SRM Medical College Hospital & Research Centre

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Continuing Medical Education-Resurgence of Diphtheria

continuing-medical-education-resurgence-of-diphtheria

Date: 23.09.2019

Venue:Hospital Seminar Hall

Nature of Participants:Faculty Members and 250 medical and allied health science students

Audio Visual Aids Used:PI System and Desktop Computer and Overhead Projector

Name of the Resource Person:Dr. Palani, Deputy Director of Health, Chengalpattu

Goal:

At the end of the lecture,

  • the undergraduate and post graduate medical students and paramedical students of our Medical College will be able to understand and acquire knowledge on Diphtheria and skills to initiate appropriate measures to handle the epidemic of the disease.
  • The doctors will be able to update their knowledge of current government initiatives and current trends of the disease in Tamil Nadu.

Welcome Address

The lecture began with welcome address, wherein Dr. M. Logaraj, MD, Head of Community Medicine department, first briefly highlighted the resurgence of Diphtheria in our areas despite the government’s consistent effort to curb the spread of disease. He explained that the disease gradually emerged again among the migrant children, whose parents were engaged in construction works around Maraimalai Nagar. “It is also commonly seen among the children irrespective of their states across India, whose parents have migrated to other states in search of jobs for their livelihood”. “These children have been left under the care of elderly people at their homes, who pay very less attention to their health”, he added. He warmly welcomed Dr. Palani, Deputy Director of Health, Kanchipuram Districtand said that Doctor had come to their hospitalthen to deliver a speech on Resurgence of Diphtheria, in spite of his busy work schedule.

Introductory Address

Dr. Sekar, MD, Head of Paediatrics department, SRM MC&RC gave a brief introductory talk and explained that Institute of Child Health used to have 80 to 100 children admittedregularly for treatment in the hospital with Polio Miletus, Neonatal Tetanus, Pertussis and Diphtheria, which had symptoms of sore throat, coughing and swelling over neck. In 1985, DPT vaccination was invented and administeredcontinually toall new born children, which prevented many killerdiseases. He pointed out that most recently, many children with Diphtheria had been identified in Malapuram, Kerala, because they had not been correctly vaccinated, as their parents were in Middle East Countries for long time employment in various fields. Similarly, Tamil Nadu had become a tiny hub of Diphtheria disease. It was due to many people migrating continuedly to Tamil Nadu state from Bihar, Orrisa, West Bengal Madhya Pradesh, Assam states. Children are mostly affected by the disease. The children of the migrant parents are susceptible to have disease, as they were not vaccinated on the right time. However, The Government of Tamil Nadu convened a meeting recently with health officials working across the state and assessed the existing situation in the state and geared up the works to curb the disease. The government has taken an appropriate measure to cover the adult population by administering vaccination to them, he added. With this he concluded his talk and welcomed Dr. Palani.

Subsequently, Dr. Logaraj requestedDr. Swaminathan, Medical Superintendent to honourDr. Palani. Shaking hands with him, Dr. Swaminatanwrapped a shawl over his body as a gesture of welcome and presented a memento to him. Then, Dr. Venkatesh, Medical Officer, PHC Maraimalaibriefly and formally introduced Dr. Palani to the participants and he called upon him to come and enlighten the participants withthe approach adopted to control and prevent Diphtheria in Chengalpattu district. He said Dr. Palani was a deputy Director of Health in Chengalpattu district and he had been taking adequate measure to prevent the disease from spreading further. He also requested him to highlight the steps taken to curb the dengue in Kattankulathur block at the end.

