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Published Date: 2019-05-11 12:05:28
Subject: PRO/EDR> Diphtheria - Americas: PAHO/WHO update
Archive Number: 20190511.6464828
DIPHTHERIA - AMERICAS: PAHO/WHO UPDATE
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International Society for Infectious Diseases
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Date: Fri 10 May 2019
Source: Pan American Health Organization (PAHO) [edited]
https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=diphtheria-8968&alias=48504-10-may-2019-diphtheria-epidemiological-update-1&Itemid=270&lang=en


Diphtheria in the Americas -- Summary of the situation
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In 2018, 3 countries in the Region of the Americas (Colombia, Haiti, and the Bolivarian Republic of Venezuela) reported confirmed cases of diphtheria. In 2019, Haiti and Venezuela reported confirmed cases.

The following is a summary of the epidemiological situation in Haiti and Venezuela.

In Haiti, between epidemiological week (EW) 32 of 2014 and EW 16 of 2019, there were 838 probable cases (see note 1 below) reported, including 108 deaths; of these, 276 were confirmed (267 by laboratory criteria and 9 by epidemiological link) (Table 1).

Table 1. Probable and confirmed diphtheria cases in Haiti, 2014-2019 (up to EW 16) (see note 2 below).

Year / Probable / Confirmed cases* / Deaths (confirmed for diphtheria) / Case-fatality rate
2014 / 23 / 4 / 2 / 50%
2015 / 77 / 31 / 7 / 23%
2016 / 118 / 57 / 22 / 39%
2017 / 194 / 73 / 6 / 8%
2018 / 375 / 105 / 14 / 13%
2019 / 56 / 6 / 1 / 17%
Total / 843 / 276 / 52 / 19%

*By laboratory criteria or epidemiological link.
Source: Haiti Ministere de la Sante Publique et de la Population (MSPP)

The number of probable and confirmed cases reported between EW 1 and EW 16 of 2019 (56 cases) is higher than reported for the same period in 2017 (44 cases) and lower than the same period in 2018 (136 cases).

Of the 56 probable cases reported in 2019, 6 cases and one death were confirmed by laboratory. The case-fatality rate among cases confirmed by laboratory or epidemiological link was 23% in 2015, 39% in 2016, 8% in 2017, 13% in 2018, and 17% in 2019.

Notes:
1. Per the Haiti Ministry of Public Health and Population, a probable case is defined as any person, of any age, who presents with laryngitis, pharyngitis, or tonsillitis with false adherent membranes in the tonsils, pharynx and/or nasal pits, associated with edema of the neck.
2. Preliminary data subject to change based on retrospective investigation.

Among confirmed cases in 2019, the highest incidence rate is reported in the age-group of 6- to 14-year-olds, followed by 1- to 5-year-olds. The fatal case occurred in a 5-year-old child.

In 2019, the highest cumulative incidence rate of the probable cases was reported in the communities of Acul du Nord (3.58 cases per 100 000 population) in the Nord Department and in Tabarre (3.07 cases per 100 000 population) in the Ouest Department.

[Figure 1. Distribution of reported diphtheria cases by epidemiological week of onset of symptoms, Haiti, EW 32 of 2014 to EW 16 of 2019 is available at the source URL. - Mod.ML]

In Venezuela, the diphtheria outbreak that began in July 2016 remains ongoing (Figure 2). Since the beginning of the outbreak until EW 13 of 2019, a total of 2752 suspected cases were reported (324 cases in 2016, 1040 in 2017, 1198 in 2018, and 190 in 2019); of these, 1688 were confirmed (554 by laboratory and 1134 by clinical criteria or epidemiological link). A total of 284 deaths were reported (17 in 2016, 103 in 2017, 151 in 2018, and 13 in 2019). In 2019, the highest case-fatality rate occurred in the age-group of 5- to 9-year-olds (7%), followed by 10- to 15-year-olds (4%).

[Figure 2. Distribution of suspected and confirmed diphtheria cases by epidemiological week of onset of symptoms, Venezuela, EW 28 of 2016 to EW 13 of 2019, available at the source URL.]

In 2018, 22 federal entities and 99 municipalities reported confirmed cases. As of EW 13 of 2019, 16 of the federal entities, 45 municipalities, and 65 parishes are reporting cases. Therefore, vaccination and control activities continue to be implemented.

Cases have been reported among all age-groups. The incidence rate among children under 15 years old is 4 cases per 100 000 population; in 15- to 40-year-olds, it is 3 cases per 100 000 population; and in persons over 40, it is 1 case per 100 000 population.

Advice for Member States
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The Pan American Health Organization/World Health Organization (PAHO/WHO) reiterates to Member States the recommendations to continue their efforts to ensure vaccination coverage over 95% with the primary series (3 doses) and booster doses (3 doses). This vaccination scheme will provide protection throughout adolescence and adulthood (up to 39 years and possibly beyond). Booster doses of diphtheria vaccine should be given in combination with tetanus toxoid, using the same schedule and age-appropriate vaccine formulations, namely, diphtheria, tetanus, and pertussis (DPT) for children aged 1 to 7 years old, and diphtheria toxoid (Td) for children over 7 years old, adolescents, and adults.

PAHO/WHO stresses that the most at-risk populations are unvaccinated children under 5 years of age, schoolchildren, healthcare workers, military service personnel, inmate communities, and persons who, due to the nature of their occupation, are in contact with a large number of persons on a daily basis.

Although travelers do not have a special risk for diphtheria infection, it is recommended that national authorities remind travelers going to areas with diphtheria outbreaks to be properly vaccinated prior to travel in accordance with the national vaccination scheme established in each country. If more than 5 years have passed since their last dose, a booster dose is recommended.

PAHO/WHO recommends that Member States strengthen their surveillance systems and their capacity of laboratory diagnosis through culture, ELEK test, and PCR for diphtheria toxin (tox) gene.

PAHO/WHO recommends maintaining a supply of diphtheria antitoxin. Vaccination is key to preventing cases and outbreaks, and adequate clinical management reduces complications and mortality.

Sources of information
1. Haiti Ministere de la Sante Publique et de la Population (MSPP) report received by PAHO/WHO via e-mail communication.
2. Venezuela International Health Regulations (IHR) National Focal Point (NFP) report received by PAHO/WHO via e-mail communication.

References
1. Diphtheria vaccine: WHO position paper - August 2017. Available at http://bit.ly/2CCN7UW.
2. Final report of the 3rd Ad-Hoc Meeting of the Technical Advisory Group (TAG). Ad-hoc Virtual Meeting, 19 Mar 2018. Available at https://bit.ly/2wsLeIk.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[HealthMap/ProMED-mail maps:
Haiti: http://healthmap.org/promed/p/25
Venezuela: http://healthmap.org/promed/p/29]

See Also

2018
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Diphtheria - Americas (04): PAHO/WHO update
Diphtheria - Americas (03): PAHO/WHO epidemiological update
Diphtheria - Americas (02): PAHO/WHO epidemiological update
Diphtheria - Americas: PAHO/WHO epidemiological update
2017
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Diphtheria - Americas (02): PAHO epidemiological update
Diphtheria - Americas: PAHO epidemiological update
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