Diphtheria Epidemic- Yemen, June 2017-August 2018

  • Vaccine preventable diseases
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Background:
By the end of 2017, as a consequence of war and collapse of health system, diphtheria is re-emerging in Yemen. The aims are to describe the epidemiology of diphtheria, determine the vaccination status of affected population and provide recommendations for interventions.

Methods:
Analysis for surveillance data was performed. Data for reported patients who meet the WHO case definition of diphtheria was obtained from diphtheria surveillance program. Population from Central Statistical Organization was used for calculating incidence per 100,000 of population. P value < 0.05 was the cut point for significance.

Results:
From June 2017 to August 2018, a total of 2,243 patients were reported. Out of them 1390 (62%) were ≤ 15 years old, 1144 (51%) were females, 1099 (49%) were unvaccinated, 830 (37%) partially vaccinated and 180 (8%) were confirmed by microbial culturing. The patients were reported in 20/23 (87%) governorates. The overall incidence was 8/100,000, significantly higher in three governorates; Al Dhale’e, Ibb and Sana’a (20/100,000 vs 7/100,000, P value <0.001) and among age group <15 years (11/100,000 vs 5/100,000, P value <0.001). The overall case fatality rate (CFR) was 5.3% compared to standard WHO estimate (10%). CFR was significantly higher in difficult access governorates; Raymah, Abyan, Lahj, Al Jawf and Sa’adah, (22% Vs ≤ 10%, P value <0.001) and among children < five years (10% vs. 4%, P value <0.001).

Conclusion:
Diphtheria reported in 87% of Yemeni governorate. The majority of patients were partially or not vaccinated. Children ≤ 15 years were more affected with higher fatality among < five years. Five governorates due to difficulties in access had double CFR of WHO stated. Strengthen outreach immunization coverage and introduce booster vaccination against diphtheria in whole governorate especially in difficult access governorates; Raymah, Abyan, Lahj, Al Jawf and Sa’adah, is crucial to control epidemic. Increase public health awareness toward diphtheria disease to control and prevent more cases. Strengthen the surveillance of Diphtheria for early detection, immediate response and providing antitoxin in difficult access areas are recommended.

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