Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox’s Bazar, Bangladesh, 2017 to 2019: A retrospective study

作者：Jonathan A. Polonsky, Melissa Ivey, Md Khadimul Anam Mazhar, Ziaur Rahman, Olivier le Polain de Waroux, Basel Karo, Katri Jalava, Sirenda Vong, Amrish Baidjoe, Janet Dı́az, Flavio Finger, Zakir Hossain Habib, Charls Erik Halder, Christopher Haskew, Laurent Kaiser, Ali S. Khan, Lucky Sangal, Tahmina Shirin, Quazi Ahmed Zaki, Md. Abdus Salam, Kate White · 发表于：PLoS Medicine · 年份：2021 · DOI：10.1371/journal.pmed.1003587 · 被引用次数：78 · 研究领域：Diphtheria, Corynebacterium, and Tetanus、Bacterial Infections and Vaccines、Peripheral Neuropathies and Disorders

BACKGROUND: Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS: Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) c...