A Case-Control Study for Diphtheria in East Java, Indonesia, 2012

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Authors: Panduasa D1,Lakapu JA1,Leny1,Simbolon M1,Mas’ud NA1,Jamaluddin1, Rokhmayanti1,Pertiwi RD1,Jaya I2,Alam S2, Ricardo MM3, Estivariz C3, Lam E3, Tiwari T3 Senior Author: Santoso H2 1 FETP Trainee, Indonesia 2 MOH, Indonesia 3UNICEF, Indonesia

Background:Diphtheria, caused by toxigenic Corynebacterium diphtheriae, is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent pseudomembrane over the tonsils, pharynx and/or nasal cavity. Since 2010, the East Java provincial health department reported a rise in diphtheria cases. From January–September 2012, 500 cases were reported and 53 were laboratory-confirmed by culture for toxigenic C. diphtheriae. In November 2012, the MOH and FETP Indonesia conducted a case-control study to identify risk factors for diphtheria in East Java. Method:We reviewed the East Java provincial surveillance database and identified 39 laboratory culture-confirmed cases from 6 districts during January–September, 2012. Two age-matched neighbourhood controls were recruited per case. Information collected on participants using pretested questionnaires during household interviews included demographic characteristics, travel history, and vaccination status with a diphtheria-containing vaccine (DCV). We estimated mOR and 95% CI using multivariate conditional logistic regression. Result:Thirty-seven cases and 74 controls were enrolled, median age was 9 years. The multivariate model included vaccination status, DCV doses received, household size, recent travel, years living at current residence, and number of children aged <5 years. Receiving 1 DCV dose (mOR: 0.027; 95% CI:0.001–0.763), 2 DCV doses (mOR:0.013; 95% CI:0.0004–0.415) and &#8805;3 DCV doses (mOR:0.008; 95% CI:0.0002–0.384) were significantly protective against diphtheria. Households with >7 members had increased risk compared with households having &#8804;3 members (mOR:27.9; 95% CI:1.7–461.9). Conclusion: Vaccination with any dose of DCV was protective against diphtheria but &#8805;3 doses had the greatest effect. Prevention efforts should focus on strengthening delivery of routine immunizations. Key words: diphtheria, outbreaks, case control study

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