Aderia Rintani, Tita Mintarsih, Yosef Muhammad Rachman Baniaz Muliawan, Juli Sapitri Siregar, Adhy Prasetyo Widodo


Background: Diphtheria is a vaccine preventable disease. In the last 10 years a significant fluctuation of diphtheria incidence led to an outbreak reported in some developing countries. The aim of this study was to review about risk factors in developing countries which are associated with high incidence of diphtheria.

Methods: We conducted systematic search studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods based on electronic sources from Pubmed, Proquest, Science Direct, Scopus, and EBSCO for relevant studies. Studies are eligible if the population studies were in developing countries; outcomes were related in risk factors associated to diphtheria outbreak; and design study was observational study.

Results: The 10 selected studies were done in India, Thailand, Lao PDR, Brazil, Dominican Republic, South Africa, and Nigeria. Low vaccination coverage, partially vaccinated or unvaccinated status and poor access to health care services are identified as the main factors that associated directly to diphtheria outbreak in most of the countries. The health care system factors such as availability of Diphtheria anti-toxin and the capability of health personnel in making early diagnosis and prompted treatment also play important roles in controlling Diphtheria outbreak. The study also highlight increasing risk for infection in adult due to waning antibody levels in adulthood.

Conclusion: Low vaccination coverage, poor access to health services, and low income were factors that had led to resurgence of diphtheria in developing countries. The strengthening of surveillance and health care system could give better chance in tackling the diphtheria outbreak.

Keywords: Outbreak, diphtheria, vaccination, risk factors



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