Volume 97, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Diphtheria is an acute disease caused by exotoxin-producing . Globally, diphtheria has been showing a declining trend due to effective childhood vaccination programs. A substantial proportion of global burden of diphtheria is contributed by India. Hospital-based surveillance studies as well as diphtheria outbreaks published in last 20 years (1996–2016) indicate that diphtheria cases are frequent among school-going children and adolescents. In some Indian states, Muslim children are affected more. As per the national level health surveys, coverage of three doses of diphtheria vaccine was 80% during 2015–2016. Information about coverage of diphtheria boosters is not routinely collected through these surveys, but is expected to be low. Few studies also indicate low diphtheria immunity among school-going children and adults. The strategies for prevention of diphtheria need to focus on improving coverage of primary and booster doses of diphtheria vaccines administered as a part of Universal Immunization Program as well as introducing diphtheria vaccine for school-going children.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Vitek CR, Wharton M, , 1998. Diphtheria in the former Soviet Union: reemergence of a pandemic disease. Emerg Infect Dis 4: 539550.[Crossref] [Google Scholar]
  2. WHO, 2006. Diphtheria vaccine WHO Position Paper. 81: 21–32.
  3. Galazka A, , 2000. The changing epidemiology of diphtheria in the vaccine era. J Infect Dis 181: S2S9.[Crossref] [Google Scholar]
  4. WHO, 2016. Immunization, Vaccines and Biologicals. Reported Cases of Selected Vaccine Preventable Diseases (VPDs). Available at: http://www.who.int/immunization/monitoring_surveillance/data/en/. Accessed April 15, 2017.
  5. Central Bureau of Health Intelligence (CBHI), Govt of India. National Health Profile 2005 Onwards. Available at: http://www.cbhidghs.nic.in/index1.asp?linkid=267. Accessed April 15, 2017.
  6. National family health survey (NFHS-2) 1998–99, 2000. Mumbai: International Institute for Population Sciences (IIPS) and Macro International. Available at: http://www.rchiips.org/nfhs/nfhs2.shtml. Accessed April 14, 2017.
  7. National family health survey (NFHS-3) 2005–06, 2007. Mumbai: International Institute for Population Sciences (IIPS) and Macro International. Available at http://www.rchiips.org/nfhs/nfhs3.shtml. Accessed April 14, 2017.
  8. National family health survey (NFHS-4) 2015–16, 2016. Mumbai: International Institute for Population Sciences (IIPS) and Macro International. Available at http://www.rchiips.org/nfhs/nfhs4.shtml. Accessed April 14, 2017.
  9. District level household & facility survey (DLHS-1). Mumbai: International Institute for Population Sciences. Available at: http://www.rchiips.org/ARCH-1.html. Accessed April 14, 2017.
  10. District level household & facility survey (DLHS-2). Mumbai: International Institute for Population Sciences. Available at: http://www.rchiips.org/ARCH-2.html. Accessed April 14, 2017.
  11. District level household & facility survey (DLHS-3). Mumbai: International Institute for Population Sciences. Available at: http://www.rchiips.org/ARCH-3.html. Accessed April 14, 2017.
  12. Ministry of India, Govt of India. Coverage of Evaluation Survey. Available at: http://hshrc.gov.in/wp-content/uploads/National_Fact_Sheet_CES_2009.pdf. Accessed April 14, 2017.
  13. Ministry of Women and Child Development, Govt of India. Rapid Survey on Children (ROSC) 2013-14. Available at: http://wcd.nic.in/sites/default/files/RSOC%20FACT%20SHEETS%20Final.pdf. Accessed April 14, 2017.
