td travel phone number

• Customer Service
• En Español

Securities and other investment and insurance products are: not a deposit; not FDIC insured; not insured by any federal government agency; not guaranteed by TD Bank, N.A. or any of its affiliates; and, may be subject to investment risk, including possible loss of value.

SECURITIES AND OTHER INVESTMENT AND INSURANCE PRODUCTS ARE: NOT A DEPOSIT; NOT FDIC INSURED; NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY; NOT GUARANTEED BY TD BANK, N.A. OR ANY OF ITS AFFILIATES; AND, MAY BE SUBJECT TO INVESTMENT RISK, INCLUDING POSSIBLE LOSS OF VALUE.

Based on average store hour data pulled in January 2024 of Top Banks (as defined below) in metropolitan statistical areas in which TD Bank operates ("TD MSAs"), excluding drive-thru hours and hours of locations in retail stores (such as grocery stores). Top banks are the top 20 banks by total deposits across TD MSAs, the top five banks by store share (or by total deposits, if store share is equal) in each TD MSA, and any bank with greater or equal store share compared to TD Bank in each TD MSA ("Top Banks").

©2022 TD Bank, N.A. All Rights Reserved.

• Customer Service

TD First Class SM Visa ® Signature Credit Card

Travel rewards – Earn triple miles on travel and dining

Compare TD cards >

Read complete terms and conditions for details about APRs, fees, eligible purchases, balance transfers and program details.

Offer details, rates, fees and terms

Bonus miles offer.

Earn up to 25,000 bonus miles within the first 6 billing cycles of account opening, which equals a $250 statement credit towards travel or dining purchases

Bonus miles will be reflected on your credit card statement 6 to 8 weeks after a qualified first purchase and/or 6 to 8 weeks after $3,000 in total net purchases made within the first 6 billing cycles of your credit card account opening date. This offer is non-transferable. This online offer is not available if you open an account in response to a different offer that you may receive from us. This online offer is not available if you open an account in response to a different offer that you may receive from us.

Rewards details

3X First Class miles on travel and dining purchases , including flights, hotels, car rentals, cruises and dining, from fast food to fine dining

1X First Class miles on all other purchases – no categories or gimmicks and earn points that never expire as long as your account is open and in good standing.

Rates and fees

Need more information?

Take a look at our terms and conditions or personal cardmember agreement .

Earn unlimited points with every purchase, and triple the miles on travel

See how many miles you can earn from travel and other purchases.

Redeem your First Class miles for a statement credit toward travel and dining purchases >

To earn and redeem points, your account must be open and in good standing.

Credit Card FAQs

Manage your card, security you can count on.

Don't worry-we're protecting your every move. Our built-in chip technology helps guard you against fraud. Plus, you get the benefits of Visa Zero Liability 2

Managing your account is easy

Get the service you need, when you need it. Log in to your account or talk to a TD Bank representative 24/7 at 1-877-468-3178.

Redeem your rewards

Visit the td first class rewards site >.

Prince of Travel

Prince of Travel is a full-service travel brand with an emphasis on luxury travel.

Get in-depth information on hotel programs and learn more about Prince Collection’s premier brands and vendors.

Credit Cards

Get the latest news, deals, guides, and travel reviews straight to your inbox with a Prince of Travel newsletter subscription.

Join Our Newsletter

Subscribe to the prince of travel newsletter.

You'll receive priority information about the newest luxury properties worldwide, exclusive reservations and deals through Prince of Travel , and unique destinations across the globe.

By providing your email, you agree to the Prince of Travel Privacy Policy

Thank you for subscribing!

Please check your email to confirm your subscription!

Id ea eiusmod magna cupidatat proident commodo tempor sit incididunt. Fugiat aliquip officia exercitation ad culpa ipsum est.

Points Programs

Hotel programs, best credit cards, back to {post.category_name}, back to guides, the beginner’s guide to td rewards credit cards.

TD offers three personal credit cards in the TD Rewards lineup, allowing cardholders to earn points that can be used for travel and more.

Written by Erin Partridge

Written by {post._embedded?.author[0].name || post.data.author}

On May 10, 2024

Read time 28 mins

TD Rewards is the in-house points currency offered exclusively by TD Bank. The rewards program allows TD Rewards credit card holders to earn TD Rewards Points.

The rewards program is available through three of TD’s personal credit cards: the TD Rewards Visa* Card, the TD Platinum Travel Visa* Card, and the TD First Class Travel® Visa Infinite* Card.

In this guide, we’ll go over how to access this program with a personal TD credit card, and how to earn and redeem TD Rewards Points for excellent value.

What Is TD Rewards?

TD Rewards is TD Bank’s in-house points currency that’s accessible through three personal credit cards and one business TD Rewards credit card.

Credit cards in the TD Rewards program earn TD Rewards Points, which are a fixed-value points currency that’s exclusive to the bank.

The fact that the currency has fixed value means that the value of the points doesn’t fluctuate, and instead its value is based on the way in which you choose to redeem them (more on this below).

TD Rewards Points can be earned exclusively through credit card welcome bonuses that you can access as a first-time cardholder when you get a TD Rewards credit card, and through spending on the same eligible card.

As you earn a welcome bonus and additional points through day-to-day spending, your TD Rewards account balance will grow.

These accumulated points can be redeemed several ways, with the fixed value of a single TD Rewards Point ranging from 0.25 cents per point to 0.5 cents per point (all figures in CAD).

This means that if you had 100,000 TD Rewards Points in your account, you could redeem these for a value of between $250 and $500, depending on which type of redemption you choose.

The most valuable way to redeem TD Rewards Points is for travel, which we’ll explore in detail below.

TD Rewards Points are a great points currency to collect if you’re someone who wants to be able to redeem points for travel, and especially if you often book your trips through Expedia.

