DIPHTHERIA REQUIRES ATTENTION: CURRENT STATE OF THE PROBLEM AND OWN OBSERVATIONS
DOI:
https://doi.org/10.11603/1681-2727.2022.3.13478Keywords:
diphtheria, incidence, children, vaccinationAbstract
SUMMARY. The aim of the work is to draw doctors’ attention to «forgotten» diphtheria and to analyze the clinical case of a severe form of diphtheria in a vaccinated child and the possible causes of the fatal outcome of the disease.
Materials and methods. According to the results of the article analysis obtained by searching in the databases PubMed, SCOPUS, Web of Science, MedScape, using the combination of terms «diphtheria in children», «diphtheria vaccination», «diphtheria incidence», «lethality in vaccinated children», we highlighted and summarized literary data related to the incidence, patterns of development of the unfavorable epidemic situation with diphtheria in the conditions of a decrease in collective antitoxic immunity, features of the clinical course and treatment of diphtheria in children, the current state of the problem.
The data of the inpatient card and the results of the pathological examination protocol of a child who died due to complications of a severe form of diphtheria were analyzed.
Results. Analyzing the data of the fatal course of diphtheria in a girl aged 4 years and 11 months, who was fully vaccinated, there are reasons to believe that unexplained violations of background immunological reactivity had an aggravating effect on the dynamics of disease manifestations. Under such preconditions, there is a discrepancy between the concepts of «vaccination» and «immunity» related to a certain infectious disease, in our case – in relation to diphtheria. It can be assumed that the child vaccinated according to the calendar plan was non-immune.
Conclusions. In the conditions of increasing sporadic incidence of diphtheria, doctors’ alertness regarding this dangerous disease should be increased. The given clinical case of diphtheria in a vaccinated child disproves the misconceptions about the impossibility of vaccinated persons contracting diphtheria and developing a severe form of the disease. Timely detection of the source of infection is determined, first of all, by the degree of doctors’ awareness, especially in primary health care, of the clinical manifestations of diphtheria, timely isolation of patients, conducting adequate treatment with the achievement of a sustainable remedial effect, as well as the implementation of epidemiological measures in the focus of infection. A necessary condition for the stabilization of epidemiological well-being and prevention of diphtheria is mandatory coverage of the entire child population with preventive vaccinations with diphtheria toxoid.
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