  14. Singh J, Harit AK, Jain DC, Panda RC, Tewari KN, Bhatia R, Sokhey J, , 1999. Diphtheria is declining but continues to kill many children: analysis of data from a sentinel centre in Delhi, 1997. Epidemiol Infect 123: 209215.[Crossref] [Google Scholar]
  15. Sharma NC, Banavaliker JN, Ranjan R, Kumar R, , 2007. Bacteriological and epidemiological characteristics of diphtheria cases in and around Delhi: a retrospective study. Indian J Med Res 126: 545552. [Google Scholar]
  16. Singhal T, Lodha R, Kapil A, Jain Y, Kabra SK, , 2000. Diphtheria-down but not out. Indian Pediatr 37: 728738. [Google Scholar]
  17. Lodha R, Dash NR, Kapil R, Kabra SK, , 2000. Diphtheria in urban slums in north India. Lancet 355: 204.[Crossref] [Google Scholar]
  18. Kanwal SK, Yadav D, Chhapola V, Kumar V, , 2012. Post-diphtheritic neuropathy: a clinical study in paediatric intensive care unit of a developing country. Trop Doct 42: 195197.[Crossref] [Google Scholar]
  19. Bhagat S, Grover SS, Gupta N, Roy RD, Khare S, , 2015. Persistence of Corynebacterium diphtheriae in Delhi and National Capital Region (NCR). Indian J Med Res 142: 459461.[Crossref] [Google Scholar]
  20. Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK, , 2004. A retrospective study of diphtheria cases, Rajkot, Gujarat. Indian J Community Med 29: 161163. [Google Scholar]
  21. Talsania N, Chauhan J, Nayak H, Shah C, Modi K, Devaliya J, , 2011. Investigation of an outbreak of diphtheria in Dabela village of Amirgagh taluka and CHC, Banaskantha, Gujarat (current scenario). Nat J Commun Med 2: 196200.[Crossref] [Google Scholar]
  22. Iyer V, Azhar GS, Choudhury N, Dhruwey VS, Dacombe R, Upadhyay A, 2014, . Emerg Infectious disease burden in Gujarat (2005–2011): comparison of selected infectious disease rates with India. Health Threats J 7: 22838. [Google Scholar]
  23. Singh SN, Singh A, Chandra S, , 2014. Clinical profile and predictors of poor outcome of hospitalized diphtheria cases in children from Lucknow region of north India. Clin Epidemiol Glob Heal 2: 7579.[Crossref] [Google Scholar]
  24. Kumar R, Kumar P, Prajapati NC, Kumar D, Goyal A, Vijayran M, , 2013. Diphtheria: is it really OUT? J Pediatr Sci 5: e188. [Google Scholar]
  25. Nandi R, De M, Browning S, Purkayastha P, Bhattacharjee AK, , 2003. Diphtheria: the patch remains. J Laryngol Otol 117: 807810.[Crossref] [Google Scholar]
  26. Saikia L, Nath R, Saikia NJ, Choudhury G, Sarkar M, , 2010. A diphtheria outbreak in Assam, India. Southeast Asian J Trop Med Public Health 41: 647652. [Google Scholar]
  27. Nath B, Mahanta TG, , 2010. Investigation of an outbreak of diphtheria in borborooah block of dibrugarh district, Assam. Indian J Community Med 35: 436438.[Crossref] [Google Scholar]
  28. Das PP, Patgiri SJ, , 2016. Saikia L3 Paul D. Recent outbreaks of diphtheria in Dibrugarh District, Assam, India. J Clin Diagn Res 10: DR01DR03. [Google Scholar]
  29. Khan N, Shastri J, Aigal U, Doctor B, , 2007. Resurgence of diphtheria in the vaccination era. Indian J Med Microbiol 25: 434.[Crossref] [Google Scholar]
  30. Dravid MN, Joshi SA, , 2008. Resurgence of diphtheria in Malegaon and Dhule regions of north Maharashtra. Indian J Med Res 127: 616617. [Google Scholar]
  31. Phalkey RK, Bhosale RV, Joshi AP, Wakchoure SS, Tambe MP, Awate P, Marx M, , 2013. Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India. BMC Publ Health 13: 317.[Crossref] [Google Scholar]
  32. Basavaraja GV, Chebbi PG, Joshi S, , 2016. Resurgence of diphtheria: clinical profile and outcome: a retrospective observational study. Int J Contemp Pediatr 3: 6063. [Google Scholar]
  33. Dandinarasaiah M, Vikram BK, Krishnamurthy N, Chetan AC, Jain A, , 2013. Diphtheria re-emergence: problems faced by developing countries. Indian J Otolaryngol Head Neck Surg 65: 314318.[Crossref] [Google Scholar]
