Re-emergence of pediatric diphtheria patients in Mae Sot Hospital, Tak Province in 2024: A cases series

Abstract

Background: The re-emerging of vaccine preventable disease, including respiratory diphtheria reflected gaps of the immunization-administration system among migrants of countries affected by political or armed conflicts.

Objective: To describe the clinical characteristics, management strategies, and outcomes of pediatric diphtheria cases in Thailand-Myanmar border at Mae Sot Hospital, Tak province, in 2024.

Methods: A retro-prospective descriptive study was conducted by reviewing the medical records of five pediatric patients diagnosed with diphtheria, confirmed either by laboratory testing or clinical criteria. Data collected included demographics, immunization history, clinical manifestations, complications, treatment modalities, and clinical outcomes.

Results: Five Myanmar pediatric patients were diagnosed respiratory diphtheria. One case lived in Myanmar and the remaining were in Mae Sot. They were among 4.25-9.08 years old and did not achieve vaccination schedule. Most of them presented with fever, sore throat, and pharyngeal diphtheric patch. Confirmatory lab was performed in 4 cases and the other was presumed clinically diagnosis as diphtheria. Severe complications included upper airway obstruction (2 cases), myocarditis (2 cases), acute kidney injury (2 cases), and neuritis (1 case). The overall case fatality rate was 40%, with myocarditis being the leading cause of death.

Conclusions: Diphtheria remains a significant public health concern among migrant populations and in high-risk areas due to inadequate immunization coverage. Efforts to ensure comprehensive vaccine coverage among both Thai population and migrants are essential to establish herd immunity and prevent the re-emergence of vaccine-preventable diseases.