DIPHTHERIA IN INDIA: TRENDS, ANTITOXIN AVAILABILITY, AND CHALLENGES IN EARLY DIAGNOSIS

Introduction: Although Diphtheria, caused by toxigenic strains of Corynebacterium diphtheriae, is a vaccine-preventable disease, a resurgence of cases has been seen in recent times, including among older children and adults in India. A timely dose of Diphtheria Antitoxin is critical for reducing mortality, but evidence suggests persistent problems with antitoxin availability and delays in diagnosis. It aims to describe recent epidemiological trends of diphtheria in India between 2010-2025, availability of DAT, and key challenges in early diagnosis and case management of the disease. Methods: A narrative review was carried out of peer-reviewed literature, national surveillance reports, and global health organization documents from 2010 through 2025. Sources of data included PubMed, Google Scholar, and official public health reports of India and the WHO. Inclusion criteria consisted of original research articles, outbreak reports, and policy briefs that addressed incidence, immunization status, antitoxin supply, and diagnostic capacity. Non-English articles and studies out of the specified time frame were excluded. Data regarding age distribution, mortality, immunization, availability of DAT, and diagnostic practices were extracted and synthesized qualitatively. Results: India continues to report a disproportionate share of global diphtheria cases, approximately 78% as of 2020. PubMed+1 Whereas primary vaccination coverage reached around 78–84%, the booster-dose coverage is low and geographically uneven, with gaps in immunity. Lippincott Journals+1 Several recent outbreaks have shown a shift in the age distribution to older children, adolescents, and even adults. CDC+2IJCMPH+2 The case-fatality rates during outbreaks were reported to range between 15% and 18%, often higher among unimmunized or partially immunized cases. CDC+2PMC+2 Shortages and delays to access DAT have been frequently documented as the global supply has dwindled, and many Indian health facilities lack the stock. Indian Council of Medical Research+2Knowledge Hub+2 Delays in clinical suspicion, a lack of laboratory capacity for toxin confirmation, and low awareness among primary care clinicians impede early diagnosis and treatment. PMC+2IJORL+2 Conclusion: Diphtheria remains a critical public health issue in India. Resurgence is fueled by suboptimal booster immunization, waning immunity, gaps in antitoxin supply, and delays in diagnosis. National surveillance urgently needs strengthening; a reliable supply of DAT should be ensured; incorporation of regular booster doses within immunization programs has to be implemented, and enhancement of clinical and laboratory capacity should be done to facilitate early diagnosis for the mitigation of morbidity and mortality.