Kerala - Thiruvananthapuram   

Diphtheria claims seven-year-old girl

Thiruvananthapuram: A seven-year-old child, Manjusha, from the Kottoor tribal settlement near Vellanad in the district, died at SAT Hospital on Monday evening following suspected diphtheria.

Manjusha, clinically diagnosed with a severe case of laryngeal diphtheria, was fighting for her life in the intensive care unit since last Friday. It is not yet clear if she had been immunised, even though the health workers in the area, which comes under the Kuttichal sub-centre, claimed that all the children there were immunised.

This is the first reported case of death from diphtheria in the State in several years, as diphtheria is a vaccine-preventable disease (VPD). Though it can affect people of all ages, it usually strikes un-immunised children. The disease is quite rare now and doctors said it had been ages since they saw an acute case since the DPT vaccine began to be administered as part of the universal immunisation programme.

The child’s death has thrown up questions about the state of public health and field-level health activities in the State, where the routine immunisation coverage has been steadily declining and currently stands at just 75.3 per cent (NFHS III).

The anti-toxin for diphtheria is not available anywhere in Kerala or the neighbouring States. The State Health Department, after failing to procure the serum, had sent an urgent communication to the Union Health Ministry on Monday that it be made available from the World Health Organisation or the northern States.

The Health Department had issued a public health alert in the tribal settlements in Kottoor and other areas under the Kuttichal sub-centre after the girl was hospitalised on Friday. Though the results of the throat culture – the confirmatory test – are yet to be obtained, all clinical details pointed to laryngeal diphtheria.

A team of health officials, including the District Medical Officer and the RCH officer, visited Kottoor on Monday. Another team from Government Medical College Hospital (MCH) here plans to visit the area on Tuesday to launch epidemiological studies.

It is not yet clear how the child could have contracted the disease even though it is possible that the organism might be present in the community. Health officials have begun investigating the immunisation status of children in the area. Other public health measures will have to be launched as diphtheria is a bacterial disease which can spread through coughing or sneezing. Those in close contact with the infected person will have to be administered prophylactic dose of antibiotics.

Doctors at SAT Hospital said three cases of post-diphtheria myocarditis and paralysis from the district had been treated last year.

The reportage of VPDs is also quite poor and doctors are never willing to report clinically diagnosed cases to the Health Department, officials claim. Confirmatory tests or culture tests often take long and might not show positivity and thus cases get missed.

The re-emergence of VPDs owing to the sliding coverage of routine immunisation is something that public health activists in the State have been crying hoarse for years now. “The reporting of a VPD is a clear indication of lack of field-level health work. If the vaccination coverage in the community was sufficient, the herd immunity would have protected this child to a certain extent even if she had not been vaccinated,” a senior department official said.

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