Outbreak of Diphtheria in South Darfur, Sudan

Introduction: A cluster of suspected cases of diphtheria among children occurred in Al-Sunta locality in State of South Darfur, Sudan triggered an investigation to confirm occurrence, assess magnitude of and assist in response to the outbreak. Methodology: Village-to-village active case-finding guided with a sensitive case definition and verbal autopsy. Focus Group Discussions (FGDs) with community leaders in 15 villages and nomadic pastoralists that reported cases. Results: Out of 97 cases of diphtheria including 12 deaths (Case Fatality Ratio (CFR) = 12.4%). Female: male sex ratio was 1.69. The mean age (N. SD, IQR, was 12.5 (61, 8.6., 7.0-16.0) and 11.0 (36, 6.0-13.5) for females and males respectively; (p>0.05). Most of the cases occurred among ten neighboring villages. There were no cases reported among nomadic pastoralists. Of all cases, 46 (83.6%) were not vaccinated. Only 40 out of 111 school children were vaccinated (36.4%; [95% Confidence Interval (CI): 27.1% - 45.7%]). There were more vaccinated children among older pupils (grade 6-8) as compared to younger children (grade 1-3). Only five of the fifty-two (9.6%; 95% CI: 3.2- 21.0%) nomadic pastoralists who attended an extended FGD among nomads indicated that vaccinating their children against poliomyelitis 3.8% (95% CI: 1.6% -17.6%). Only two (3.8%; 95% CI: 1.6% -17.6%) reported taking their children to one or more of the routine vaccinations at fixed sites. Conclusions: The vaccination coverage against childhood immunize able [ET1] was very low in affected localities in South Darfur corrected by implementation of a vaccination campaigns and strengthening routine childhood vaccination program.