TD Rewards Points are also a great currency to collect in addition to other airline and hotel points, since they’re useful in offsetting other travel costs, such as cruises, independent hotels, and short-term rentals that aren’t covered by brand-specific programs (e.g., Aeroplan, Marriott Bonvoy, WestJet Rewards ).

Since TD Rewards Points are redeemable at a fixed value that’s tied to the cash value of the redemption, they’re not the best choice for aspirational travel like business class or First Class flights; however, they remain a valuable currency for other travel expenses.

TD Rewards Credit Cards

As we mentioned above, TD Rewards Points can only be earned through TD Rewards credit cards.

TD currently offers three personal credit cards for this program: the TD First Class Travel® Visa Infinite* Card, the TD Platinum Travel Visa* Card, and the TD Rewards Visa* Card.

To sort out which of the above three is best for you, let’s look at each of the personal credit cards’ features and eligibility requirements.

TD First Class Travel® Visa Infinite* Card

This is the TD Rewards program’s flagship card, offering the strongest earning rates and the best welcome bonus.

The card’s welcome bonus fluctuates depending on the bank’s current offer, often coming in around 100,000 TD Rewards Points and with an all-time high of 135,000 TD Rewards Points.

Given this, it’s ideal to time your application to coincide with an elevated welcome bonus, as this is a one-time opportunity for new cardholders.

The fees and eligibility requirements of this card are as follows:

• Annual fee: $139
• Supplementary cardholders: $50
• Minimum income requirement: $60,000 (personal), $100,000 (household)
• Estimated credit score needed: Good to Excellent

Since this is a premium credit card, you can enjoy elevated earning rates in specific categories, with earning rates as follows:

• Earn 8 TD Rewards Points† per dollar spent on eligible travel booked through Expedia® for TD†
• Earn 6 TD Rewards Points† per dollar spent on eligible grocery and restaurant purchases†
• Earn 4 TD Rewards Points† per dollar spent on eligible recurring bill payments set up on your account†
• Earn 2 TD Rewards Points† per dollar spent on all other eligible purchases†

As an example of the earning power of these rates, let’s imagine that you spend $500 on groceries and restaurants in a month.

Given the earning rate of 6 TD Rewards Points per dollar spent, $500 in spending within this category will earn you 3,000 points. These 3,000 TD Rewards Points can then be redeemed for between $7.50 and $15 in value, depending on the redemption path you choose.

This value is equivalent to a 1.5–3% return on your $500 in purchases ($7.50/$500 = 1.5%, $15/$500 = 3%).

Since TD Rewards Points can be redeemed for a maximum value of 0.5 cents per point, the return on spending you get is 4%, 3%, 2%, or 1%, depending on your purchase.

Plus, as an annual birthday perk, you can earn 10% of the TD Rewards Points earned in the previous 12 months back on your cardholder anniversary,† up to 10,000 TD Rewards Points per year.†

The TD First Class Travel® Visa Infinite* Card also comes with a range of perks and benefits.

For example, cardholders are eligible to earn a $100 TD Travel Credit† on accommodations and vacation packages of at least $500 booked through Expedia® for TD†, and can also enjoy car rental discounts at Avis and Budget to the tune of 10% in Canada and the US, and 5% internationally.†

Additionally, the card often offers a first-year annual fee rebate, and it comes with strong insurance coverage for travel and eligible purchases.

Overall, the TD First Class Travel® Visa Infinite* Card is best suited for individuals who meet the income requirements and who are looking to accumulate TD Rewards Points rapidly with the elevated earning rates.

More in-depth information about the TD First Class Travel® Visa Infinite* Card can be found in our dedicated guide for the card.

• Earn 20,000 TD Rewards Points upon making your first purchase †
• Earn 115,000 TD Rewards Points upon spending $5,000 within 180 days of account opening †
• Plus, earn up to 10,000 TD Rewards Points back on your birthday †
• Plus, earn 8x TD Rewards Points † on eligible travel purchases when you book through Expedia ® for TD †
• Get an annual TD Travel Credit † of $100 when you book through Expedia ® for TD †
• Use your rewards for any travel bookings available on Expedia ® for TD †
• Minimum income: $60,000 personal or $100,000 household
• Annual fee: $139, rebated for the first year †
• Application must be approved by January 6, 2025 to receive this offer

TD Platinum Travel Visa* Card

The TD Platinum Travel Visa* Card is the mid-tier card in the TD Rewards lineup, and it offers good earning rates and an enticing welcome bonus.

• Annual fee: $89
• Supplementary cardholders: $35
• Minimum income requirement: N/A

Similarly to the TD First Class Travel® Visa Infinite* Card , the TD Platinum Travel Visa* Card also earns elevated rates in specific categories, just at a slightly lower rate than its premium counterpart.

These earning rates are as follows:

• 6 TD Rewards Points† per dollar spent on eligible Expedia® for TD†
• 4.5 TD Rewards Points† per dollar spent on eligible groceries and dining†
• 3 TD Rewards Points† per dollar spent on eligible recurring bill payments set up on your account†
• 1.5 TD Rewards Points† per dollar spent on all other eligible purchases†

To see these rates in action, let’s again imagine that you spent $500 on groceries and restaurants in a month.

With the 4.5 TD Rewards Points per dollar rate, $500 in spending within this category will earn you 2,250 points. These 2,250 TD Rewards Points can then be redeemed for between $5.60 and $11.25 in value, depending on the redemption path you choose.

This value is equivalent to a 1.12–2.25% return on your $500 in purchases ($5.60/$500 = 1.12%, $11.25/$500 = 2.25%).

In terms of perks and benefits, the TD Platinum Travel Visa* does not provide much, which is expected with a mid-tier card.

Cardholders can often enjoy a first-year annual fee rebate as well as car rental discounts at Avis and Budget to the tune of 10% in Canada and the US, and 5% internationally†. The card also provides some basic insurance coverage.

This card is best suited for individuals who would like to earn TD Rewards Points with elevated earning rates, but who don’t meet the eligibility requirements of the TD First Class Travel® Visa Infinite* Card.

