A Case-Control Study for Diphtheria in East Java, Indonesia, 2012

Date published
Panduasa D, Lakapu JA, Leny, Simbolon M, Mas’ud NA, Jamaluddin, Rokhmayanti, Pertiwi RD, Jaya I, Alam S, Ricardo MM, Estivariz C, Lam E, Tiwari T, Santoso H


Background: Diphtheria, caused by toxigenic Corynebacterium diphtheriae, is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent pseudomembrane over the tonsils, pharynx and/or nasal cavity. Since 2010, the East Java provincial health department reported a rise in diphtheria cases. From January-September 2012, 500 cases were reported and 53 were laboratory-confirmed by culture for toxigenic C. diphtheriae. In November 2012, the MOH and FETP Indonesia conducted a case-control study to identify risk factors for diphtheria in East Java.

Method: We reviewed the East Java provincial surveillance database and identified 39 laboratory culture-confirmed cases from 6 districts during January-September, 2012. Two age-matched neighbourhood controls were recruited per case. Information collected on participants using pretested questionnaires during household interviews included demographic characteristics, travel history, and vaccination status with a diphtheria-containing vaccine (DCV). We estimated mOR and 95% CI using multivariate conditional logistic regression.

Result: Thirty-seven cases and 74 controls were enrolled, median age was 9 years. The multivariate model included vaccination status, DCV doses received, household size, recent travel, years living at current residence, and number of children aged 7 members had increased risk compared with households having ≤3 members (mOR:27.9; 95% CI:1.7–461.9).

Conclusion: Vaccination with any dose of DCV was protective against diphtheria but ≥3 doses had the greatest effect. Prevention efforts should focus on strengthening delivery of routine immunizations.

Key words: diphtheria, outbreaks, case control study

Author type
FETP affiliate
Resource type
Applied epidemiology
Infectious diseases
Southeast Asia
Country or Area