Diphtheria situation and factors associated with death from diphtheria, Thailand, 2003–2020

Abstract

Background: Diphtheria was one of the leading causes of childhood death in the pre-vaccine era. However, after the diphtheria toxoid vaccine was invented in 1923, and subsequently was used on a large scale in United States and other industrialized countries in 1940s-1950s, incidence in these nations quickly declines. After the Second World War, there was a continued decline in Underdevelopment countries after the launch of the Expanded Program on Immunization in 1977. The study aims to epidemiological studies and determine the factors associated with death from diphtheria.
Methods: Analytics study using data from the national surveillance data and collected data from all provincial health offices in Thailand during 2003–2013. Case definition of diphtheria is patients attending health facilities with diphtheria follow the clinical criteria as described by the surveillance case definition from Division of Epidemiology. Data were analyzed by calculating numbers, percentage and using chi-square test and Binary Logistic Regression to test the factors associated with death from diphtheria.
Results: The number of reported diphtheria cases initially decrease during 2003–2009. It climbed to 77 cases in 2010 and dropped to 28 cases in 2011. Since 2013, the number of reported diphtheria cases progressively declined until 2020. For the period 2003–2013, a total of 348 diphtheria cases were reported; 81 were fatal. The sex of the fatal cases was mostly male (55.6%), the female to male ratio was 1 : 1.25. Number of diphtheria cases was highest in the 0–4 year age group at 36.2%. In the Binary Logistic Regression, the following factors associated with death from diphtheria were found to be significant: marital status (OR = 5.75, P–value <0.05), region (OR = 2.82, P–value < 0.01).
Conclusion: Case-fatality rates from diphtheria are high in the 0–4 year age group and southern area. Prevention and control measure for diphtheria is to increase the vaccine coverage in the three southern border provinces by using a multispectral partnership for disease prevention and control to achieve the vaccination goals.