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Case study

Investigation of diphtheria outbreak in Al-Sunta locality in South Darfur State - Sudan, 2019/2020: a teaching case-study

Investigation of diphtheria outbreak in Al-Sunta locality in South Darfur State - Sudan, 2019/2020: a teaching case-study

Leena El-Samani1,&, Razan Abdalla Taha1, Yousef Khader2


1Sudan Federal Ministry of Health, Nile Street, Khartoum P.O Box 303, Sudan



&Corresponding author
Leena El-Samani, Sudan Federal Ministry of Health, Nile Street, Khartoum P.O Box 303, Sudan




Diphtheria is a highly contagious and potentially life-threatening bacterial infection caused by Corynebacterium species; most commonly by toxin-producing Corynebacterium diphtheria. Over the past 10 years, approximately 4000 to 8000 cases have been reported with a case fatality ratio of up to 10%. With the introduction of diphtheria vaccine (DTP; Diphtheria-Tetanus-Pertussis), the morbidity and mortality rates of diphtheria have substantially decreased. However, poor coverage of vaccination in developing countries has led to numerous diphtheria outbreaks. The first documented diphtheria outbreak in Sudan dates back to 1974. Although routine DTP vaccination is part of the Expanded Programme on Immunization (EPI), there are still reported cases and outbreaks of diphtheria across the country. The most recent outbreak occurred in 2019 with 105 reported cases with the majority of cases coming from one locality in South Darfur state. The goal of this case-study is to build the capacity of FETP residents and strengthen their competencies in outbreak investigation and response to vaccine-preventable disease outbreaks. This case study is designed for training basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.



How to use this case study    Down

General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 15 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.

Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.

Prerequisites: before using this case study, participants should have received lectures on communicable diseases, disease surveillance and outbreak investigation.

Materials needed: Flash drive, flip charts, markers and computers with MS Excel

Level of training and associated public health activity: Novice - Outbreak investigation

Time required: 2-3 hours

Language: English



Case study material Up    Down

  • Download the case study student guide
  • Request the case study facilitator guide



Competing interest Up    Down

The authors declare no competing interests.



Acknowledgement Up    Down

Authors would like to acknowledge The Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We wish to acknowledge the public health officers at the epidemiology department at national and state level who participated in the outbreak investigation on which this case study is based. We also would like to thank the Federal Ministry of Health-Sudan, The Health Emergency and Epidemiological Control Directorate and the Surveillance Unit for their fullest support and contributions and for providing us with the data.



References Up    Down

  1. World Health Organization. Vaccine-preventable Diseases Surveillance Standards - Diphtheria. Accessed on 21 February 2020.

  2. Abubakar MY, Lawal J, Dadi H, Grema US. Diphtheria: a re-emerging public health challenge. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2020;6(1):191. Google Scholar

  3. The College of Physicians of Philadelphia. History of Diphtheria. Accessed on 21 February 2020.

  4. World Health Organization. Immunization, Vaccines and Biologicals - Diphtheria. Accessed on 21 February 2020.

  5. The World Fact Book. Sudan. Accessed on 21 February 2020.

  6. Knoema. Sudan - Diphtheria Reported Cases. Accessed on 21 February 2020.

  7. Ismail IT, El-Tayeb EM, Omer MD, Eltahir YM, El-Sayed ET, Deribe K. Assessment of routine immunization coverage in nyala locality, reasons behind incomplete immunization in south darfur state, sudan. Asian journal of medical sciences. 2014 Feb 25;6(1):1-8. PubMed | Google Scholar

  8. World Health Organization. WHO Vaccine-preventable Diseases: Monitoring System - 2019 Global Summary. Accessed on 21 February 2020.