Weekly epidemiological record/ Relevé épidémiologique hebdomadaire 4 AUGUST 2017, 92th YEAR / 4 AOÛT 2017, 417-436
Diphtheria in the Americas -Summary of the situation.
In 2018, three countries in the Region of the Americas (Colombia, Haiti, and the Bolivarian Republic of Venezuela) reported confirmed cases of diphthe...ria. In 2019, Haiti and Venezuela reported confirmed cases.
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WHO has published the first-ever guidance on the clinical management of diphtheria. The only previously available guidance was an operational protocol. The new guidance followed the rigorous process for developing guidance at WHO.
It addresses th...e use of Diphtheria Antitoxin (DAT) in the treatment of diphtheria. There is a worldwide shortage of DAT and evidence based recommendations on the use of DAT were requested by many Member States.
The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.
This clinical practice guideline has been rapidly developed recognizing the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria. Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving.
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Diphtheria is caused by Corynebacterium species, mostly by toxin-producing Corynebacterium diphtheriae and rarely by toxin-producing strains of C. ulcerans and C. pseudotuberculosis. The most common... type of diphtheria is classic respiratory diphtheria, whereby the exotoxin produced characteristically causes the formation of a pseudomembrane in the upper respiratory tract and damages other organs, usually the myocardium and peripheral nerves. Acute respiratory obstruction, acute systemic toxicity, myocarditis and neurologic complications are the usual causes of death. The infection can also affect the skin (cutaneous diphtheria). More rarely, it can affect mucous membranes at other non-respiratory sites, such as genitalia and conjunctiva.
C. diphtheriae is transmitted from person to person by intimate respiratory and direct contact; in contrast, C. ulcerans and C. pseudotuberculosis are zoonotic infections, not transmitted person-to-person. The incubation period of C. diphtheriae is two to five days (range 1– 10 days). A person is infectious as long as virulent bacteria are present in respiratory secretions, usually two weeks without antibiotics, and seldom more than six weeks. In rare cases, chronic carriers may shed organisms for six months or more. Skin lesions are often chronic and infectious for longer periods. Effective antibiotic therapy (penicillin or erythromycin) promptly terminates shedding in about one or two days.
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Vaksen DTaP (Difteri, Tetanòs, Koklich): Sa Ou Bezwen Konnen
Infographic/Map on Cholera and Diphteria cases in Yemen
As of 21 September, the diphtheria oubreak has resulted in a total of 453 deaths recorded among all confirmed cases (Case Fatality Rate/ CFR: 6.3%). A total of 11,587 suspected and 7,202 confirmed cases have been reported with 99 local government a...reas (LGAs) affected across 18 states. Event has been categorized as Grade 2 Emergency, requiring moderate 3 level coordinated support to the Government Response.
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SITUATION OVERVIEW as of 30 Jan.
- 688 000 refugees into Bangladesh (of which 585 000 in Kutupalong and Bulukhali camps)
- over 5000 clinically suspected Diphtheria cases and 37 deaths (reported in refugee camps)
Vaksen Td
Sa Ou Bezwen Konnen