More in-depth information about the TD Platinum Travel Visa* Card can be found in our dedicated guide for the card.

• Earn  15,000 TD Rewards Points upon first purchase †
• Earn 35,000 TD Rewards Points upon spending $1,000 in the first 90 days †
• Plus, earn 6x TD Rewards Points † on eligible travel purchases when you book through Expedia ® for TD †
• Earn  4.5x TD Rewards Points † on eligible grocery and restaurant purchases †
• No minimum income requirement
• Annual fee: $89, rebated in the first year †

TD Rewards Visa* Card

The TD Rewards Visa* Card is the program’s entry-level, no-fee card. It offers the lowest earning rates of the three TD Rewards credit cards, and it typically comes with the opportunity to earn a modest welcome bonus.

• Annual fee: $0
• Supplementary cardholders: $0
• Estimated credit score needed: N/A

As can be expected with any no-fee credit card, the earning rates for the TD Rewards Visa* Card are lower than the other TD Rewards cards; however, there are still elevated rates in specific categories.

The TD Rewards Visa* comes with the following earning rates:

• 4 TD Rewards Points† per dollar spent on eligible Expedia® for TD purchases†
• 3 TD Rewards Points† per dollar spent on eligible groceries and dining purchases†
• 2 TD Rewards Points† per dollar spent on eligible recurring bill payments set up on your account†
• 1 TD Rewards Point† per dollar spent on all other eligible purchases†

To help understand the value of these earning rates, let’s look at the same monthly spend of $500 on groceries and restaurants as above.

Since you earn 3 TD Rewards Points per dollar in the groceries and dining category, $500 of spending within this category will earn you 1,500 points. These 1,500 TD Rewards Points can then be redeemed for between $3.75 and $7.50 in value, depending on the redemption path you choose.

This value is equivalent to a 0.75–1.5% return on your $500 in purchases ($3.75/$500 = 0.75%, $7.50/$500 = 1.5%).

In terms of perks and benefits, the TD Rewards Visa* Card comes with very little.

Cardholders can enjoy car rental discounts at Avis and Budget to the tune of 10% in Canada and the US, and 5% internationally†, and they will have access to some minimal insurance coverage, such as extended warranty, purchase protection, and Mobile Device Insurance.

The TD Rewards Visa* Card is best suited for individuals who are looking for a no-fee way to earn TD Rewards Points.

More in-depth information about the TD Rewards Visa* Card can be found in our dedicated guide for the card.

• Earn 15,152 TD Rewards Points when you spend $500 within 90 days of Account opening+ †
• Plus, earn 4x TD Rewards Points † on eligible travel purchases when you book through Expedia ® for TD †

Redeeming TD Rewards Points

TD Rewards Points can be redeemed for travel, gift cards and merchandise, higher education, statement credits, and on amazon.ca,

We’ll focus on the travel options in the sections below since these are the most valuable options, and given that you’re on our website, they’re likely the options that most intrigue you.

That said, if you’re interested in learning more about the other available options, check out our Essential Guide to TD Rewards, which goes over each alternative in detail.

Redeeming TD Rewards Points on Expedia for TD

The most valuable way to redeem TD Rewards Points is by using them through Expedia for TD.

When redeemed this way, each TD Rewards Point is worth 0.5 cents per point, meaning that 100,000 TD Rewards Points can be redeemed for $500 worth of travel.

Expedia for TD is essentially the same as the regular Expedia platform, except it’s linked with your TD Rewards Points account, and you log in with your TD credentials.

To access Expedia for TD, simply sign in to your TD Rewards account, click “Expedia for TD” under the “Redeem” tab, and then click through to the Expedia for TD portal.

You can use Expedia for TD the same way you would use regular Expedia, allowing you to book flights, hotels, car rentals, and other travel purchases.

Notably, through this redemption avenue, you can also redeem your TD Rewards Points for cruises, tours, and Disney tickets.

After signing in to Expedia for TD, you can search for your desired hotel, cruise, tour, or whatever else you might like to book.

As an example, let’s say you’d like to redeem your TD Rewards Points for tickets to Universal Orlando Resort.

Once you’ve selected your purchase on Expedia for TD, look for “Use your TD Points” on the check-out page. From there, select the number of points you’d like to redeem and then proceed with your purchase.

The minimum redemption amount is 200 points (equal to $1), and you’re able to make the purchase with a combination of cash and points, allowing you to decide how much of the purchase you’d like offset with your TD Rewards Points.

When redeeming your points through Expedia for TD, you still need to pay the full purchase amount up front. The value from your redeemed points will be credited to your TD Rewards credit card statement after the purchase is completed and within 3–5 business days.

When booking through Expedia for TD, it’s important to remember that you’re booking through a third-party vendor (Expedia) and not directly with the airline, hotel, car rentals, etc.

For hotel bookings, this means that you won’t earn any hotel status benefits or accrue elite qualifying nights. For car rentals, you won’t earn things like Hertz points or free rentals through National Free Days.

However, you will still be able to accrue elite-qualifying points/miles with airlines as long as you attach your associated membership number to your booking at the time of purchase or add it at the check-in counter.

Most importantly, when booking a flight through Expedia for TD, be aware that any and all changes and cancellations must be pursued through Expedia for TD, and can’t be done through the airline.

Redeeming TD Rewards Points with Book Any Way Travel

If you’d rather book travel directly with vendors (e.g., Hyatt, WestJet, VIA Rail) instead of using Expedia for TD, you can still get great value from your points.

When redeemed for purchases made outside of Expedia for TD, each of your TD Rewards Points is worth 0.4 cents. This means that 100,000 TD Rewards Points is worth $400 for travel booked using your TD Rewards credit card.

To redeem your TD Rewards Points through the Book Any Way option, all you need to do is charge the eligible flight, hotel, train ticket, etc. to your TD Rewards credit card.

