• EPI official says most patients reported at SIDHRC from other provinces
• Doctors cite lack of vaccination, shortage of antitoxin for increase in cases

KARACHI: As many as 29 deaths from diphtheria — a highly contagious but vaccine-preventable bacterial infection — are reported at just one hospital in the metropolis that saw a significant number of such infections during the current year, it emerged on Sunday.

Sources said that the 29 deaths were recorded at the Sindh Infectious Disease Hospital and Research Centre (SIDHRC), where at least eight patients are presently under treatment.

Commenting on the deaths, Dr Muha­mmad Naeem Rajput of the Expanded Programme on Immunisation (EPI) said a lot of the patients reporting at the SIDHRC were from other provinces.

“Our Sindh-specific data shows that 84 cases have so far been reported this year with no mortality — most of them were recorded in January and from district East with the highest [30 per cent] patient load,” he said.

The sources said that this year Karachi had seen a significant number of diphtheria cases largely involving adolescents with high mortality rate.

The cases, they said, were diagnosed across the city and mortalities often remained unaccounted for as patients experiencing respiratory distress were brought in critical condition at emergency departments of hospitals where they died during treatment.

“Though we have seen the patients at irregular intervals this year, it’s still alarming to have cases of a potentially life-threatening disease that can easily be prevented with proper vaccination,” shared Dr Samreen Sarfaraz, senior infectious diseases consultant at the Indus Hospital.

Unvaccinated patients

The sources revealed that most of the patients reporting with diphtheria at hospitals were from Karachi and the majority of them were unvaccinated.

For instance, SIDHRC had over 60 cases from Karachi out of a total of 82 diphtheria cases. The majority of patients aged between one year and 14 years and 73 of them were unvaccinated, they added.

Diphtheria vaccine is part of the childhood immunisation programme and the disease prevalence and associated mortality are directly linked with absence of vaccination protection — the sole reason seen behind the spike in several other infectious diseases among children in the province, particularly Karachi.

The sources said that the mortality risk increased in Karachi having large pockets of unvaccinated children. Patient often reported late at hospitals when the illness reached an advanced stage, causing health complications.

“The disease most commonly infects the respiratory system and can cause weakness, fever, sore throat and swollen glands in the neck. If the toxins [released by the bacteria] get into the blood, it can cause fatal heart, nerve and kidney damage,” senior child specialist at the National Institute of Child Health (NICH) Dr Liaquat Ali Halo said.

Patients were kept in absolute isolation and the doctors concerned and families were given post-exposure prophylactic treatment, he added.

According to Dr Halo, “The three-dose diphtheria vaccine should be administered within one year of birth. We can’t offer this vaccine [under the government system] if the child is over one and a half years of age,” he said.

Dr Rajput of the EPI regretted persistent hesitancy for vaccination among parents despite the government’s rigorous efforts to create awareness and increase vaccine accessibility to improve immunisation coverage.

“The government has taken several steps to improve low vaccination coverage as we realise that this single step can help tackle several other infectious diseases among children.

“We have engaged local religious and community representatives at the grassroots level as well as initiated public-private partnerships at high-risk union committees to ensure vaccination at birth,” he said.

Shortage of anti-diphtheria toxin Sources said that hospitals were frequently facing an acute shortage of the anti-diphtheria serum (toxin). Dr Samreen Sarfaraz, the infectious diseases consultant, linked the high mortality rate in diphtheria to shortage of its serum.

“Some patients brought to the hospital in critical condition couldn’t survive while several cases were referred out [to health facilities where they could get the life-saving serum] as the hospital did not have the antitoxin at that time,” she explained, adding that she later learnt that those patients couldn’t survive.

Seconding her opinion, officials at the NICH stated that shortage of the costly anti-diphtheria toxin was a major barrier to saving lives of patients.

Dr Khalid Shafi of the Pakistan Paediatric Association said that the health department supplied the costly serum to hospitals. “But, sometimes there is a shortage that needs to be addressed,” he said.

Sources said hospitals were being forced to purchase a single vial of the serum from the black market at prices ranging between Rs12,000 and Rs15,000. A patient usually gets six to 12 vials of the medicine during treatment.

“The availability of the serum is a major problem. It’s made in India and if the government legally imports this anti-toxin from the neighbouring country, its prices could drop to as low as Rs5,000 here,” a senior doctor associated with a private hospital told Dawn.

Published in Dawn, August 21st, 2023