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Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis

机译：二民迪文菌的流行病学，2017-2018：监测数据分析

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Background As a consequence of war and the collapse of the health system in Yemen, which prevented many people from accessing health facilities to obtain primary health care, vaccination coverage was affected, leading to a deadly diphtheria epidemic at the end of 2017. Objective This study aimed to describe the epidemiology of diphtheria in Yemen and determine its incidence and case fatality rate. Methods Data were obtained from the diphtheria surveillance program 2017-2018, using case definitions of the World Health Organization. A probable case was defined as a case involving a person having laryngitis, pharyngitis, or tonsillitis and an adherent membrane of the tonsils, pharynx, and/or nose. A confirmed case was defined as a probable case that was laboratory confirmed or linked epidemiologically to a laboratory-confirmed case. Data from the Central Statistical Organization was used to calculate the incidence per 100,000 population. A P value .05 was considered significant. Results A total of 2243 cases were reported during the period between July 2017 and August 2018. About 49% (1090/2243, 48.6%) of the cases were males. About 44% (978/2243, 43.6%) of the cases involved children aged 5 to 15 years. Respiratory tract infection was the predominant symptom (2044/2243, 91.1%), followed by pseudomembrane (1822/2243, 81.2%). Based on the vaccination status, the percentages of partially vaccinated, vaccinated, unvaccinated, and unknown status patients were 6.6% (148/2243), 30.8% (690/2243), 48.6% (10902243), and 14.0% (315/2243), respectively. The overall incidence of diphtheria was 8 per 100,000 population. The highest incidence was among the age group 15 years (11 per 100,000 population), and the lowest incidence was among the age group ≥15 years (5 per 100,000 population). The overall case fatality rate among all age groups was 5%, and it was higher (10%) in the age group 5 years. Five governorates that were difficult to access (Raymah, Abyan, Sa'ada, Lahj, and Al Jawf) had a very high case fatality rate (22%). Conclusions Diphtheria affected a large number of people in Yemen in 2017-2018. The majority of patients were partially or not vaccinated. Children aged ≤15 years were more affected, with higher fatality among children aged 5 years. Five governorates that were difficult to access had a case fatality rate twice that of the World Health Organization estimate (5%-10%). To control the diphtheria epidemic in Yemen, it is recommended to increase routine vaccination coverage and booster immunizations, increase public health awareness toward diphtheria, and strengthen the surveillance system for early detection and immediate response.
机译：背景作为战争的后果和也门卫生系统的崩溃，这阻碍了许多人访问卫生设施，以获得初级保健，受到疫苗接种覆盖率受到影响，导致2017年底致命的白喉流行病。目的是这项研究旨在描述也门白喉的流行病学，并确定其发病率和病例死亡率。方法使用世界卫生组织的案例定义，从白喉监督计划中获得数据。可能的情况被定义为涉及患有喉炎，咽炎或扁桃体炎和扁桃体，咽和/或鼻子的粘附膜的案例。确认的情况被定义为实验室确认或链接到实验室证实案例的实验室的可能案例。来自中央统计组织的数据用于计算每10万人口的发病率。 P值＆ 05被认为是显着的。结果2017年7月至2018年7月期间共报告了2243例。案件的约49％（1090/2243,48.6％）是男性。大约44％（978/2243,43.6％）涉及5至15年的儿童。呼吸道感染是主要的症状（2044/2243,91.1％），其次是假膜（1822/2243,81.2％）。基于疫苗接种状态，部分疫苗接种，疫苗接种，未接种疫苗和未知状态患者的百分比为6.6％（148/2243），30.8％（690/2243），48.6％（10902243）和14.0％（315/2243） ）， 分别。白喉的总发病率为每10万人8人。最高发病率是年龄组＆ 15岁（每10万人的11名），最低的发病率是年龄组≥15岁（每10万人55人）。所有年龄组中的总体病例死亡率为5％，年龄组中的较高（10％）较高（10％）。难以访问的五个省（Raymah，Abyan，Sa'ada，Lahj和Al Jawf）的死亡率非常高（22％）。结论白喉在2017 - 2018年在也门影响了大量人群。大多数患者部分或未接种疫苗。年龄≤15岁的儿童受到更大的影响，年龄较大的儿童的死亡率更高。难以访问的五个省的案件死亡率是世界卫生组织估计的两倍（5％-10％）。为了控制也门的白喉流行病，建议增加常规疫苗接种覆盖率和增强免疫，提高对白喉的公共健康意识，加强早期检测和立即反应的监测系统。

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