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Diphtheria in Metro Manila, the Philippines 2006-2017: A Clinical, Molecular, and Spatial Characterization.

Nobuo Saito, Virginia O Dimapilis, Hiroshi Fujii, Motoi Suzuki, Elizabeth Freda O Telan, Dorcas Valencia Umipig, Rontgene M Solante, Alexis Q Dimapilis, Ferdinand De Guzman, Eumelia P Salva, Fumihito Nakayama, Kohei Toda, Chris Smith, Koya Ariyoshi, Christopher M Parry
Clinical Infectious Diseases ; doi:10.1093/cid/ciaa005

Abstract: Diphtheria is a vaccine-preventable disease that persists as a global health problem. An understanding of the pattern of disease is lacking in low- and middle-income countries such as the Philippines. We conducted a retrospective review of the clinical, microbiological, and epidemiological features of patients admitted with a clinical diagnosis of diphtheria to an infectious disease referral hospital in Metro Manila, the Philippines, between 2006 and 2017. Cases were mapped and the distribution was compared with population density. Corynebacterium diphtheriae isolates from between 2015 and 2017 were examined by multilocus sequence typing (MLST). We studied 267 patients (range:12-54 cases/year) admitted between 2006 and 2017. The case fatality rate (CFR) was 43.8% (95% confidence interval, 37.8-50.0%). A higher number of cases and CFR was observed among children
Keywords: diphtheria / vaccination / MLST / the Philippines / Diphtheria antitoxin

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