Once the purchase has posted to your credit card account, you can redeem your TD Rewards Points to offset the cost by using the TD Rewards website or by calling 1-800-983-8472 within 90 days of the purchase date.

To redeem TD Rewards Points online, log in to your TD Rewards account and select “Book Any Way Travel” from the “Redeem” tab.

On the next screen, fill in the information about the transaction against which you’d like to redeem points.

You’ll need to have the purchase transaction date, its description, and the exact dollar amount before proceeding. This information can be found on your credit card account statement.

If you’d like to redeem points for multiple transactions at once, simply click on “add another transaction” and fill in the additional information.

Once you’ve submitted your request for redemption, you can expect to receive the value back as a statement credit within 3–5 business days.

While you won’t get the best value from your TD Rewards Points this way, this option does offer excellent flexibility as TD has one of the most generous definitions of an eligible “travel expense” in the industry.

Using Book Any Way, you can redeem your TD Rewards Points for the vast majority of travel expenses, including campsites, jet-ski rentals, and even theatre tickets as long as they were purchased while travelling.

Keep in mind though that in the cases involving more unique travel expenses, you may need to speak with a customer service representative in order to redeem your points.

If you’d like more details about how you can redeem your TD Rewards Points through other redemption methods, we’ve included more options and additional details in our Essential Guide for TD Rewards.

Alternatively, you can always check out the TD Rewards website to explore the program further.

TD Bank offers three personal TD Rewards credit cards that allow you to earn TD Rewards Points.

These points are a valuable currency that can be redeemed for almost all your travel expenses at a fixed value, making them one of the most flexible fixed-value currencies on offer in Canada.

If you’re looking for a credit card that earns points redeemable for travel expenses and you prioritize flexibility, the TD Rewards travel cards are great options to consider. 

Can I have a TD Rewards credit card if I don’t bank with TD?

Yes, you can. To pay your TD Rewards credit card bill without a TD bank account, simply search for TD as a payee within your online banking’s bill payment feature, and then add your TD credit card number as the account number.

Can I book travel for other people with my TD Rewards Points?

Yes, you can make a booking for someone else using your TD Rewards Points. To do so, go through the search and booking process as usual, using your friend/family member’s name and information in lieu of your own.

Do I have to redeem my TD Rewards Points for travel?

No. TD Rewards Points can also be redeemed for merchandise, gift cards, statement credits, higher education, and on amazon.ca.

Can I exchange my TD Rewards Points for cash?

TD Rewards Points can be redeemed for a cash credit towards your TD credit card statement at a rate of 400 points = $1 (CAD).

Share this post

Copied to clipboard!

• Small Business
• Private Client Advice
• British Columbia
• New Brunswick
• Newfoundland Labrador
• Northwest Territories
• Nova Scotia
• Prince Edward Island
• Saskatchewan
• English Selected

• secure Login

Get a quote

Home/ Condo/ Tenant

TD Insurance Contact Us

We're here to help. Select your insurance and let's get started.

Download policy documents, update your billing and other self-serve options

Manage your policy, update your payment plan and other self-serve options

Calculate the coverage you need, learn how to submit a claim and more

Get answers to common travel questions, learn how to submit a claim, and more

Get information about our claims process and find answers to your Accident & Health questions

Learn how to submit a claim, explore your TD Protection Plan options and more

Download policy documents, update your billing and find ways to reach us

Explore our flexible business insurance coverage options

Have a question? Find answers here

Popular questions, helpful related questions, did you find what you were looking for.

Sorry this didn't help. Would you leave us a comment about your search?

Claims information and other useful tips

Making a claim

We have helpful information to assist you through your insurance claims experience.

Get helpful tips

The Learning Centre has insurance-related tips, tutorials, articles, videos and more.

Raise a concern

Do you have a concern or complaint to share? We want to make it right.

Learn about problem resolution at TD Insurance

See you in a bit

You are now leaving our website and entering a third-party website over which we have no control.

TD Bank Group is not responsible for the content of the third-party sites hyperlinked from this page, nor do they guarantee or endorse the information, recommendations, products or services offered on third party sites.

Third-party sites may have different Privacy and Security policies than TD Bank Group. You should review the Privacy and Security policies of any third-party website before you provide personal or confidential information.

Sorry, we do not offer this product in the selected province

Please visit our  homepage  to see products available in your province.

• Small Business

• English Selected

Travel with confidence

Be ready for your next travel adventure, with coverage that best suits your needs.

Available for eligible TD Bank Group customers only

Ready to choose a plan?

Td travel insurance for td bank group customers, why consider travel insurance.

From eligible flight cancellations to medical emergencies while travelling, travel insurance can help you prepare for unexpected, covered events. Whether you're travelling alone, with family or a travelling companion, find the coverage that best suits your needs for your trip.

Why choose TD Travel Insurance?

Emergency travel medical coverage

Feel good about your next trip with emergency travel medical coverage up to $5 million for eligible costs.

Worldwide 24/7 emergency assistance by phone

Call our administrator anytime if you have an emergency during your trip.

Convenient claims submission

Convenient claims submission available over the phone or online.

Explore our Travel Insurance Plans

Single Trip Plan 1

Travelling solo, with family or travelling companions? Our single trip plan offers up to $5 million in emergency travel medical coverage for a covered trip, while travelling outside of your province or territory of residence.

View Sample Certificate of Insurance

View Product Summary and Fact Sheet (for residents of Quebec only)

Annual Plan 1

Ideal for frequent travelers, our annual plan offers a more convenient and cost-effective option than buying a single plan each time you travel. You'll get up to $5 million in emergency travel medical coverage for an unlimited number of covered trips, up to your chosen maximum trip duration, for one year.

Trip Cancellation & Trip Interruption Insurance 1

Travel with confidence knowing you have coverage if your covered trip is cancelled or interrupted because of an eligible medical or non-medical emergency event.

Top-up or extension 2

Is your trip longer than your existing plan covers?