  34. Parande MV, Parande AM, Lakkannavar SL, Kholkute SD, Roy S, , 2014. Diphtheria outbreak in rural north Karnataka, India. JMM Case Rep. doi:10.1099/jmmcr.0.003558. [Google Scholar]
  35. Havaldar PV, Sankpal MN, Doddannavar RP, , 2000. Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome. Ann Trop Paediatr 20: 209215.[Crossref] [Google Scholar]
  36. Anima H, Malay M, Santanu H, Rajashree R, Sita C, Baran SA, , 2008. A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID and BG Hospital of Kolkata. J Commun Dis 40: 5358. [Google Scholar]
  37. Basak M, Chaudhuri SB, Ishore K, Bhattacherjee S, Das DK, , 2015. Pattern and trend of morbidity in the infectious disease ward of North Bengal Medical College and Hospital. J Clin Diagn Res 9: LC01LC04. [Google Scholar]
  38. Kole AK, Roy R, Kar SS, Chanda D, , 2010. Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital. Indian J Med Sci 64: 373377.[Crossref] [Google Scholar]
  39. Bitragunta S, Murhekar MV, Hutin YJ, Penumur PP, Gupte MD, , 2008. Persistence of diphtheria, Hyderabad, India, 2003–2006. Emerg Infect Dis 14: 11441146.[Crossref] [Google Scholar]
  40. Meera M, Rajarao M, , 2014. Diphtheria in Andhra Pradesh: a clinical-epidemiological study. Int J Infect Dis 19: 7478.[Crossref] [Google Scholar]
  41. Jhancy M, Satyavani A, Manikyamba D, Tulasi Deepthi K, , 2015. Re-emergence of diphtheria: an outbreak from east Godavari District, Andhra Pradesh. Pediatr Infect Dis 7: 3335.[Crossref] [Google Scholar]
  42. Jain A, Samdani S, Meena V, Sharma MP, , 2016. Diphtheria: it is still prevalent!!! Int J Pediatr Otorhinolaryngol 86: 6871.[Crossref] [Google Scholar]
  43. Singh N, Singh AK, Gaur S, , 2013. A study of diphtheria menace in Kumaun region of Uttarakhand state in India. Journal of Drug Delivery & Therapeutics 3: 105107. [Google Scholar]
  44. Jayashree M, Shruthi N, Singhi S, , 2006. Predictors of outcome in patients with diphtheria receiving intensive care. Indian Pediatr 43: 155160. [Google Scholar]
  45. Poddar B, Parmar VR, , 2000. Diphtheria–certainly not out. Indian Pediatr 37: 13931395. [Google Scholar]
  46. John TJ, Rajappan K, Arjunan KK, , 2004. Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India. Indian J Med Res 120: 8693. [Google Scholar]
  47. Murhekar MV, Bitragunta S, Hutin Y, Ckakravarty A, Sharma HJ, Gupte MD, , 2009. Immunization coverage and immunity to diphtheria and tetanus among children in Hyderabad, India. J Infect 58: 191196.[Crossref] [Google Scholar]
  48. Singh J, Ichhpujani RL, Prabha S, Chandra R, Khare S, Panda RC, Datta KK, , 1996. Immunity to diphtheria in women of childbearing age in Delhi in 1994: evidence of continued Corynebacterium diphtheriae circulation. Southeast Asian J Trop Med Public Health 27: 274278. [Google Scholar]
  49. Saxena S, Jais M, Dutta R, Dutta AK, , 2009. Serological immunity to diphtheria and tetanus in healthy adults in Delhi, India. Trop Doct 39: 160163.[Crossref] [Google Scholar]
  50. Satwekar AM, Telang SS, Ghorpade NA, Barde PJ, Patwardhan MR, Kulkarni PS, , 2011. Diphtheria and tetanus antibody persistence in Indian pre-school children and response to a booster dose of DT vaccine. World J Vacc 1: 59.[Crossref] [Google Scholar]
  51. Kulkarni PS, Raut SK, Dhorje SP, Barde PJ, Koli G, Jadhav SS, , 2011. Diphtheria, tetanus, and pertussis immunity in Indian adults and immunogenicity of td vaccine. ISRN Microbiol 2011: 745868.[Crossref] [Google Scholar]
  52. Havaldar PV, , 1992. Diphtheria in the eighties: experience in a South Indian District Hospital. J Indian Med Assoc 90: 155156. [Google Scholar]

Data & Media loading...

  • Received : 18 Jan 2017
  • Accepted : 19 Apr 2017
  • Published online : 26 Jun 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error