Massive diphtheria outbreak in South Asia: an epidemiological evidence review and lesson learnt

Abstract

Vaccination is to be considerd as one of the most well-known economically viable medical procedures to prevent massive diphtheria outbreaks happening in recent times. Under this circumstance, the available data on diphtheria and vaccination coverage of three South Asian countries is warranted. The published English-language literature between January 2007 and January 2019 was retrieved from search results in eight highly resourceful journal databases using the specific terms. A massive diphtheria outbreak was occurred in refugee camps in Cox Bazar, a harbour city in Bangladesh, between November 2017 and March 2019. A total of 8641 diphtheria case-patients were reported including 45 deaths in the refugee camps. Our synthesis data shows that there is a gap of immunity which creates a large scale of potentiality for a new pandemic for adult couples along with children. The DTP3 coverage in India and Myanmar is less than 90% and these two countries had no standard coverage of DTP3 dose. We concluded that the massive outbreak of diphtheria in South Asia normally occurred due to low coverage of vaccination or incomplete vaccination. Crowded living environment, low socio-economic conditions, cultural belief, and importation of microorganisms are considered for massive outbreak of diphtheria outbreaks. Community-based awareness program and vaccinating individuals and some cases revaccination of older age groups are needed to stop further transmission and control the diphtheria outbreaks in South Asia. Further research is required to fully assess the vaccination coverage in the stateless populations in this region.