DOI: https://doi.org/10.36347/sjmcr.2026.v14i01.003

Pages: 10-14

Diphtheria remains a persistent public-health concern in India, with a worrying resurgence and shifting epidemiology over the last several years. After steady declines in the late 20th century, recent surveillance and outbreak reports document increases in reported cases and an age-shift from young children toward older children, adolescents and adults — driven by incomplete immunization, gaps in booster coverage, and pockets of susceptible populations. India contributed a substantial share of globally reported diphtheria cases in recent surveillance data. Therapy for toxin-mediated disease depends critically on timely administration of diphtheria antitoxin (DAT) in addition to antibiotics and supportive care. However, the global supply chain for DAT is fragile: manufacturers are few, production is limited, and shortages have been reported constraints that complicate outbreak response and raise case-fatality risk in resource-limited settings. India has been both a producer and a country facing distribution challenges in coordinating antitoxin access during outbreaks. Early diagnosis is frequently delayed for several reasons. Clinically, diphtheria can mimic other causes of pharyngitis and lower-respiratory infections, producing diagnostic uncertainty at initial presentation. Laboratory confirmation requires culture and demonstration of toxigenicity (historically by the Elek test) or molecular detection of tox gene — methods that are unevenly available across peripheral laboratories. Shortages of diagnostic reagents (including diphtheria antitoxin used in some toxigenicity assays), limited molecular capacity, and delays in specimen transport further hinder rapid confirmation and public-health action. These diagnostic gaps, together with suboptimal booster vaccine uptake, lead to delayed treatment, missed contact tracing, and sustained transmission. To reduce morbidity and mortality, India’s response must combine strengthened routine and booster immunization (catch-up