title: A Case-control Study of Diphtheria in the High Incidence City of Hyderabad, India.
abstract: BACKGROUND
  India accounts for approximately 72% of reported diphtheria cases globally, the majority of which occur in the state of Andhra Pradesh. The aim of this study is to better understand lack of knowledge on diphtheria vaccination and to determine factors associated with diphtheria and low knowledge and negative attitudes.
  
  
  METHODS
  We performed a 1:1 case-control study of hospitalized diphtheria cases in Hyderabad. Eligible case patients were 10 years of age or older, resided within the city of Hyderabad and were diagnosed with diphtheria per the case definition. Patients admitted to the hospital for nonrespiratory communicable diseases and residing in the same geographic region as that of cases were eligible for enrolment as controls
  
  
  RESULTS
  : There were no statistical differences in disease outcome by gender, education, economic status and mean room per person sleeping in the house in case and control subjects. Not having heard of diphtheria (adjusted odds ratio: 3.56; 95% confidence intervals: 1.58-8.04] and not believing that vaccines can prevent people from getting diseases (adjusted odds ratio: 3.99; 95% confidence intervals: 1.18-13.45) remained significantly associated with diphtheria on multivariate analysis.
  
  
  CONCLUSIONS
  To reduce the burden of diphtheria in India, further efforts to educate the public about diphtheria should be considered.
authors: From the *Department of Health Research, SHARE India, Hyderabad, India; †Division of Epidemiology and Biostatistics, University of Illinois, Chicago, Illinois; ‡Department of Integrated Disease Surveillance, Directorate of Health; and §Department of Medicine, Sir Ronald Ross Hospital, Hyderabad, India.
authors: Ramesh Reddy
authors: RR
authors: Allam
authors: Chengappa Kechamada
authors: CK
authors: Uthappa
authors: Rebecca
authors: R
authors: Duerst
authors: Evan
authors: E
authors: Sorley
authors: Prasada Rao
authors: PR
authors: Udaragudi
authors: Shankar
authors: S
authors: Kampa
authors: Mark S
authors: MS
authors: Dworkin
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D004165:Diphtheria / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult