Epidemiological Situation of Diphtheria in Tajikistan
Definition of an Epidemiological Situation of a Diphtheria in Tajikistan, Strengthening of Laboratories Potential to Assist in Usage and Expansions of Laboratory Operating Networks
Tech Area / Field
- MED-DIS/Disease Surveillance/Medicine
3 Approved without Funding
Republican Center of Immunoprophylaxy, Tajikistan, Dushanbe
- Republican Center for State Sanitary Epidemiological Control, Tajikistan, Dushanbe
Project summaryThe diphtheria is a bacterial infection caused by bacteria Corynebacterium diphtheria. These microorganisms develop toxin which damages and destroys human tissues and bodies. One of common registered forms of disease is characterized by defeat of a nasopharynx and tonsil. The diphtheria can be registered in both children and adults. In the beginning of the onset of illness, or even some weeks later, can be developed miocarditis, accompanied infringement of a rhythm of heart and cardiac decompensation. The heaviest complication of diphtheria is the hypostasis of respiratory tracts which leads to a fatal outcome.
Outbreak of diphtheria took place in Tajikistan in 1994-1997. The causes of outbreaks of a diphtheria were sharply increased population shift as well inside as a outside of country, sharply worsened social and economic conditions, decrease in life standard of the population, the created lack financial, material, manpower resources, as consequence of Civil war.
Incomplete immunization coverage and even the termination of carrying out of inoculations, against diphtheria of a significant part of the population have led to decrease in collective immunity and accumulation of not immune population to diphtheria.
Totally 47 cases of diseases are registered by a diphtheria in republic for last 5 years (2002-2006). And no any laboratory investigation was done for these cases. All diagnoses are exposed on the basis of clinical data. It was observed that attracts attention on high percent ill among vaccinated against a diphtheria in age groups of 5-9 years (85, 7 %), and 10-14 years (70 %). High prevalence of disease among vaccinated cases can be discussed (Introduction of an incomplete doze of an immune injection, non-observance of intervals between inoculations, infringement conditions of storage of a vaccine).
The indirect certificate to it is registration of two cases of a diphtheria in Dushanbe when intervals between vaccination observed from 7 up to 3 months and first revaccination was done in the age of 7 years (in 6 years after vaccination). Widespread of toxic forms of diphtheria continues to be registered In Tajikistan for last years. In 2003 toxic forms of diphtheria were observed at 26 % ill patients. In 2004 from three registered sick person with diphtheria were with the widespread and combined form (Bokhtar - 1 case, of Dushanbe - 2 cases).
In connection with low level registration of diphtheria disease in republic awareness of health workers also noticed is decreasing to diphtheritic infection. Because epidemiological surveillance on diphtheria is not in place.
In 2004, despite of recommendations of the Republican Center for Immunoprophylaxy, the system of active detection of patients with suspicion on diphtheria and their timely hospitalization was not conducted.
Because of absence of resources since 1999 in republic revaccination was not provided against diphtheria to the population in the age of 6 and 16 years. Revaccination against diphtheria in 2001 to 2003 for children of reached 6 years was not carried out, teenagers in the age of 16 years, since 2001 according to the calendar accepted by Ministry of Health were not revaccinated against a diphtheria and also none in the age of 26-36-46 and 56 years that has led to decrease in collective immunity and a proceeding registration of cases of a diphtheria in age groups 10-14 years old, 15 years old and above.
Considering that in republic for the last few years there were no resources for effective epidemiological surveillance, including laboratory diagnostics of a diphtheria, infringements in system of early revealing and treatment sick by a diphtheria and contact in the centers because of absence of necessary medical resources, absence of immune drugs for immunization of patients before an extract, contact in the centers and immunization in the age of 6, 16 years and adult population on the accepted calendar of the inoculations, and adult population according to the accepted calendar of the vaccination, the number of cases will not be decreased in Tajikistan, and the number of cases of a diphtheria are not reliable according to the official statistical reporting (only severe cases detected).
The diphtheritic infection in republic demands strengthening the control.
The adult population of republic Tajikistan did not vaccinated up to 1995. The campaign of immunization lead by republic on struggle against a diphtheria in 1995-1996, for the population in the age of with 15 till 50 years has been lead with an interval with from three about seven months, promoted fast reduction of cases of diseases by a diphtheria, but could not provide high expected effect on creation of immunity of the population, as the third round of inoculations was not done due to the lack of resources.
The mass company against diphtheria which was planned for 2006-2007 were not conducted, because of the absence of financial resources.
Health workers are not carrying out epidemiological surveillance from the moment of the first reference of the patient, therefore the role of medical workers of curative care is important. Qualitative epidemiological surveillance requires competent and responsible health workers therefore training seminars are an integral part of carrying out qualitative epidemiological surveillance.
One more indicator of quality epidemiological surveillance is laboratory diagnostics which is not provided for long years due to absence of the equipment and diagnostic. Last training on diagnostics of diphtheria among health workers has been conducted in 1995. In this connection the new equipment for carrying out of analyses is required to laboratory. Experts are a subject to training on techniques of diagnosing of diphtheria.