Cause of Resurgence and Government’s Initiate

Dr. Palani, while began his talk, thanked Dr. Swaminathan, for co-ordinating and associating with government system in implementing health program for the people in Chengalpattu District and Dr. Logaraj and Dr. Sekar for inviting him to deliver a speech on Diphtheria in CME program. He explained that it was his fourth CME programs in a short period explaining the situation of Diphtheria to the Medical fraternity. Prolonged delay in administering the booster dose to the children, who had initial dose of vaccination by their parents was the core cause for sudden outbreak of the disease in Tamil Nadu. Similarly, many cases across India had been reporting to government hospital with symptoms. There were 130 cases reported in Tamil Nadu. “The disease is largely seen in Coimbatore, Erode, Madurai and Chennai cities, where huge migration occur and population density is very high compared to other cities”, he added. He further explained that the government had initiated a research study that revealed that failure to administer the booster dose of Diphtheria-1 and Diphtheria-2 was the main reason for outbreak. Shifting of the administration of vaccination to children on every Wednesday and Friday at the field level, to institution level in 2008, due to technical fault happened in one of the districts in Tamil Nadu was the second main reason. Failure to cover the private schools under the immunization programs was also a major cause. He continued to explain that a child aged 7 years studying in a private school in Pallavaram admitted to government hospital following the symptoms of difficulty in swallowing food, for treatment was another example of his parent’s reluctant to give their consent to their child to get vaccinated at the school resulted in Diphtheria. “Diphtheria spread through droplet infection”. “Each and every one attending my session here should administer, if you have taken vaccination in the past. “Don’t assume that you won’t get the disease”.“One can easily be contracted with disease, if your immune system lacks resistant to the disease” he added.

He further explained that Government could provide booster dose of vaccination, if SRM institution did not have enough stock of it through local PHC. At the same time, their institution should keep enough stock of Erythromycin tablets, when patients came with serve fever with sore throat, they could be administered with Erythromycin and it could prevent them from further infection. He indicated that village Health Nurse in the government sector were empowered to administer Erythromycin at the field. The incubation period of Diphtheria was ten days. It had been one and half month since the school in Palavaramhad conducted vaccination camp. The refusal of child’s parents had led the child to have Diphtheria then. It could have been prevented. The parents should always co-operate with the government, when it implemented health programs for the well-being of their children at school level. Dr. Perumal, District Medical Officer would apparently explain in detail on Diphtheria. He said,if he came across any person with symptoms of Diphtheria in the locality, where they worked. They would initiate immediate treatment to him/her. They would also seek to identify the people, whom the patients had contacted and interacted with,in the last two days and initiate an appropriate action to prevent them from being contracted with the disease. With this let me conclude my session and Dr. Perumal would make detailed power point presentation on Diphtheria he added.

Session on Diphtheria

Dr. Perumal began to explain on Diphtheria. He clearly and profoundly explained that it wasonce prevalence in Tamil Naduand was eradicated completely, because of the stringent implementation of vaccination program across our state by the State Government. However, it had reemerged there due the constant migration of people from other state into their state. During the program implementation, it was found that children of other states and parents working abroad were more susceptible to have disease than other people in the state. Despite the government’sintense efforts to bring down the prevalence rate in the state, there were other factors like language of migrant people, children under the care of elderly and ignorance and lack of access to health care system that hinderedpeople to get their children immunized. After giving brief overview of the disease.

He explained various components of disease and control measures such as definition of disease, Magnitude of the problem, signs and symptoms, VPD cases in Kerala, Risk Carriers, Aetiopathology, Statistics of Disease in India, Public Health Significance and Clinical Feature. The other aspects covered by during the presentation were Complications, Treatment, Control measures, Case Management, Close monitoring Administration of Diphtheria vaccine, Early intervention, Shocking Management, Discharge Policy, Community Intervention Program, etc. At the end of the presentation, the participants were encouraged to ask questions pertaining to the disease control and role of the doctors in the prevention work. Dr. Palani was fervently engaged himself in clarifying doubts raised by the faculty members and students. At last, Dr. Perumal was honoredby presenting mementos and wrapping up of shawl over his body by Dr. Sekar.Dr. Logaraj proposed vote of thanks.

Conclusion

The programreceived overwhelming co-operation and supports from the students and staffs. itwas very informative and obviously beneficial to all those who had participated. The participation of staff members and students with resource persons in Question and Answer session was creditable and paved a way for getting to know current trends in disease prevention and control.The information shared on the practical experience and program implementation of government of Tamil Nadu has enlightened the students to aware of government program.