If you have an existing travel medical insurance plan and you need to extend your period of coverage for a particular trip, you can top-up or extend your existing coverage with TD. Our coverage begins after your existing plan ends.

Also, if you have a trip cancellation and trip interruption plan, you can add additional coverage if your trip cost is higher than what your existing plan covers .

Compare Plans

Please refer to the applicable Certificate of Insurance for defined terms and a full description of features, benefits, limitations and exclusions .

Let's connect

Our administrator is ready to answer your questions and help you on your way.

For quotes, to purchase a plan or any general inquiries: 1-888-992-9163 Mon-Fri 8 a.m. to 8 p.m. ET Saturday 9 a.m. to 5 p.m. ET

For 24/7 emergency assistance: 1-800-359-6704  (Canada and the U.S., toll free) or  + 1-416-977-5040  (worldwide, collect).

For claims:  1-800-359-6704

Start a travel insurance claim

Start the claims process by visiting the Online Claims Portal .

Check your TD Credit Card Travel Insurance benefits

Planning a trip? If you're an existing TD Credit Cardholder, you may have travel insurance benefits available on your TD Credit Card.

Other products and services you may want to consider for your trip

TD offers banking solutions, credit cards and competitive exchange rates for your travel needs. Explore our products to learn how TD can enhance your trip.

TD Travel Credit Cards

Earn travel Rewards Points on everyday purchases to redeem for flights, hotels and other eligible rewards items.

• Foreign Exchange Services

We have over 50 foreign currencies available at competitive rates.

• Cross Border Banking

Canadian-based U.S. dollar products with TD Canada Trust can help you avoid foreign exchange fees by allowing you to save and spend in U.S. dollars.

TD Travel Insurance is administered by Global Excel Management Inc. and its subsidiary, CanAm Insurance Services (2018) Ltd.  

TD Travel Medical Insurance Single Trip Plan and Annual Plan are underwritten by TD Life Insurance Company. TD Trip Cancellation and Trip Interruption Insurance is underwritten by TD Life Insurance Company (medical covered causes) and TD Home and Auto Insurance Company (non-medical covered causes). TD Travel Insurance is designed exclusively for the clients of TD Bank Group and are distributed by The Toronto-Dominion Bank. Medical and claim assistance, claim payment and administration services are provided by the Administrator described in the applicable Certificates of Insurance. 

1  Coverages and benefits are subject to eligibility conditions, limitations, and exclusions, including pre-existing medical condition exclusions. Please refer to the applicable Sample Certificate of Insurance for full details.

2 You must confirm with your original insurance carrier that your coverage is eligible to be topped up with a TD Travel Insurance plan. Top-up or extension coverage from TD may offer different benefits with different terms and conditions than your existing coverage. Coverages and benefits are subject to eligibility conditions, limitations, and exclusions, including pre-existing medical condition exclusions. Please refer to the applicable Sample Certificate of Insurance for full details. 

3  Answering a Medical Questionnaire will be required for those between 60 to 64 years of age who are travelling for 30 days or more and for those 65 years of age or older to determine eligibility for this product. If you are between 65 to 74 and are travelling for 17 days or less, you will have an option to bypass the Medical Questionnaire (this may impact your premium and pre-existing stability period).

Mailing Address: TD Life Insurance Company P.O. Box 1 TD Centre Toronto, Ontario M5K 1A2

TD Home and Auto Insurance Company P.O. Box 1 TD Centre Toronto, Ontario M5K 1A2

The TD logo and other trademarks are the property of The Toronto-Dominion Bank or its subsidiaries.

See you in a bit

You are now leaving our website and entering a third-party website over which we have no control.

TD Bank Group is not responsible for the content of the third-party sites hyperlinked from this page, nor do they guarantee or endorse the information, recommendations, products or services offered on third party sites.

Third-party sites may have different Privacy and Security policies than TD Bank Group. You should review the Privacy and Security policies of any third-party website before you provide personal or confidential information.

TD Personal Banking

• Personal Home
• My Accounts
• Today's Rates
• Accounts (Personal)
• Chequing Accounts
• Savings Accounts
• Youth Account
• Student Account
• Credit Cards
• Aeroplan points
• Travel Rewards
• No Annual Fee
• U.S. Dollar
• Personal Investing
• GIC & Term Deposits
• Mutual Funds
• TFSA - Tax-Free Savings Account
• RSP - Retirement Savings Plan
• RIF - Retirement Income Options
• RESP - Education Savings Plan
• RDSP - Disability Savings Plan
• Precious Metals
• Travel Medical Insurance
• All Products
• New To Canada
• Banking Advice for Seniors (60+)
• Ways to Pay
• Ways to Bank
• Green Banking

TD Small Business Banking

• Small Business Home
• Accounts (Business)
• Chequing Account
• Savings Account
• U.S. Dollar Account
• AgriInvest Account
• Cheque Services
• Overdraft Protection
• Line of Credit
• Business Credit Cards
• Business Mortgage
• Canada Small Business Financial Loan
• Agriculture Credit Solutions
• TD Auto Finance Small Business Vehicle Lending
• Invest for your Business
• Advice for your Profession or Industry
• TD Merchant Solutions
• Foreign Currency Services
• Employer Services

TD Investing

• Investing Home
• Direct Investing
• Commissions and Fees
• Trading Platforms
• Investment Types
• Investor Education
• Financial Planning
• Private Wealth Management
• Markets and Research

TD Corporate

• Investor Relations
• Environment
• Supplier Information
• TD Newsroom

Other TD Businesses

• TD Commercial Banking
• TD Asset Management
• TD Securities
• TD Auto Finance

U.S. Banking

• TD Bank Personal Banking
• TD Bank Small Business Banking
• TD Bank Commercial Banking
• TD Wealth Private Client Group
• TD Bank Personal Financial Services

• Open access
• Published: 27 September 2024

Risk factors of diphtheria outbreak in damt district of Al Dhalea Governorate, 2023 -Yemen: a case–control study

• Sameer Shedaiwah 1 ,
• Hamood Alsharabi 2 ,
• Labiba Anam 3 &
• Mohammed Abdullah Al Amad   ORCID: orcid.org/0000-0002-1566-4964 4  

BMC Infectious Diseases volume  24 , Article number:  1034 ( 2024 ) Cite this article

Metrics details

In Yemen, diphtheria has become an important health problem since 2017 when diphtheria re-emergence as a consequence of war and the collapse of the health system. In 2023, there has been a 57% increase in diphtheria cases compared to 2021 and 2022. Damt district of Al Dhalea Governorate had the highest reported cases for year 2023. The study aims to determine the risk factors associated with diphtheria outbreak in Damt District.

