A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response

Introduction: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Although the incidence of diphtheria worldwide has rapidly declined following the largely successful diphtheria toxoid-based vaccines, concerns persist for those who were unvaccinated or incompletely vacc...

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Main Authors: Peter Seah Keng Tok, Misbaha Jilani, Nurul Fateha Misnar, Nor Suzila Bidin, Norli Rosli, Haidar Rizal Toha
Format: Article
Language:English
Published: The Journal of Infection in Developing Countries 2022-07-01
Series:Journal of Infection in Developing Countries
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Online Access:https://jidc.org/index.php/journal/article/view/16076
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author Peter Seah Keng Tok
Misbaha Jilani
Nurul Fateha Misnar
Nor Suzila Bidin
Norli Rosli
Haidar Rizal Toha
author_facet Peter Seah Keng Tok
Misbaha Jilani
Nurul Fateha Misnar
Nor Suzila Bidin
Norli Rosli
Haidar Rizal Toha
author_sort Peter Seah Keng Tok
collection DOAJ
description Introduction: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Although the incidence of diphtheria worldwide has rapidly declined following the largely successful diphtheria toxoid-based vaccines, concerns persist for those who were unvaccinated or incompletely vaccinated. In this report, we describe a recent diphtheria outbreak in Malaysia involving four confirmed diphtheria cases. Methodology: The outbreak investigation efforts and epidemiological characteristics of a diphtheria outbreak in Malaysia are described. For all suspected cases, swabs were taken and sent for isolation of Corynebacterium diphtheriae and confirmation of toxigenic strains. Results: The index case was a two-year-old child living with his family in a welfare home. Following contact tracing efforts and investigation for suspected cases, seven samples came back as culture positive for Corynebacterium diphtheriae. Confirmation of toxigenic strains was performed using PCR and Elek’s test, which showed 100% correlation in positivity for four of the samples. All four confirmed cases were below 18 years of age, and three of them did not have complete vaccination history (two unvaccinated, one unknown). The index case eventually succumbed due to severe diphtheria with multiorgan failure while all the other cases were discharged healthy. Conclusions: In Malaysia, despite good vaccination coverage, sporadic diphtheria outbreaks still occur. The rising trend of cases reported over the recent years underscores the need to remain vigilant. Addressing pockets of unvaccinated children and potential waning immunity levels in the population remains pivotal.
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publisher The Journal of Infection in Developing Countries
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spelling doaj-art-340a9fd86d9b45ce9c8ec00af556e19d2025-08-20T02:27:07ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802022-07-01160710.3855/jidc.16076A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and responsePeter Seah Keng Tok0Misbaha Jilani1Nurul Fateha Misnar2Nor Suzila Bidin3Norli Rosli4Haidar Rizal Toha5Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, MalaysiaBacteriology Unit, Johor Bahru Public Health Laboratory, Ministry of Health Malaysia, Johor, MalaysiaBacteriology Unit, Johor Bahru Public Health Laboratory, Ministry of Health Malaysia, Johor, MalaysiaJohor Bahru District Health Office, Ministry of Health Malaysia, Johor, MalaysiaJohor Bahru District Health Office, Ministry of Health Malaysia, Johor, MalaysiaJohor Bahru District Health Office, Ministry of Health Malaysia, Johor, Malaysia Introduction: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Although the incidence of diphtheria worldwide has rapidly declined following the largely successful diphtheria toxoid-based vaccines, concerns persist for those who were unvaccinated or incompletely vaccinated. In this report, we describe a recent diphtheria outbreak in Malaysia involving four confirmed diphtheria cases. Methodology: The outbreak investigation efforts and epidemiological characteristics of a diphtheria outbreak in Malaysia are described. For all suspected cases, swabs were taken and sent for isolation of Corynebacterium diphtheriae and confirmation of toxigenic strains. Results: The index case was a two-year-old child living with his family in a welfare home. Following contact tracing efforts and investigation for suspected cases, seven samples came back as culture positive for Corynebacterium diphtheriae. Confirmation of toxigenic strains was performed using PCR and Elek’s test, which showed 100% correlation in positivity for four of the samples. All four confirmed cases were below 18 years of age, and three of them did not have complete vaccination history (two unvaccinated, one unknown). The index case eventually succumbed due to severe diphtheria with multiorgan failure while all the other cases were discharged healthy. Conclusions: In Malaysia, despite good vaccination coverage, sporadic diphtheria outbreaks still occur. The rising trend of cases reported over the recent years underscores the need to remain vigilant. Addressing pockets of unvaccinated children and potential waning immunity levels in the population remains pivotal. https://jidc.org/index.php/journal/article/view/16076Diphtheriadisease outbreaksCorynebacterium diphtheriavaccine-preventable diseasesMalaysia
spellingShingle Peter Seah Keng Tok
Misbaha Jilani
Nurul Fateha Misnar
Nor Suzila Bidin
Norli Rosli
Haidar Rizal Toha
A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
Journal of Infection in Developing Countries
Diphtheria
disease outbreaks
Corynebacterium diphtheria
vaccine-preventable diseases
Malaysia
title A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
title_full A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
title_fullStr A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
title_full_unstemmed A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
title_short A diphtheria outbreak in Johor Bahru, Malaysia: Public health investigation and response
title_sort diphtheria outbreak in johor bahru malaysia public health investigation and response
topic Diphtheria
disease outbreaks
Corynebacterium diphtheria
vaccine-preventable diseases
Malaysia
url https://jidc.org/index.php/journal/article/view/16076
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