Diphtheria is declining but continues to kill many children: analysis of data from a sentinel centre in Delhi, 1997

Although diphtheria is declining in Delhi, case fatality rates (CFRs) are r ising. In 1997, of 143 clinically suspected cases admitted to the Infectiou s Diseases Hospital 45 (32%) died. We examined their records to understand the epidemiology and reasons for high CFRs. About 53% of cases were from De lhi; they were not limited to any particular area. All the deaths and 92% ( 131/143) of cases occurred in children below 10 years of age. Only 12% of c ases had received one or more doses of DPT. Muslims contributed significant ly more cases than Hindus. CFRs were significantly higher in young (P = 0.0 3) and unvaccinated (P = 0.01) children and in those who received antitoxin on the third day of illness or later (P = 0.03). The study highlights the importance of improved vaccine coverage and early diagnosis and prompt admi nistration of antitoxin in reducing CFRs for diphtheria in Delhi.