A retrospective matched case–control (1:2) was used. All confirmed cases based on the WHO case definition reported from Damt district during 2023 were considered cases. Two age-matched (± 5years) neighborhood controls were recruited per case. A pretested questionnaire was used for collecting data during household interviews including demographic and household characteristics, knowledge of diphtheria, vaccination status, contact with a case of diphtheria, and travel history. Frequency and proportion for quantitative and median with interquartile range (IQR) for quantitative variables. Chi-square and Mann–Whitney tests to compare the distribution of categorical and numerical variables between cases and controls. Univariate and multivariate conditional binary logistic regression, and Adjusted Odds ratio (AOR) with a 95% confidence interval at P  < 0.05 were used to identify risk factors.

A total of 118 cases and 236 controls were enrolled, 56% were females (63% of cases vs. 53% of controls). The median (IQR) age was 14 (9,22) years for cases vs 12(7,23) of control, it was significantly higher for females than males in the case group: (16(10,29) Vs 10(6,18), P  < 0.001) and control group: (15(8,25) vs 12(7,18), p -value = 0.022). Partial vaccination status AOR = 13.7(6.1–31.1), P -value < 0.001), contacts with a case of diphtheria AOR = 8.5(2.3–31.0), P value < 0.001) and Female gender, AOR = 3.3(CI; 1.1–9.5, P value = 0.029), were the main risk factors.

Conclusions

Poor vaccination and contact with a case of diphtheria were the main contributors to diphtheria in the Damt district particularly among adult females. Increasing the vaccination coverage with a diphtheria-containing vaccine through routine immunization as well as tetanus-diphtheria vaccine for childbearing age females along with community awareness regarding protection measures during home care of diphtheria cases. Vaccination services as well as gender barriers related to Td vaccination should be investigated.

Peer Review reports

Diphtheria is an acute disease caused by toxin-producing strains of Corynebacterium diphtheriae mainly affects the upper respiratory tract (tonsils, pharynx, larynx, nose) [ 1 ]. Diphtheria is a vaccine-preventable disease but multiple doses and booster doses are necessary to establish and maintain immunity [ 1 , 2 ].

Thus, young children and those who are not immunized or under-immunized are at risk of the disease which spreads from person to person directly through respiratory droplets, within 2–3 days of infection, a thick, grey coating pseudo-membrane covers the affected area of the respiratory system and could lead to airway obstruction [ 2 ]. The released toxin also can reach other organs and can cause myocarditis, paralytic symptoms, and nephritis death could occur if proper treatment is delayed and severe cases have a mortality rate of 5–10% [ 1 , 2 , 3 ].

Despite the availability of a safe and effective vaccine, recent outbreaks have occurred due to under-vaccination, particularly in developing countries [ 1 ].

In Yemen, diphtheria has become an important health problem since 2017 when the diphtheria epidemic occurred as a consequence of war, the health system collapsed, and low vaccination coverage [ 4 , 5 ]. Between July 2017 and August 2018, 2243 cases were reported with an incidence rate of 8 cases per 100,000 population [ 6 ]. As a response, many efforts focused on: the clinical management of cases, referral pathways, and isolation units have been made along with three vaccination campaigns conducted in 2018 and 2019 and targeting children between the ages of 6 weeks and 15 years [ 7 ].

The widespread political instability, displacement of populations, and damaged infrastructure along with nearly half of the non-functional health facilities are the main challenges of vaccine delivery in Yemen that increased the risk of a diphtheria outbreak [ 8 ]. Furthermore, the insecurity and the destruction of transportation networks disrupted supply chains, particularly in remote areas, extremely challenging [ 9 ].

Recently, diphtheria cases have risen gradually since 2021, with a significant increase noted from June to September 2023 which indicates a 57% increase in diphtheria cases compared to 2021 and 2022. From January up to September 2023, a total of 1671 suspected diphtheria cases with 109 associated deaths have been reported from the whole country compared to 1283 cases reported in the whole of 2022 [ 10 ]. Furthermore, this increase marks a change from the usual winter seasonal pattern [ 11 , 12 ].

Many studies have been conducted to describe the impact of war and ongoing conflicts such as health system collapse and low vaccination coverage as the root causes of a diphtheria outbreak in Yemen [ 4 , 5 ]. The epidemiology, clinical, and microbiological features also have been described and investigated by many studies [ 6 , 12 , 13 ].

As for the risk factors of diphtheria transmission at the level of the individual, a study conducted in Sana’a city in 2019 indicated Sharing a bedroom with at least two people, contact with a diphtheria case, and Non-vaccination as the main risk factors for diphtheria in Sana’a city [ 14 ].

There is still a gap in the information related to the risk factors of diphtheria transmission in rural areas such as Damt district which is the district of Al Dhalea Governorate that reported 204 diphtheria cases and 14 associated deaths. So, it is considered the first district to report diphtheria cases and related deaths for 2023. The study aims to determine the risk factors associated with diphtheria infection in Damt District.

Study design

A matched case–control study with a ratio of (1:2) cases to controls matched by age ± 5 years and residency was performed in Damt District, Al Dhalea Governorate.

