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Bangladesh Hit With Diphtheria Outbreak

DEC 08, 2017 | CONTAGION® EDITORIAL STAFF
According to a news release from the World Health Organization (WHO), diphtheria has been spreading among Rohingya refugees located in Cox’s Bazar, Bangladesh.

Caused by the bacterium Corynebacterium diphtheriae (C. diphtheriae), symptoms of the infection occur within 2 to 5 days of exposure and can range from mild to severe, according to WHO. Infected individuals typically first experience a sore throat and fever. In more severe cases, individuals may experience a thick grey or white patch at the back of their throat which can lead to a barking cough as the individual struggles to breathe or swallow. In addition to this coating on the throat, the poison toxin produced by C. diphtheriae can enter the bloodstream, “causing complications that may include inflammation and damage of the heart muscle, inflammation of nerves, kidney problems, and bleeding problems due to low blood platelets. The damaged heart muscles may result in an abnormal heart rate and inflammation of the nerves may result in paralysis,” according to WHO.

Spread through person-to-person contact or breathing in respiratory droplets produced by infected individuals by coughing or sneezing, more than 110 suspected cases of diphtheria have already been reported in Bangladesh. A total of 6 individuals have died. Navaratnasamy Paranietharan, MD, WHO Representative to Bangladesh was quoted in the press release as saying, “These cases could be just the tip of the iceberg. This is an extremely vulnerable population with low vaccination coverage, living in conditions that could be a breeding ground for infectious diseases like cholera, measles, rubella, and diphtheria.”

Why is diphtheria spreading in Bangladesh? WHO speculates the outbreak is related to the large influx of refugees from Myanmar who have fled the violence in their country into temporary settlements in the area. According to WHO, more than 624,000 individuals have come into the area since August 2017. Almost all of them are dealing with, “poor access to clean water, sanitation and health services,” and WHO states that the numbers are expected to increase.

As a result, WHO stated that they are, “working with the Bangladesh Ministry of Health and Family Welfare, the United Nations Children's Fund (UNICEF) and partners [such as Médecins Sans Frontières (MSF)] to contain the spread of the highly infectious respiratory disease through effective treatment and adequate prevention.” This includes, “ensuring adequate supplies of medicines, and preparing a vaccination campaign targeting all children up to age 6 with pentavalent (DPT-HepB-Hib) and pneumococcal vaccines, which protect against diphtheria and other diseases.” A total of 1000 vials of antitoxins have also been obtained. They are expected to arrive in Bangladesh by the weekend.

Once a disease that led to a whopping 206,000 cases in 1921 and 15,520 deaths in children in the United States, thanks to the introduction of a vaccine, only 2 cases of diphtheria were reported in the United States between 2004 and 2015, according to the Centers for Disease Control and Prevention (CDC). Still, because vaccines are not readily available in all countries, the world saw a total of 7321 cases in 2014.

Although it is recommended that babies receive their first of multiple doses of the vaccine at 2 months of age, once the vaccine series is complete, the CDC recommends that individuals should receive a booster dose of the vaccine every 10 years, as immunity wanes over time.
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