Diphtheria deaths: What makes children vulnerable to disease that can be prevented by vaccinationhttps://indianexpress.com/article/cities/delhi/diphtheria-deaths-what-makes-children-vulnerable-to-disease-that-can-be-prevented-by-vaccination-5496495/

Diphtheria deaths: What makes children vulnerable to disease that can be prevented by vaccination

In the last four months, over 60 children have died of diphtheria in Delhi’s Maharishi Valmiki Infectious Diseases Hospital. The Indian Express tracked down their families to understand what makes children vulnerable to a disease that can be prevented by vaccination.

A mother prays at the capital’s Maharishi Valmiki Infectious Diseases Hospital, which saw a spate of deaths in September.

The single-storey building of the Infectious Disease Hospital (IDH), Vrindavan, has three rooms — one for the doctor, and the others for medicines and equipment. A hand pump lies abandoned, bathroom doors are broken, and a corner of the one-acre campus also serves as a home to monkeys, cows and pigs. Pharmacist Rakesh Yadav is engaged in banter with two other staff members. “The hospital has facilities to deal with fever, cough, cold, etc. For serious diseases like diphtheria, we refer patients to the district hospital as we don’t have facilities to admit them,” he said.

A half-hour distance from IDH is Mathura’s district hospital, situated in the heart of Civil Lines. Two doctors sit at the entrance to the emergency ward. “For diseases like diphtheria, we refer the patient to Delhi or a private medical college. We don’t have isolation centres needed to prevent other patients from getting infected,” said a doctor.

That’s why Prabhu Dayal, who lost his five-year-old son Pankaj on October 1, had to bring him to Maharishi Valmiki Infectious Diseases (MVID) Hospital in Delhi for treatment.

Forty kilometres from Mathura’s district hospital is the small hamlet of Janu, population 3,000. Dayal sits in the verandah of his home, surrounded by village elderly who have come to offer condolences. “He was suffering from fever and neck pain since September 28. We took him to a nursing home in Govardhan, 18 km away. They referred him to Mathura Civil Hospital, where he was given blood and referred to a private hospital. From there, he was referred to MVID. We were there for four days, after which he died,” he said.

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Like Dayal, most families The Indian Express spoke to in Jewar, Mathura, Aligarh and Bulandshahr said it took them two-three days to figure out what their children were suffering from, and by the time they reached MVID, precious time had been lost.

Chief Medical Officer of Mathura district, Dr Sher Singh, said that after several cases were reported from MVID Hospital, communications to stock up on anti-diphtheria serum were sent out by top government officials. “Currently, hospitals in Mathura and nearby districts do not have the serum. We are planning to procure some,” he said.

Dr Yogesh Jain, a public health physician at Jan Swasthya Sahyog, Chhattisgarh, said it should be compulsory for district hospitals to have the serum, whether or not it is needed.

As reported by The Indian Express, at Delhi’s MVID Hospital, too, doctors had spoken about two factors that contributed to the deaths: A delay in patients coming to them, and the lack of the life-saving serum.

A consultant at the North-MCD run hospital, senior doctor D K Seth, said, “Diphtheria needs to be diagnosed early and treated with the serum. If you delay treatment by three-four days, bacteria kills cells in the mouth, nose and throat. The dead cells form a membrane which can attach to the throat and lead to death by choking. It also causes heart failure.”

Under pressure

A comparison of the last five years shows 2018 saw the highest number of diphtheria cases being admitted to MVID Hospital, the only one in Delhi that deals with the disease. Of the 746 patients admitted here till December 15, 96 died, most of them children.

The hospital was in news in September, when 11 children died of diphtheria between September 6 and 19, with parents attributing the deaths to non-availability of the serum. A total of 25 children died that month. October and November saw 22 and 12 deaths.

The hospital did not have the serum since November last year, and it was procured only after the intervention of the Union Health Ministry following the September deaths.

But doctors at the hospital insist most patients reach them when it’s already too late. They added that the last four months of the year are usually the worst as weather conditions are conducive to the disease. Over 500 patients were admitted to the hospital in this duration, as compared to the 250-odd cases from January to August.

Pigs outside the campus of Vrindavan’s Infectious Disease Hospital.

A report presented by the North civic body in the wake of the deaths also pointed to a host of other problems: The hospital has no blood bank, ambulance, X-ray, intensive care or high dependency facilities for patients, and operation theatre services are non-functional. “The diphtheria wards were poorly lit, proper isolation facilities were not available, intravenous infusion pumps and contagious cardiac respiratory monitoring facilities were not available and there were no intensive care or high dependency facilities for sick patients,” the report stated.