The study was conducted in Damt District of Al Dhalea Governorate, which has a total of nine districts. Three districts are under the authority of the northern government (Damt, Jaban, and Al-Hasha) and five districts are under the authority of the southern government (Al-Shuaib, Al-Husayn, Al-Dhalea, Jahaf and Al-Azaraq). The last one (Qa’taba district) is divided between the two authorities. Damt district is located and far away from the south of the capital Sana'a by 198 km 2 , has an area of 371 km 2 with (10) sub-districts shown in Fig.  1 . The population density is 284 people/km 2 and the majority of the population works in agriculture. There are 4 Medical Health Centres and 12 health units, where immunization services are provided. According to the electronic Integrated Diseases Early Warning System (eIDEWS), Damt district is the first district in Al Dhalea Governorate and Yemen that reported diphtheria cases and assoiled deaths for the year 2023.

Map of Al Dhalea Governorate and Damt District

Definition of cases and controls

The WHO case definition for diphtheria was used as any persons at any age who have lived in one of the Damt subdistricts, Al Dhalea Governorate, stuffed from inflammation of the tonsils, pharynx, or larynx, with a membrane attached and difficult to remove from the tonsils, pharynx, or nose and reported by eIDEWS during the year 2023.

Controls were defined as; any person who matched the case by age (± 5years) lived in the same neighborhood since January 2023 and did not suffer from any of the diphtheria symptoms.

Study sample and sampling procedure

All confirmed or probable cases of diphtheria reported by eIDEWS from January to December 2023 were considered cases. Two age-matched (± 5years) neighborhood controls were recruited per case, particularly from houses located on the right side of the case house, with one control per house. If no matched control in a house or the matched control refused to participate in the study, another control was recruited from the next house.

Inclusion and exclusion criteria

All confirmed or probable cases of diphtheria reported by eIDEWS from January to December 2023 were included. Cases were excluded if they lived outside of Damt district during the year 2023, refused to participate, died, were psychiatric patients, or moved from the district at the time of study conducting. Controls were excluded if they lived outside of Damt district during the year 2023, or refused to participate in the study or psychiatric patients at the time of study conducting.

Data collection tools and procedures

A pretested structured questionnaire was adopted from literature in English [ 14 , 15 ]. It was translated into Arabic and tested through a pilot study among 14 participants who were not included in this study.

The questionnaire covered sociodemographic characteristics of cases and controls (age; sex; sub-district; education and occupation) travel history, vaccination status with diphtheria toxoid-containing vaccines diphtheria-pertussis and tetanus vaccine, and contact with diphtheria cases. The variables related to the head of household characteristics; (education, occupation), household type, number of rooms, family size, family income, availability, and number of handwashing and toilet facilities were collected, in addition to (Yes/No) answers to 5 questions related to diphtheria general information.

Data collected during household interviews and the line list of reported cases was used to identify the address of cases to be visited at their homes by well-trained interviewers, and face-to-face interviews either with participants ≥ 18 years or with the head of the household /parents of participants < 18 years who agree to participate in the study.

As for data quality, the questionnaires were reviewed each day and checked for any incomplete or missing data, and ten percent of questionnaires were selected randomly for validation which was performed through phone calls or home visits by supervisors.

Variables and operational definitions

The vaccination status was defined as follows: participants were considered fully vaccinated if they had received three or more doses of diphtheria toxoid-containing vaccines or partially vaccinated if they had received less than three doses of diphtheria toxoid-containing vaccines confirmed by vaccination card or verbally for older people who only vaccinated in the national campaigns.

For analysis purposes, the householders were categorized as the following. As for cases and controls, the education was further categorized as uneducated; illiterate individuals who could not read and write or were at pre-school age and educated; or individuals with a basic and secondary school or university education. The occupation was categorized as pre-school age for children at that age, students for people at schools, employed for those who had a job in private or public sector, and unemployed for individuals without a job. As for householders, illiterate individuals who could not read and write or with basic school education (attained 9 or fewer years of school education), were classified as having low-level education, whereas individuals with a secondary school or university or above were classified as high-level of education. Individuals who had a job and were working were classified as employed while those who had not a job and were not working as unemployed. The World Bank classification for low-income countries for the year (2022–2023), was used to classify monthly income of householder by Yemeni Rial (YR) equivalent to USD: low income (≤ 61,000 YR), moderate (> 61,000 YR and ≤ 273,500 YR), and high income (> 273,500 YR), For knowledge, the scoring system for answers to five questions: 1 for correct answer and 0 for wrong answers) the scores were summed and categorized according to the median as good ≥ median or poor < median scores.

Data analysis

Epi Info Version 7.2 was used for data analysis. Frequency and percentage were used to summarize qualitative variables, mean standard deviation for quantitative variables with normally distributed data, and otherwise median and interquartile range (IQR). Chi-square, and T/ANOVA otherwise the Mann–Whitney tests were used respectively to compare the distribution of categorical and numerical variables of cases and controls. Conditional logistic regression was used to allow for age and residency matching. Univariate analysis was used to calculate the cured odds ratio (COR), and all variables with P  < 0.25 were included in multivariate analysis and the likelihood ratio test (LRT) was checked to ensure fitness. Adjusted Odds ratio (AOR) with a 95% confidence interval (CI) was used to report the strength of the association between the variables and diphtheria infection. P  < 0.05 was considered to indicate statistical significance.

A total of 118 cases and 236 controls were enrolled in the study with a median (IQR) age of 13(8,23) years;14 (9,22) years of cases compared to 12(7,25) of controls. In both groups, 47% of participants were from the Damt subdistrict. More than half (56%) were females (63% of cases vs. 53% of controls), and 59% had basic schools (64% of cases vs 57% of controls). Almost half (51%) of the participants were students (52% of cases vs. 51% of control) (Table  1 ).

