An Investigation of Confirmed Diphtheria and Death Case in Khanom District, Nakhon Si Thammarat Province, 23rd November 2012 – 25th January 2013

Abstract

On 22^nd November 2012, the SRRT in Khanom Hospital was notified of a suspected diphtheria case at Emergency Department of Khanom Hospital in Nakhon Si Thammarat Province. An investigation was conducted during 23rd November 2012 – 25th January 2013 by the SRRT in Khanom District. This outbreak investigation aimed to confirm diagnosis and outbreak, describe epidemiological characteristics, determine factors leading to disease transmission and death, and prevent and control further spread of the disease.
Descriptive study was performed by reviewing medical record of cases, interviewing family members and caregivers with specific case investigation form, conducting active case finding in community according to case definition and collecting throat swab specimens from suspected cases and close contacts to identify Corynebacterium diphtheriae and its toxigenicity.
Of 10 confirmed diphtheria cases found with Corynebacterium diphtheriae toxigenic strain, 2 of them died. The first cluster of two sibling cases lived in Khanom District and had incomplete vaccination. Additional 8 cases were household members and close contacts in the community. Vaccine coverage among children under the age of 5 years was less than 90% in the community. Mother of the first 2 sibling cases was likely to be a carrier and caused diphtheria transmission in the community. She worked as an indirect sex worker in a karaoke with most clients as migrant workers.
The investigation suggested that developing case database system would be useful to monitor diphtheria situation. Clinical criteria of suspected case were set up for physicians to early diagnose diphtheria cases and collect throat swab specimens for culture. Vaccination campaign was done in the community.