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Letters to the Editor Indian Pediatrics 2000;37: 1393-1395 |
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Diphtheria – Certainly Not Out |
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The opening statement that "The decline in incidence of diphtheria.....that is has become a medical curiosity...." certainly does not hold true for our country. Though not a very common disease, there is always a steady trickle of cases of diphtheria (not being reported probably). The authors, being from an apex institution, perhaps do not get to see such patients and hence feel it to be a rare entity. Chandigarh has a sizeable migrant population (30%) (mostly residing in slums) among whom immunization coverage is poor and hence diphtheria still occurs. Table I gives the details of the patients with diph-theria admitted in out hospital from 1998 till date. We feel that the experience from other pediatric centres which cater to such popula-tion would be similar. The figure of 1326 cases reported in 1997 is certainly a gross underestimate, as already pointed out by the authors(1). From the above, it is obvious that the disease still exists and one must have a high level of suspicion especially in unimmunized or partially immunized children. Banani Poddar,
We would like to thank Drs. Poddar and Parmar for highlighting the problem of diphtheria in our country owing to the poor immunization status which was also the primary aim of our article. The opening remark "The decline in incidence of diphtheria has been so remark-able that it has now supposedly become a medical curiosity from a major public health problem in the past" merely reflects the general impression about the global change in epidemiology of diphtheria with introduction of routine immunization. It is not meant to imply that the disease is no longer seen in our country. On the contrary, our article high-lights the need for continued high index of suspicion for diagnosis in view of unsatis-factory immunization coverage (The disease is not out!). It is inappropriate to derive conclusions from a single sentence and ignore the contents of the whole article. It is the disease awareness which is low (not the disease burden) which has resulted in misdiagnosis and under-reporting of cases. This is also evident from the above letter where Case 1 was misdiagnosed as a case of severe asthma and eventually succumbed to his illness. Even though our hospital is a tertiary care center, we also cater to common childhood illnesses in addition to referrals. Our observation of a recent increase in occurrence of diphtheria cases is also seconded by a government notification F6 (49) Surveillance/MCH/DFW/98-99 that stated "that due to a considerable decline in DPT3/DT coverage in Delhi particularly in urban slums during the last three years a rise in incidence of diphtheria has been observed". The authors of the letter have highlighted the cases seen in their center over one year. It would have been better if they had provided the data for preceding years as well. To conclude, there is an urgent need to improve both disease awareness and immu-nization status failing which the disease incidence is likely to rise even further. Tanu Singhal, | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
