Diphtheria outbreak in Indonesia, 2017: An outbreak of an ancient and vaccine-preventable disease in the third millennium

Diphtheria, caused by toxin-producing strains of Corynebacterium diphtheria, is a highly contagious but vaccine-preventable communicable disease. The bacterium primarily infects the pharynx, tonsils and nose but the toxin could affect vital organs such as the heart, kidneys, and nervous system. Globally, the case-fatality rate for diphtheria is 5%–10% but it could be higher (approximately 20%) among children younger than five years old and the elderly.1 Although many countries in the world have succeeded in eliminating diphtheria, it is re-emerging in some countries, including in the Republic of Indonesia, the most populous country in the South-east Asia region.