Introduction of Diphtheria Component Addition in Immunization During Pregnancy

Dear Editor,

As medical science advances, new inventions and information become available on a daily basis. Various infectious diseases lead to illnesses and deaths. Every year, millions of people die as a result of a lack of precaution and disease prevention. Proper hygiene, adequate knowledge and implementation, standard living conditions, adequate nutrition, and vaccines are some of the important interventions in disease prevention. ¹

When we think of pregnant women, it is important to practice extra caution before advising and prescribing any health tips, medicines, or investigations. Without appropriate information we cannot advise any new thing to a pregnant female. Everyone has an equal role in it, including the government and the World Health Organization (WHO). Procedures or medicines used during the pregnancy not only affect the mother, but also the child during the intrauterine period as well as after birth. ²

Several infectious diseases can be prevented with the use of vaccines in children. Universal immunization program caters for this goal. Vaccines are given to mothers during pregnancy to protect the child from infection, as a part of national immunization schedule. In 2013, Advisory Committee on Immunization Practices recommended administrating the Tetanus, Diphtheria, and Pertussis vaccines to Ante-Natal Care (ANC) women to prevent those diseases in newborns and children. ³

WHO has recommended replacing the Tetanus (TT) vaccine with Td Vaccine in 1998, which was not implemented at that time in India. As per data, majority of diphtheria cases are occurring in the more than 5 years of age children. In 2016, a Diphtheria outbreak occurred in Kerala, where more than 3/4th of cases were in above 10 years of age group. The outbreak helped government to focus and add diphtheria component in the ANC immunization program, as several South American and eastern Europe regions had already implemented the same strategy and seen a noticeable reduction in diphtheria cases in their area. ⁴

In 2017, the National Technical Advisory Group on Immunization (NTAGI), Ministry of Health and Family Welfare (MoHFW), India recommended and added Diphtheria component in the ANC immunization program as Td vaccine. However, by this time, more than half of the world’s countries had already implemented it. ⁴

Empires are not built in a day; similarly, vaccine implementation and its effect cannot be seen in 1 year. The benefits of the Td vaccine administration in ANC mothers are visible as the number of diphtheria cases have reduced. Figure 1 shows the last few years’ diphtheria caseload of our country.

Figure 1.

Diphtheria cases number in India from 2011 to 2021. ⁶

If government had replaced the TT vaccine with the Td vaccine earlier like other countries before waiting for outbreaks, we could have saved many lives that were lost in the last decade. Fortunately, strategic changes were implemented in 2017, resulting in a decreasing trend in diphtheria cases in 2020 and 2021; otherwise, we cannot predict the number of cases in the current and upcoming decade.

Centers for Disease Control and Prevention (CDC) has recommended in 2017 to add pertussis also in ANC immunization along with Td. ⁵ The effects of diphtheria addition are visible; we hope that our government and MoHFW will take appropriate action before pertussis outbreaks occur in our country.