidemiologia , Vacinação
8.
Wiad Lek ; 74(1): 137-143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851604

RESUMO

OBJECTIVE: The aim: Of the paper is to analyze the current views on diagnosis and management of diphtheria in children. PATIENTS AND METHODS: Materials and methods: The data of scientific literature have been analyzed, using the bibliosemantic method of study. CONCLUSION: Conclusions: The specific prophylaxis is recommended to prevent the infection. It has cross-protection against different strains.


Assuntos
Difteria , Criança , Difteria/diagnóstico , Difteria/epidemiologia , Difteria/prevenção & controle , Humanos , Saúde Pública , Ucrânia
9.
Indian Pediatr ; 58(3): 233-236, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33713058

RESUMO

OBJECTIVE: To determine seroprotective titres for diphtheria, pertussis, tetanus and measles in children with nephrotic syndrome who had received essential immunization. METHODS: Children (2-18 years) with steroid sensitive nephrotic syndrome (SSNS) or steroid-resistant nephrotic syndrome (SRNS) who were in disease remission and had received essential childhood immunization were included. Anti-diphtheria, anti-pertussis, anti-tetanus and anti-measles antibody titres were measured. RESULTS: Seventy-six (40 with SSNS; 36 with SRNS) children with mean (SD) age 7.54 (3.96) years were enrolled. The time elapsed since last vaccination was >5 years in 68.4% patients. The seroprotection rates for diphtheria, tetanus, pertussis, and measles were 86.8%, 93.4%, 31.6% and 77.6% respectively; lower in SRNS subjects compared to SSNS. Robust seroprotection titers (1.0 IU/mL) for diphtheria were seen in 23.8% SSNS and 17.9% SRNS; P=0.04, and for tetanus in 69.3% SSNS and 43.8% of SRNS subjects; P=0.03, respectively. CONCLUSIONS: Children with nephrotic syndrome especially those with SRNS have lower seroprotective titers for diphtheria, tetanus, pertussis and measles, necessitating a booster dose of DPT/DT/Td and MR/MMR.


Assuntos
Difteria , Sarampo , Síndrome Nefrótica , Tétano , Coqueluche , Anticorpos Antibacterianos , Criança , Difteria/epidemiologia , Vacina contra Difteria, Tétano e Coqueluche , Humanos , Imunização Secundária , Síndrome Nefrótica/complicações
10.
Sci Rep ; 11(1): 6378, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33737710

RESUMO

In 2016, Venezuela faced a large diphtheria outbreak that extended until 2019. Nasopharyngeal or oropharyngeal samples were prospectively collected from 51 suspected cases and retrospective data from 348 clinical records was retrieved from 14 hospitals between November 2017 and November 2018. Confirmed pathogenic Corynebactrium isolates were biotyped. Multilocus Sequence Typing (MLST) was performed followed by next-generation-based core genome-MLST and minimum spanning trees were generated. Subjects between 10 and 19 years of age were mostly affected (n = 95; 27.3%). Case fatality rates (CFR) were higher in males (19.4%), as compared to females (15.8%). The highest CFR (31.1%) was observed among those under 5, followed by the 40 to 49 age-group (25.0%). Nine samples corresponded to C. diphtheriae and 1 to C. ulcerans. Two Sequencing Types (ST), ST174 and ST697 (the latter not previously described) were identified among the eight C. diphtheriae isolates from Carabobo state. Cg-MLST revealed only one cluster also from Carabobo. The Whole Genome Sequencing analysis revealed that the outbreak seemed to be caused by different strains with C. diphtheriae and C. ulcerans coexisting. The reemergence and length of this outbreak suggest vaccination coverage problems and an inadequate control strategy.


