{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:11:03Z","timestamp":1793394663284,"version":"4.5.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In 2017, a diphtheria outbreak occurred in several provinces in Indonesia. The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort study was conducted using patient medical records at five referral hospitals in the Province of Jakarta and one in Tangerang District, Banten Province during January 2017 to 31 August 2018. All children in the age group of 1\u201318 years old discharged with diagnosis of clinical diphtheria formed the study group. All anonymized patient data were evaluated for demographic issues, clinical features, immunization status, complication, laboratory profiles and outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 283 patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. All mortal patients had the complication of myocarditis. Regression analyses revealed factors for predicting mortality. Incomplete primary diphtheria toxoid immunization, stridor, bull neck, leukocytosis \u226515 x10<jats:sup>9<\/jats:sup> cells\/L and thrombocytopenia \u2264150 x10<jats:sup>9<\/jats:sup> cells\/L in each combination for 2 predictors modeling were correlated with death.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>We report key predictors of mortality in pediatric patients with clinical diphtheria. The presence of these features when admitted to the hospital must be taken into account, because they can lead to fatal outcome.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246301","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:27:28Z","timestamp":1612484848000},"page":"e0246301","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":33,"title":["Diphtheria outbreak in Jakarta and Tangerang, Indonesia: Epidemiological and clinical predictor factors for death"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7462-7904","authenticated-orcid":true,"given":"Eggi","family":"Arguni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulya Rahma","family":"Karyanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hindra Irawan","family":"Satari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Rezeki","family":"Hadinegoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"issue":"Suppl1","key":"pone.0246301.ref001","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1086\/315533","article-title":"The changing epidemiology of diphtheria in the vaccine era","volume":"181","author":"A. Galazka","year":"2000","journal-title":"J Infect Dis"},{"key":"pone.0246301.ref002","unstructured":"Clarke, KEN. Review of the epidemiology of diphtheria 2000\u20132016. US Centers for Disease Control and Prevention. Available from: http:\/\/www.who.int\/immunization\/sage\/meetings\/2017\/april\/1_Final_report_Clarke_april3.pdf"},{"key":"pone.0246301.ref003","unstructured":"Kementrian Kesehatan Republik Indonesia. 2017. Profil Kesehatan Indonesia 2016"},{"key":"pone.0246301.ref004","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.cegh.2018.03.007","article-title":"Diphtheria outbreak in Indonesia, 2017: an outbreak of an ancient and vaccine-preventable in the third millennium","volume":"7","author":"H Harapan","year":"2018","journal-title":"Clin Epidemiol Glob Health"},{"issue":"3","key":"pone.0246301.ref005","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/02724936.2000.11748136","article-title":"Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome","volume":"20","author":"PV Havaldar","year":"2000","journal-title":"Ann Trop Paediatr"},{"issue":"Suppl1","key":"pone.0246301.ref006","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.1086\/315544","article-title":"Diphtheria epidemic in the Republic of Georgia, 1993\u20131997","volume":"181","author":"N Khetsuriani","year":"2000","journal-title":"J Infect Dis"},{"issue":"Suppl1","key":"pone.0246301.ref007","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1086\/315563","article-title":"Risk factors for diphtheria: a prospective case-control study in the Republic of Georgia, 1995\u20131996","volume":"181","author":"ML Quick","year":"2000a","journal-title":"J Infect Dis"},{"key":"pone.0246301.ref008","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.12688\/f1000research.16433.1","article-title":"Risk factors for diphtheria outbreak in children aged 1\u201310 years in East Kalimantan Province, Indonesia","volume":"7","author":"I Muhamad Ramdan","year":"2018","journal-title":"F1000Res"},{"issue":"11","key":"pone.0246301.ref009","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1086\/425305","article-title":"Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children","volume":"39","author":"R Kneen","year":"2004","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0246301.ref010","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4269\/ajtmh.17-0047","article-title":"Epidemiology of Diphtheria in India, 1996\u20132016: implications for prevention and control","volume":"97","author":"M. 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