Date: Thu 6 Sep 2012
Source: Hindustan Times [edited]
Following death of 5 children due to a suspected outbreak of diphtheria here [in the city of Panipat] in the past week, the Haryana health authorities have sounded an alert to control the bacterial disease. The deaths have been reported from the urban slum areas – Davar Colony and Ashok Vihar – located adjacent to Kutani road.
Panipat chief medical officer Dr SP Gupta told the Hindustan Times on Wednesday that the situation was quite serious and the authorities had taken appropriate steps. He said: “More than 500 children have been medicated in these colonies and special isolation wards have been set up at Bhim Sain Sachhar Civil Hospital for those who are ill.” On Tuesday [4 Sep 2012], 9 children were referred to a New Delhi hospital for further treatment.
All those who died were reportedly below 5 years of age and the chief medical officer said medical teams were camping in the areas to handle emergency situations. “So far 5 deaths have been reported from these 2 areas since [30 Aug 2012]. No death has been reported in the past 2 days. Though samples of 24 patients have been sent to a national laboratory in New Delhi for the confirmation of diphtheria, prima facie all patients, including those who died, were suffering from diphtheria and we are treating them accordingly,” the chief medical officer said. He said reports would reach the town in next 2 or 3 days.
The health officials admitted that the outbreak confirmed that the victims were not administered DPT vaccinations. A visit to the areas revealed the sorry state of hygiene. Hundreds of workers engaged in various handloom and other units of the industrial area were residing in these illegal colonies, which lack any provision of sewer and drains.
The district officials said residents were migrant workers and a large population residing here frequently moved to and from Panipat in search of unskilled jobs.
Meanwhile, deputy commissioner Mona Sriniwas directed the health and sanitation authorities to remove filth and drain water accumulated all over the area. Sriniwas said the chief minister had been approached to grant financial assistance to those who died of the disease.
[Byline: Vishal Joshi]
Diphtheria is a vaccine-preventable disease. In India, under the Universal Immunization Programme (UIP), vaccines for 6 vaccine-preventable diseases (tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles) are available for free of cost to all. UIP was launched in 1985 to attain the target to immunize all eligible children by 1990. However, the UIP has chronically failed to meet its goals (http://www.isical.ac.in/~wemp/Papers/PaperNilanjanPatra.pdf).
Data from WHO/UNICEF revealed that the estimated national coverage rates for India for 1 dose of diphtheria/tetanus/pertussis vaccine for the years 2000-2008 was 77 to 83 percent. However, estimated national coverage rates for India for receipt of all 3 initial doses of childhood diphtheria/tetanus/pertussis vaccine fell to only 58 to 66 percent for the years 2000-2008 (http://www.unicef.at/fileadmin/medien/pdf/Immunization_Summary_2008_r6.pd).
Migrant workers and their families, as illustrated in the current outbreak in the city of Panipat, as well as high absenteeism rates among health care providers and unreliable supplies of vaccines, are said to contribute to low vaccination rates in India (http://www.povertyactionlab.org/evaluation/improving-immunization-rates-through-regular-camps-and-incentives-india). A lack of understanding of the benefits of vaccination and even a suspicion of government health services are thought to be contributing factors.
Diphtheria toxoid vaccine is not manufactured as a monovalent vaccine; it is available combined with tetanus toxoid, both in full-strength doses (denoted by upper case letters “DT”) in pediatric formulations and in reduced-strength dose combined with full-strength dose of tetanus toxoid (denoted by upper case T and lower case d, “Td”) in adult formulations. These are combined with acellular or whole-cell pertussis antigens in full strength in pediatric formulations (DTaP, DTwP) or in reduced strength in the adolescent/adult-formulations (Tdap).
In India, DPT vaccine is recommended at 6 weeks, 10 weeks and 14 weeks and then a booster at 1.5 years and 5 years. (http://www.iapcoi.com/hp/pdf/Figure%201-IAPCOI%20Immunization%20Timetable%202012%20for%200-6%20yrs%20_with%20range_.pdf)
The fully immunized person who is exposed can become a carrier of the bacterium but may only develop a mild case, or may not get sick at all. But if not fully vaccinated, the risk of getting severely ill is 30 times higher (http://www.immunizationinfo.org/vaccines/diphtheria).
Panipat is a historic city, with a population of 1.2 million in 2011, in Haryana state, India (http://en.wikipedia.org/wiki/Panipat#cite_note-2). Panipat is a center for textiles and carpets and has a handloom weaving industry with a supply of migrant workers from other states of India in search of employment (http://www.panipatcity.net). It is 90 km (56 miles) north of Delhi and 169 km (105 miles) south of Chandigarh. Panipat can be located on a map of India at: http://maps.google.com/maps?client=safari&rls=en&q=panipat.
The HealthMap/ProMED-mail interactive map of India can be accessed at: http://healthmap.org/r/008o. – Mod.ML]
Commentary: It’s a sad state and a severe indictment of India’s primary health care system that a disease for which free routine vaccination is being provided by the Government since 1985 is still prevalent! Urban slums continue to remain a huge challenge for providing universal healthcare in our country.