CHENNAI : Diphtheria, a contagious and potentially fatal bacterial disease, could be on the comeback trail with sporadic cases surfacing at children's hospitals in the city.

At least six children have reported with full-blown diphtheria at two major children's hospitals in the past four months, prompting a recheck on a host of issues concerning what was deemed as an eradicated scourge. And, given the high chance of underreporting and misdiagnosis of diphtheria, the actual incidence could be much higher in the community, paediatricians said.

Once a major killer of children, the diphtheria threat faded with the implementation of the Universal Immunisation Programme (UIP) that immunises millions of children in the country every year against a range of diseases including tuberculosis, pertussis, tetanus, poliomyelitis and measles.

The reporting of diphtheria cases at the Institute of Child Health, Egmore, and the Kanchi Kamakoti CHILDS Trust Hospital — two important paediatric healthcare institutions — has now raised concerns over possible slip-ups in the immunisation programme.

"The full significance of seeing diphtheria cases today goes beyond the numbers that reach hospitals," said Bala Ramachandran, consultant at CHILDS Trust. Theoretically, as a Vaccine Preventable Disease (VPD), diphtheria should have been a `textbook phenomenon' had the UIP offered the vaccinated children blanket protection.

However, the reappearance of diphtheria cases could put under the scanner a range of issues such as compliance levels for the immunisation schedule, availability of the life-saving anti-diphtheria serum and the efficacy of the vaccines, especially in relation with the cold chain continuum in vaccine shipment.

The evaluation of the clinical history of diphtheria patients has led doctors to suspect that slackness in getting children administered booster doses in the fifth year as the most likely cause for the compromised immunity against the bacteria.

"Though diphtheria usually strikes in children under five years of age, the cases that have been reported so far are in the 8-10 age group," said Muralidharan, Professor of Paediatrics, Stanley Medical College and formerly RMO of ICH.

Diphtheria usually attacks the throat forming a pseudomembrane on the tonsils, and in more serious cases, it targets the heart or nerves. The organism releases a toxin that damages the heart muscles leading to heart failure or paralysis of the muscles involved in breathing. Treatment involves administering anti diphtheria serum and broad-spectrum antibiotics. However, the life-saving serum is difficult to acquire outside of Government hospitals, Dr. Bala Ramachandran pointed out.

Progress cards

Paediatricians also recommend issuance of immunisation progress cards that record each dose given to every child who is vaccinated. In its January issue, the Indian Journal of Medical Research too makes this suggestion through an article that critically examined the immunisation programme in the country.

Its editorial member T. Jacob John recommends in the article, `Quo vadis, expanded programme on immunization,' that every child be provided a family-retained health card and every dose of vaccine given — including those given in mass campaigns — be documented.

The author underscored the importance of district level disease surveillance and vaccine coverage and disease prevalence to be matched for epidemiological evaluation of vaccine efficacy/effectiveness and quality.

Vaccine utilisation and vaccination coverage should be monitored, tallied at local levels and cumulated at district level, he said.

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