Diphtheria, a vaccine preventable disease (VPD), was a major killer amongst children before the era of vaccination. The incidence of diphtheria has come down drastically and many developed countries have virtually eliminated diphtheria over the last three decades [1].

Recently, at our Institute, we received many cases of diphtheria with high mortality, of which there were three with atypical presentation in form of an absence of pseudo-membrane. All three children came from the same geographical belt, and were about 10 years of age. These three patients and others with faucial diphtheria with the pseudo-membrane were immunized only with oral polio vaccine as a part of Pulse Polio Immunization. With this, they believed that their children were safe against all VPD.

We, in India, are caught between two ends of a spectrum, where certain classes of people go beyond the IAP recommendations for Immunization while the other classes are unaware of the routine vaccines. A coverage evaluation by WHO and UNICEF estimated that 87%, 73%, 70% and 74% of the children in India till the age of 24 months were vaccinated with Bacillus-Calmette-Guerin (BCG) vaccine, three doses of oral polio vaccine (OPV) and Diphtheria-Pertussis-Tetanus (DPT) vaccine, and a dose of measles vaccine, respectively [2]. A 13% drop from BCG to measles shows that a significant chunk of children in contact with service providers miss out on subsequent doses.

The President’s message in Indian Pediatrics on "vaccination saves lives" stressed on the need for closing the gaps in immunization [3]. There is a need to emphasize about routine immunization to prevent mortalities due to VPD, and about active surveillance to ensure high coverage of routine immunization along with Pulse Polio Immunization and catch-up vaccination. There should be comprehensive efforts by social media, IAP, non-government organizations and political leaders to bring about awareness in the community regarding immunization through public-private partnerships. Parents should be educated about the vaccination program and its schedule, so that they do not miss on the important vaccines.