In countries of the Eastern Mediterranean Region diphtheria continues to occur in the form of localized outbreaks. In 2010, 154 cases of diphtheria were reported in the Region. These occurred in Islamic Republic of Iran (106), Iraq (2), Pakistan (37), Sudan (1), United Arab Emirates (1) and Yemen (7). In 2008 it was estimated that diphtheria was responsible of 475 deaths in countries of this Region.
Disease burden
Disease surveillance
Recommended case classifications of diphtheria
A probable case of diptheria is a case that meets the clinical description of an illness characterized by laryngitis or pharyngitis or tonsillitis, and by an adherent membrane of the tonsils, pharynx and/or nose.
Confirmed case
A confirmed case is a probable case that is laboratory confirmed or linked epidemiologically to a laboratory-confirmed case of isolation of Corynebacterium diphtheriae from a clinical specimen, or fourfold or greater rise in serum antibody (but only if both serum samples were obtained before the administration of diphtheria toxoid or antitoxin).
Surveillance of diphtheria consists of a routine monthly report of probable or confirmed diphtheria cases; and immediate investigation of all diphtheria outbreaks with collection of case-based data. Monitoring the number of infants who have received the third dose of diphtheria toxoid-containing vaccine (DPT3) is also important. In countries with low incidence (usually where coverage is >85%–90%) immediate reporting of case-based data of probable or confirmed cases is recommended from peripheral level to intermediate and central levels.
Vaccine and vaccination
Diphtheria is preventable through active immunization. Effective control of the disease can be ensured through high population immunity by providing three doses of diphtheria-containing vaccine to all children below one year of age. The first dose of diphtheria-containing vaccine is given to children at age 6 weeks and then at least four weeks apart for the second and third dose of the vaccine.
Diphtheria vaccine is a toxoid that is available in different combinations with other vaccines. Diphtheria vaccine is safe, effective and well tolerated.