Assuntos
Corynebacterium diphtheriae/genética , Difteria/epidemiologia , Filogenia , Adolescente , Adulto , Criança , Pré-Escolar , Corynebacterium diphtheriae/isolamento & purificação , Corynebacterium diphtheriae/patogenicidade , Difteria/genética , Difteria/microbiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Estudos Retrospectivos , Venezuela/epidemiologia , Adulto Jovem
11.
Indian J Public Health ; 65(1): 60-63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33753692

RESUMO

Despite strengthening of the universal immunization program, diphtheria remains endemic in India. Diphtheria is under surveillance for vaccine-preventable diseases of the World Health Organization and also in India. The present record-based retrospective study was conducted on 241 confirmed diphtheria patients admitted in an infectious disease hospital of Kolkata over 5 years (2015-2019) with the objectives of assessing the admission trend, immunization status, and outcome of patients. Among the patients, majority (57.3%) were female; 50.6% were ≥15 years; 49.0% resided in rural areas. Five-year admission rate did not show any declining trend. Major number of cases occurred in 2016; another peak observed in 2019. Only 27.4% fully immunized rest either partiality immunized (44.4%) or nonimmunized (28.2%). Overall, 54% of the patients developed any complications, and case fatality was 9.5%. Gradual age shift toward adults reiterated the widespread use of adult immunization with Td vaccines. Early reporting to the hospital is necessary to reduce complications and case fatality.


Assuntos
Difteria , Adulto , Difteria/epidemiologia , Feminino , Humanos , Imunização , Programas de Imunização , Índia/epidemiologia , Masculino , Morbidade , Estudos Retrospectivos
12.
Emerg Infect Dis ; 27(3): 953-956, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33622492

RESUMO

We report a diphtheria outbreak mostly among children (median 12 years; range 4-26 years) of a religious minority in urban India. Case-fatality rate (15%, 19/124) was higher among unimmunized patients (relative risk 4.1, 95% CI 1.5-11.7). We recommend mandating and integrating immunization into school health programs to prevent reemergence.


Assuntos
Corynebacterium diphtheriae , Difteria , Adolescente , Criança , Difteria/epidemiologia , Surtos de Doenças , Humanos , Imunização , Índia , Vacinação
13.
PLoS One ; 16(2): e0246301, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33539453

RESUMO

BACKGROUND: In 2017, a diphtheria outbreak occurred in several provinces in Indonesia. The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria. METHODS: A retrospective cohort study was conducted using patient medical records at five referral hospitals in the Province of Jakarta and one in Tangerang District, Banten Province during January 2017 to 31 August 2018. All children in the age group of 1-18 years old discharged with diagnosis of clinical diphtheria formed the study group. All anonymized patient data were evaluated for demographic issues, clinical features, immunization status, complication, laboratory profiles and outcome. RESULTS: A total of 283 patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. All mortal patients had the complication of myocarditis. Regression analyses revealed factors for predicting mortality. Incomplete primary diphtheria toxoid immunization, stridor, bull neck, leukocytosis ≥15 x109 cells/L and thrombocytopenia ≤150 x109 cells/L in each combination for 2 predictors modeling were correlated with death. CONCLUSIONS: We report key predictors of mortality in pediatric patients with clinical diphtheria. The presence of these features when admitted to the hospital must be taken into account, because they can lead to fatal outcome.


Assuntos
Difteria/epidemiologia , Difteria/mortalidade , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Difteria/complicações , Surtos de Doenças/prevenção & controle , Feminino , Hospitalização , Humanos , Imunização , Indonésia/epidemiologia , Lactente , Masculino , Registros Médicos , Miocardite/epidemiologia , Miocardite/mortalidade , Análise de Regressão , Estudos Retrospectivos , Vacinação
14.
Occup Med (Lond) ; 71(1): 50, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33548132
15.
Lancet Infect Dis ; 21(6): 868-875, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33485469

RESUMO

BACKGROUND: Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India. METHODS: We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural). FINDINGS: 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035). INTERPRETATION: The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine. FUNDING: Indian Council of Medical Research.


