NEW DELHI: The death of 14 children in two Delhi hospitals — 13 at Maharishi Valmiki Infectious Diseases (MVID) Hospital in north Delhi and one at Lok Nayak hospital in central Delhi — due to diphtheria over the past few weeks has once again exposed the shortcomings of India’s immunisation programme.Diphtheria, an acute infectious disease, is preventable with vaccine.However, due to the low coverage and lack of awareness about the vaccine’s needs in certain communities, the disease continues to be reported in large numbers in the country. As per data from the World Health Organisation (WHO), India accounted for 60% of all diphtheria cases globally last year. “Intensive coverage of immunisation activities in vulnerable pockets is needed urgently to save more children from succumbing to the disease,” said an expert. At MVID, 141 children — aged between 2 and 15 years — have been admitted with diphtheria in the last three weeks.Of this, officials told TOI, nearly 120 are from western Uttar Pradesh, 10 each from Mewat district and different parts of Delhi. “Most of the children suffering from diphtheria didn’t receive the preventive vaccination. Also, they were referred to MVID when the symptoms had already turned severe,” said an official.Last year also, MVID admitted close to 550 children suffering from diphtheria of which nearly a hundred succumbed to the complications caused by it, sources said.Dr Sunil Gupta, medical superintendent of MVID, said diphtheria cases occur mostly in months of August, September and October, and hence the number in this season is not unusual. He also clarified that the hospital has all the required treatment facilities to handle such cases. “The patients admitted at advanced stage could not respond to the treatment and hence could not survive,” Gupta claimed.Diphtheria is caused by the bacterium Corynebacterium diphtheria. It affects the throat and upper airways, which causes sore throat like symptoms and difficulty in breathing initially. If left untreated, the infection causes production of a toxin that can damage the body’s peripheral nerves and other important organs.The primary treatment of diphtheria involves administering an anti-toxin to reduce the damage being caused by toxins released due to the infection. MVID did not have the antitoxin until Saturday, which further complicated the cases, sources added.“The Central Research Institute in Kasauli, from where we buy the vaccine, is undergoing upgradation and that is why they could not supply the vaccine to us despite multiple requests. On Saturday, after the intervention of health ministry, they have released 150 vials of the antitoxin. Another distributor based in Hyderabad has provided 50 more vials that will help us contain the crisis,” a municipal health official said.Globally, the number of diphtheria cases has declined from nearly 1 lakh in 1980 to around 9,000 cases in 2017. But researchers point out the progress in decreasing diphtheria incidence has stalled over the last 10 years. As per a WHO document, the Southeast Asia region, particularly India, is the major driver of global diphtheria incidence trends.Andhra Pradesh, Assam, Delhi, Gujarat, Haryana , Karnataka, Nagaland, Maharashtra, Rajasthan and West Bengal report the maximum number of diphtheria cases in the country. “The coverage of primary and booster diphtheria vaccinations administered as a part of universal immunisation programme needs to be improved. A special incidence needs to be given to increase the vaccine coverage among Muslim children in states like Andhra Pradesh ,” states Manoj Murhekar from National Institute of Epidemiology, while writing about implication for prevention and control of diphtheria in The American Society of Tropical Medicine and Hygiene.