Correlation between immunization status and pediatric diphtheria patients outcomes in the Sampang District, 2011-2015

Background The number of diphtheria cases recently increased, such that an outbreak was declared in East Java Province, which includes the Sampang District. Immunization completion status is a determining factor for diptheria infection. Objective To investigate for correlations between immunization status and outcomes (severity level, fatality, and complications) of diphtheria patients in the Sampang District. Methods This analytic, cross-sectional study used secondary data from the East Java Provincial Health Office on diphteria patients aged 0-20 years during the 2011-2015 outbreak in the Sampang District and interviews with diphtheria patients in that region. The Diphtheria Research Team of Soetomo Hospital collected data on immunization status, diphtheria severity (mild, moderate, or severe), case fatality (died or survived), and complications in the patients (with or without complications). Spearman’s, Chi-square, and Fisher’s exact tests were used for data analyses, accordingly. Results Seventy-one patients with clinical diphtheria were identified, 17 of whom were confirmed with positive culture results. The case fatality rates were 7% in patients with clinical and 5.9% in confirmed diphtheria. There were no correlations between patient immunization status and severity (P=0.469 clinical, P=0.610 confirmed), or fatality (P=0.618 clinical, P=0.294 confirmed) of diphtheria in the clinical and confirmed diphtheria patients. However, there was a correlation between patient immunization status and the emergence of complications in clinical (P=0.013), but not in confirmed (P=0.620) diphtheria patients. Conclusion There is a correlation between immunization status and complications in clinical diphtheria patients. Such a correlation is not found in confirmed diphtheria cases because none of the patients had complete immunization status

HUBUNGAN ANTARA STATUS IMUNISASI DENGAN TINGKAT KEPARAHAN PADA PASIEN DIFTERI DI KABUPATEN SAMPANG TAHUN 2011-2015

BACKGROUND: Diphtheria is a contagious acute infectious disease caused by the exotoxin of Corynebacterium diphtheriae bacteria. The number of diphtheriae cases is increasing in East Java province, Indonesia. Immunization completion status is considered to be the most determining factor of diptheriae incidence in population. The objective of this study is to investigate the correlation between the immunization status and the severity of diphtheriae in Sampang Regency. METHOD: This study is an analytic study with a cross-sectional approach. The sampling in this study used random sampling. Data is obtained from medical records from East Java Provincial Office of Health Affairs. Incomplete data was supported by interviewing diphtheria patients in the region. The data collected were about immunization status, the diphtheriae severity (mild, moderate, or severe diphtheriae), case fatality (dead or survived) and complications in the patients (with or without complications). Data were collected, sorted, edited, coded, cleaned, tabulated and analyzed by a computer software using Spearman, Chi-square, and Fisher’s Extract test accordingly. RESULT: 71 patients with clinical diphtheriae were identified, 17 were confirmed with positive culture results. Case Fatality Rate is 7,0% in patient with clinical diphtheria and 5,9% in those with confirmed diphtheria. Our study shows no significant correlation between patients’ immunization status with the severity (p=0,469 clinical, p=0,610 confirmed) and fatality (p=0,618 clinical, p=0,294 confirmed) of diphtheriae in the clinical and confirmed diphtheriae patients. But there is a correlation between patients’ immunization status and the emergence of complications in clinical diphtheriae (p=0,013) patients but not in confirmed diphtheriae patients (p=0,620)