Assuntos
Anticorpos Antibacterianos/sangue , Toxoide Diftérico/administração & dosagem , Difteria/imunologia , Vigilância da População , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Difteria/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Estudos Soroepidemiológicos
16.
Clin Infect Dis ; 72(1): 61-68, 2021 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-32160282

RESUMO

BACKGROUND: Diphtheria is a vaccine-preventable disease that persists as a global health problem. An understanding of the pattern of disease is lacking in low- and middle-income countries such as the Philippines. METHODS: We conducted a retrospective review of the clinical, microbiological, and epidemiological features of patients admitted with a clinical diagnosis of diphtheria to an infectious disease referral hospital in Metro Manila, the Philippines, between 2006 and 2017. Cases were mapped and the distribution was compared with population density. Corynebacterium diphtheriae isolates from between 2015 and 2017 were examined by multilocus sequence typing (MLST). RESULTS: We studied 267 patients (range:12-54 cases/year) admitted between 2006 and 2017. The case fatality rate (CFR) was 43.8% (95% confidence interval, 37.8-50.0%). A higher number of cases and CFR was observed among children <10 years. Mortality was associated with a delayed admission to hospital and a lack of diphtheria antitoxin. Between 2015 and 2017 there were 42 laboratory-confirmed cases. We identified 6 multilocus sequence types (STs). ST-302 was the most common (17/34, 48.6%), followed by ST67 (7/34, 20%) and ST458 (5/34, 14%). Case mapping showed a wide distribution of diphtheria patients in Metro Manila. Higher case numbers were found in densely populated areas but with no apparent clustering of ST types. CONCLUSIONS: Our analysis indicates that diphtheria remains endemic in Metro Manila and that the infection is frequently fatal in young children. Improved vaccine coverage and a sustainable supply of diphtheria antitoxin should be prioritized.


Assuntos
Corynebacterium diphtheriae , Difteria , Criança , Pré-Escolar , Corynebacterium diphtheriae/genética , Difteria/epidemiologia , Humanos , Tipagem de Sequências Multilocus , Filipinas/epidemiologia , Estudos Retrospectivos
17.
Clin Infect Dis ; 72(2): 285-292, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-32095828

RESUMO

BACKGROUND: The World Health Organization (WHO) does not recommend routine adult booster vaccination for tetanus and diphtheria after completion of the childhood vaccination series. However, many countries continue to implement adult booster vaccinations, leading to the question of whether this is necessary to reduce the incidence of these 2 rare diseases. METHODS: We conducted an observational cohort study based on WHO case reports from 2001 through 2016. We compared the incidence of tetanus and diphtheria in 31 North American and European countries that either do or do not recommend adult booster vaccination. RESULTS: Countries that vaccinate adults every 5-20 years (group 1) were compared with countries that do not routinely vaccinate adults for tetanus or diphtheria (group 2). Comparison of group 1 vs group 2 revealed no significant decline in tetanus incidence rates among countries that vaccinate adults (P = .52; risk ratio [RR] = 0.78; 95% confidence interval [CI], .36 to 1.70). The risk of contracting diphtheria was increased among countries that vaccinate adults due to inclusion of Latvia, a country that had poor vaccination coverage (P < .001). However, if Latvia is excluded, there is no difference in diphtheria incidence between countries that do or do not routinely vaccinate adults (P = .26; RR = 2.46; 95% CI, .54 to 11.23). CONCLUSIONS: Review of >11 billion person-years of incidence data revealed no benefit associated with performing adult booster vaccinations against tetanus or diphtheria. Similar to other vaccines, this analysis supports the WHO position on adult booster vaccination and, if approved by governing health authorities, this may allow more countries to focus healthcare resources on vulnerable and undervaccinated populations.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Difteria , Imunização Secundária , Tétano , Adulto , Anticorpos Antibacterianos , Difteria/epidemiologia , Difteria/prevenção & controle , Europa (Continente) , Humanos , Incidência , Tétano/epidemiologia , Tétano/prevenção & controle , Vacinação , Coqueluche/prevenção & controle
18.
Klin Lab Diagn ; 65(11): 699-706, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33301660

RESUMO

The problem of diphtheria infection remains relevant, since the circulation of toxigenic strains of Corynebacterium diphtheriae persists in the body of bacterial carriers, despite ongoing vaccination. The lecture presents modern ideas about the properties of the pathogen, its pathogenicity factors (toxin, pili, surface proteins (67-72P (or DIP0733), DIP1281, etc.) and their role in the pathogenesis of the disease.. Information about the clinical and epidemiological characteristics and modern methods of laboratory diagnostics of diphtheria is presented. The algorithm of bacteriological research and methods for determining the toxigenic properties of the pathogen are described. The basics of diphtheria vaccination as the only effective means of preventing mass outbreaks of this disease are considered in the framework of the proposed lecture. Knowledge of the peculiarities of the circulation of strains of Corynebacterium diphtheria in modern conditions, pathogenetic and clinical-epidemiological features of diphtheria, as well as modern methods of laboratory diagnostics is important and necessary for students of medical schools and infectious diseases doctors, pediatricians, bacteriologists, therapists, pulmonologists, epidemiologists, etc.


Assuntos
Corynebacterium diphtheriae/patogenicidade , Difteria , Técnicas de Laboratório Clínico , Difteria/diagnóstico , Difteria/epidemiologia , Toxina Diftérica , Humanos
19.
Klin Lab Diagn ; 65(11): 717-723, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33301663

RESUMO

The purpose of the work was to assess the state of bacteriological diagnosis of diphtheria infection in Russia in order to establish possible reasons for the decrease in the release of C. diphtheriae. The Reference Center for Monitoring the Pathogens of Measles, Rubella, Mumps, Pertussis and Diphtheria in 2018 in 85 subjects of Russia conducted a questionnaire of laboratories of medical organizations and the Centers for Hygiene and Epidemiology of Rospotrebnadzor, carrying out bacteriological studies for diphtheria infection. It was found that the number of studies conducted over the five-year period decreased by 1.2 times. The tendency to decrease the number of bacteriological studies for diphtheria is observed in the territories of almost all federal districts. In 99% and 29% of cases, the institutions of the FBUZ Centers for Hygiene and Epidemiology and medical organizations (MO) and use in their work documents regulating bacteriological studies for diphtheria infection. In a number of territories, the list of documents used includes documents that are invalid or do not define such studies. Most organizations use dry tampons when examining for diphtheria, however, 13.1% and 53.4% of FBUZ Centers for Hygiene and Epidemiology and medical organizations (respectively) use commercial transport environments, which does not comply with regulatory documentation. Analysis of the quality of work of bacteriological laboratories showed shortcomings at the stage of preparation of media (use of donor blood, or absence of addition of blood and potassium tellurite), Elek tests (addition of horse serum or absence of serum to the medium), setting of incomplete biochemical series (absence of tests for urease and nitrate reductase), absence of standard control strains, incomplete volume of internal laboratory quality control. Given the continuing circulation of the pathogen in various countries of the world and in our country, as well as the possibility of imported cases of infection from endemic regions, the analysis was aimed at drawing the attention of specialists to the problem of improving the quality of laboratory diagnosis of diphtheria in Russia.


Assuntos
Corynebacterium diphtheriae , Difteria , Técnicas de Laboratório Clínico , Meios de Cultura , Difteria/diagnóstico , Difteria/epidemiologia , Humanos , Federação Russa/epidemiologia
20.
PLoS One ; 15(12): e0242502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33290386

RESUMO

BACKGROUND: The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People's Democratic Republic. We also investigated factors associated with delayed immunization. METHODS: 1162 children aged 8-28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses. RESULTS: Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination. CONCLUSION: We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacinas Anti-Haemophilus/administração & dosagem , Vacinas contra Hepatite B/administração & dosagem , Programas de Imunização/organização & administração , Imunização/estatística & dados numéricos , Vacinas Combinadas/administração & dosagem , Pré-Escolar , Difteria/epidemiologia , Difteria/prevenção & controle , Escolaridade , Feminino , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/prevenção & controle , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Hospitais , Humanos , Esquemas de Imunização , Lactente , Laos/epidemiologia , Modelos Logísticos , Masculino , População Rural , Tétano/epidemiologia , Tétano/prevenção & controle , População Urbana , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
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