Outbreak investigation of Pharyngotonsillar Diphtheria in Yang Si Surat District, Mahasarakham province, Thailand, September 2015
Keywords:
pharyngotonsillar diphtheria, outbreak, Yang Si Surat, MahasarakhamAbstract
Introduction: On 11 September 2014, Bureau of Epidemiology was notified about a suspect diphtheria case in Mahasarakham province who was 11 years old, Thai girl, admitted in Mahasarakham Provincial Hospital. We conducted an investigation to confirm the diagnosis and identify the source of the outbreak, describe epidemiology characteristics and implement control measures.
Methods: A descriptive study was conducted by reviewing the investigation of both diphtheria cases with their family members. Furthermore, their medical records were reviewed. Close contacts, especially household contacts, were interviewed with the structured questionnaire. We actively searched for cases in school where cases with suspected diphtheria attended and in community where those lived between 25 August and 18 September 2014.
Results: Throat swabs in all suspected cases and contacts were collected to test for C. diphtheriae. We surveyed environment and coverage of diphtheria toxoid immunization of children in sub-district and school of diphtheria cases. Two confirmed cases of pharyngeal and tonsillar diphtheria were found. Index case was Thai female 11 years old and second confirmed case was Thai male 12 years old. Both cases lived in the same village. They were students who rode the same van to the same school. Index case had incomplete Diphtheria-tetanus-pertussis (DTP) vaccination, developed bull neck while the second confirmed case receiving the required 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccines had mild symptoms. Both cases was treated with diphtheria antitoxin and antibiotics in adequate dosage. Those who received antitoxin early had a better outcome. Throat swabs of 324 contacts were negative for C. diphtheriae. The percentage of Diphtheria-tetanus-pertussis (DTP) vaccination coverage in children younger than 7 years of age was 83%. Similarly, the percentage of DTP vaccination coverage in children 7-12 years old was 71%. A laboratory-confirmed outbreak of Diphtheria in Yang Si Surat District of Mahasarakham province.
Conclusion: There were 2 confirmed Diphtheria cases without death case in Mahasarakham province, Thailand. Index case had severe symptoms due to incomplete DTP vaccination. Both cases were the student living in the same village and shared a van to school.
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