Six-Year Surveillance of Diphtheria Outbreak in Indonesia

BACKGROUND: Diphtheria outbreak has become a major problem in Indonesia since 2011. East Java province in Java Island, with 35 millions population, is the most severely affected area contributing approximately 80% of the total cases in the country. The objective of this study is to present a 6-year (2011–2016) surveillance report of diphtheria outbreak in East Java Indonesia METHODS: This study was based on surveillance data collected (actively and passively) at East Java Provincial Health Office from all districts since January 2011 until December 2016. The data came from the district and provincial hospitals, the health officers, the patients and families, and also the contacts. Microbiology cultures were performed at an international standard diphtheria laboratory in Surabaya. RESULTS: For six years period since 2011, there were 3,353 cases reported from 35 among 38 districts (92.1%), with the peak at 2012 (955 cases). This number was the second rank in the world after India. The case fatality rate was 3.3% (110 patients). Male (1,790, 53.4%) slightly outnumbered female. Although most patients were below 15 years old (2,343, 69.4%), the trend showed the increasing proportion of adolescents and adults. The largest proportion was on below 10 years of age. Based on the immunization status, the percentage of unimmunized patients, partially immunized, and completely immunized by age were 39%, 49.3%, and 11.7%, respectively. The youngest and oldest age among those deceased were 11 month and 70 year old. Only 197 nasal and throat swab specimens were positive for toxigenic Corynebacterium diphtheriae. Among serotypes, mitis was the most followed by gravis. There was only one case of intermedius. Most of the belfanti serotypes were non toxigenic. Despite many efforts such as multiple outbreak response immunization (ORI) especially in 2011–2013 this outbreak could not be stopped. CONCLUSION: For six years (2011–2016) there have been a diphtheria outbreak in East Java Indonesia. The highest number of patient was recorded in 2012. Most of the patients affected were not completely immunized. Each year, the positivity rate of throat and nasal swab culture were low. Until today, many efforts in severely affected area could not stop the high incidence of diphtheria cases. DISCLOSURES: All authors: No reported disclosures.