Further, anti-arrhythmic drugs (used to treat abnormal heart rhythms) and tracheotomy facilities (an incision in the windpipe to relieve obstruction to breathing) were not available, it stated. The report also said OT services are non-functional and only five general duty medical officers are posted here.

Director, hospital administration, of North civic body Arun Yadav said the hospital has adequate stock of serum at the moment. He said the civic body has shared addresses of children who died with the World Health Organisation and central government agencies, and a survey is being done to know where vaccination programmes are lacking.

A preventable tragedy

To combat diphtheria, a combination vaccine is usually administered to children at the age of 2-4 months, followed by four booster shots till the age of 4-6 years. Government and private hospitals, as well as anganwadi workers, are supposed to educate parents about the vaccine and urge them to get their children vaccinated for the disease which, according to the World Health Organisation, can be fatal in 5-10% of cases.

Around 100 km from Delhi and 5 km from Jewar, passing through congested lanes that accommodate only one car at a time, lies Nangla Chitar village, population 4,000, a majority of them Muslim.

Mohammad Irfan, whose two-year-old son Kaif died at MVID Hospital, lives at the periphery. A pucca structure of one floor with an open terrace, the house is vacant except for Kaif’s grandmother Asmina Begum. Irfan and his wife have gone to visit relatives.
“Kaif’s death broke them, so Irfan took his wife to her parents’ house,” she said.

Family members said that out of Irfan’s three children — Kaif (2), Arsh (5) and Sofiya (7) — only the youngest was not vaccinated against diphtheria.

“Hamein hamesha kaha gaya hai ki jo dawa sarkar deti hai usse agar Muslim bache piyenge to woh kabhi bache paida nahi kar payenge, par pichle teen-char saal mein ye halla aur zor se hua (We were always told by villagers that in the guise of vaccination, the government is giving medicines because of which Muslim children will be rendered impotent. In the past three-four years, more and more people have been saying this),” she said.

Next to Irfan’s house are two bamboo benches where villagers have gathered.

Mohammad Jameel, whose son Sohaib died of diphtheria four months ago, blamed poor healthcare facilities. Jameel spent four days taking his son to private hospitals in Palwal, Bulandshahr, Faridabad and Delhi, but couldn’t reach MVID Hospital in time.

“My son complained of trouble swallowing food and had fever. I first consulted a local doctor in our village, who advised us to take him to Bulandshahr. They referred us to Palwal and that hospital referred us to one in Faridabad. When we reached Faridabad, they asked us to go to Kalawati hospital in Delhi. Doctors there said his kidney was damaged due to diphtheria and advised us to take him to Apollo. We thought it was better to come back as we didn’t have enough money for a kidney transplant. He died while we were on our way back,” he said.

Jameel’s daughter showed the same symptoms three months ago, but this time he immediately rushed her to MVID Hospital. “They kept her for eight-ten days and she was cured. When I was back, I made arrangements for an announcement to be made from the masjid that every parent should get their children vaccinated,” he said.

Like Jameel, Mohammad Chote, who lives in Aligarh and lost three of his nieces to diphtheria in the last three months at MVID Hospital, said, “We were told these vaccines will make you handicapped or impotent.”

Soniya, an auxiliary nurse midwife at Vrindavan, said that several families are even reluctant to get their children vaccinated against polio. “There have been times when they take their children to rooftops and threaten to throw them if Asha workers or we enter their home,” she claimed.

Dr Jain, the public health physician from Chhattisgarh, said, “If there is a myth attached to vaccination, it is the duty of the government to restore the trust. Vaccination programmes don’t just mean giving medicine to children but launching awareness programmes so such myths are broken. In Chhattisgarh, there are several Hindu families too where the disease is rampant.”

“There is no programme for vaccinating children above five years, when one should be given booster dose after every 10 years after a child reaches 10,” he said. As per the government of India’s immunisation programme, children are given vaccines at the age of one-and-a-half months, two-and-a-half months and three-and-a-half months. They are then given booster doses between 16 and 24 months and between 5 and 7 years.

Chander Kant’s four-year-old son Ashish was among those who died at MVID. At their home in Gangagarh near Aligarh, Ashish’s mother Shashi Bala said, “We got our child vaccinated regularly. I don’t know what happened.” She said that after her son complained of throat pain, she took him to local doctors in Ramghat and then to Narora and Aligarh. “The hospital in Aligarh told us they don’t have the serum and asked us to go to AIIMS, which referred him to MVID, where he died,” she said.

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Dr Jain has a theory on what could have caused the disease in such a case. DPT vaccines need to be stored at a temperature below 20 degrees Celsius, but at the same time it has to be ensured they don’t freeze. “In some cases, this could be why despite a child being vaccinated, he or she suffers from the disease,” he said.