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. 2024 Sep 7;9(9):204.
doi: 10.3390/tropicalmed9090204.

Eleven-Year Report of High Number of Diphtheria Cases in Children in East Java Province, Indonesia

Dominicus Husada  1   2 , Yustika Hartini  2 , Kalista Wahyu Nuringhati  2 , Sandy Grace Tindage  2 , Rahma Ira Mustikasari  1   2 , Leny Kartina  1   2 , Dwiyanti Puspitasari  1   2 , Parwati S Basuki  1   2 , Ismoedijanto Moedjito  1   2 , Zumaroh Zumaroh  3 , Hugeng Susanto  3 , Wahyu Wulandari  3 , Sulvy Dwi Anggraini  3 , Erwin Astha Triyono  3   4   5
Affiliations

Eleven-Year Report of High Number of Diphtheria Cases in Children in East Java Province, Indonesia

Dominicus Husada et al. Trop Med Infect Dis. .

Abstract

A high incidence of diphtheria cases in children in East Java province, Indonesia, has been observed since the beginning of this century. Despite many efforts, the outbreaks continue. This study aims to explain the high incidence of diphtheria in children in East Java province since 2013. This cross-sectional surveillance report-based study used data from 38 districts in East Java since 1 January 2013. Collected data included demographics, clinical information, additional examinations, immunization history, and close contact management. Over eleven years, there were 4009 diphtheria patients, of whom 2921 (72.86%) were under 18 years of age. Boys (59.77%) outnumbered girls, and the most common age category was >60-144 months (51.66%). Most cases had incomplete or zero immunization (76.16%). Tonsillopharyngeal diphtheria was the most common type (69.60%). The five top districts with the most cases were Surabaya, Sidoarjo, Kabupaten Blitar, Kota Malang, and Kabupaten Malang. The eleven-year case fatality rate (CFR) was 2.36% (69/2921). This study shows that diphtheria cases in children and adolescents in East Java have consistently been high, and low immunization coverage might still be the leading cause. There has also been a shift in the district distribution. Diphtheria outbreaks require complete and sustainable efforts, not just outbreak response immunizations.

Keywords: East Java province; Indonesia; adolescent; children; communicable disease; diphtheria; surveillance; vaccine-preventable disease.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The distribution of diphtheria cases in East Java by district and age group 2013–2023. x-axis: year; y-axis: number of patients; number in black: total diphtheria patients in that particular year.
Figure 2
Figure 2
Comparison of cases between the northern and eastern vs. southern and western parts of the East Java province. North and east = 1159 cases vs. south and west = 1762 cases (=2:3).
Figure 3
Figure 3
Comparison of diphtheria cases in children before and during the pandemic (4-year period).
See this image and copyright information in PMC

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