For vaccination status against diphtheria; 60% (211/354) of all participants including 25% (30/118) of cases and 77% (181/236) of controls were fully vaccinated. The rest 40% (143/354) were partially vaccinated including 75% (88/118) of cases and 23% (55/236) of controls. Of all participants, 15% (52/354) had contacts with diphtheria cases accounting for 33%(39/118) and 6%(13/236) of cases and controls, respectively. only 6% (7/118) of cases compared to 1% (3/236) of controls had a travel history to areas affected by diphtheria (Table  2 ).

Only, 16% (19/118) of household heads of cases compared to 14% (33/236)of household heads of controls had a university education, the majority, 87% (103/118) compared to 93%(219/236) of household heads of cases and controls were unemployed. Low monthly income of 58% in both groups, 81% of cases compared to 73% of controls lived at houses, and both groups had a median (IQR) of 3(2,4) rooms, 5% of both groups had no toilet facility, and 49% of cases compared to 54% of controls had not handwashing facility at their dwellings. The health facilities are not far away and could be reached by both groups in a median (IQR) of 17(12,33) minutes (Table  3 ).

The univariate analysis by conditional binary logistic regression shows a significant association between diphtheria infection and various factors related to sociodemographic characteristics, household characteristics, vaccination status, and risks of contracting infection. As for sociodemographic factors, the COR of Gender females compared to males showed a higher likelihood of diphtheria infection COR = 1.9 (95% CI; 1.1–3.3, P -Value = 0.032) and individuals who were not engaged in work compared to pre-school age had a significantly higher risk COR = 11.7(95% CI;1.3–104.6, P value = 0.028). Individuals who lived in houses compared to those who lived in apartments had higher odds of infection COR = 3.6 (95% CI: 1.4–9.3, P -Value = 0.009). As for the potential risks of contracting diphtheria, partially vaccinated individuals compared to fully vaccinated individuals were at a significantly higher risk COR = 13.4 (95% CI; 6.7–27.9, P -Value < 0.001), having contact with a person who has diphtheria or traveling to an area affected by diphtheria increases the odds of infection COR = 13.5 (95% CI; 5.3–34.4, P -Value < 0.001), COR = 4.7 (95% CI; 1.2–18.0, P -Value = 0.026), respectively. The result of univariate analysis for all variables is presented in Supplement 1. All variables with a P value < 0.25 in the univariate analysis were included for multivariate analysis by conditional logistic regression, and after adjusting for other variables, only three variables including; gender, vaccination status, and contacts with diphtheria cases, remained associated with diphtheria infection. Female gender compared to males had three times the odds of contracting diphtheria AOR = 3.3( 95%CI; 1.1–9.5, P value = 0.029), individuals with partial vaccination status had 13.7 times the odds of diphtheria infection of those fully vaccinated AOR = 13.7( 95%CI: 6.1–31.1, P -value < 0.001), people who contacted with a case of diphtheria have eight times the odds of infection of those who not contacted a case of diphtheria AOR = 8.5(95%CI; 2.3–31.0, P value < 0.001) (Table  4 ).

Diphtheria is still an important health problem, particularly in conflict countries such as Yemen where diphtheria cases have risen gradually since 2021 to reach a significant increase in 2023 [ 10 ]. Damt District of Al Dhalea Governorate is one of the affected areas, where this matched case–control study has been conducted to identify the related risk factors for such an increase.

The result of univariate analysis in this study indicated an association between diphtheria infection and female gender. Even after adjusting with other variables, the AOR suggests a potentially increased risk of diphtheria among females compared to males. While there is no specific trend in the occurrence of respiratory diphtheria by gender [ 16 ]. A slightly higher proportion of males was reported in a study conducted in the Sadah governorate of Yemen, and another study conducted in Nigeria [ 13 , 17 ]. The explanation of this result could be attributed to many factors including; the incomplete vaccination status of females [ 18 ], women might be more exposed to household contacts since they are the caregivers for patients at home. As well as even vaccinated women, are more susceptible to diphtheria infection after 10 years of vaccination [ 19 ].

The unexpected result of our study is that more than half of the female cases (based on median age) of childbearing age are supposed to be prevented as they have received the tetanus-diphtheria (Td) vaccine. Thus, the result highlighted the absence of Td administration for females of childbearing age. It might be due to the gender barrier that could be attributed to the traditional conservative customs in Yemen. The cultural and social norms often restrict women’s access to healthcare, particularly in rural and conflict-affected areas. Women may face obstacles like needing male permission to seek medical care, limited mobility due to safety concerns, and a shortage of female healthcare workers, which can be particularly significant in conservative communities where women prefer or are only allowed to be treated by female providers [ 20 ]. These barriers may lead to lower vaccination coverage among women, especially those of childbearing age, who are more likely to be isolated during pregnancy or after childbirth [ 21 ]. Additionally, the healthcare infrastructure's collapse due to ongoing conflict further exacerbates these issues, as disrupted supply chains and damaged facilities make it difficult to maintain routine immunization programs [ 8 ].

The findings of this study showed no significant association between diphtheria infection and the education level and occupation of participant or household factors: education of household head, knowledge about diphtheria, dwelling type, family size, or number of rooms. This result was similar to the findings of a previous study conducted in Yemen and a study conducted in India [ 14 , 22 ]. However, our result was contrary to the result of a study reviewing factors affecting diphtheria which revealed educational level, physical conditions of the home, and level of knowledge [ 23 ]. The discrepancy in the results might be due to the difference in study design and study populations.

The results of this study indicated that full vaccination against diphtheria could reduce the likelihood of diphtheria infection by 13.7 times as compared to partial vaccination. These findings were in line with the findings reported by a previous study in Yemen [ 14 ], and many studies conducted elsewhere [ 23 , 24 , 25 ].

As for the source of infection; contact with a case of diphtheria was found to be associated with contracting diphtheria infection which increased the likelihood of infection by 8 times as compared to the absence of contacts. This finding was in line with the findings reported by a previous study in Yemen [ 14 ], and the result of the systematic review until January 2023 [ 21 ]. Similar to the result of previous studies, travel history was not found associated with diphtheria infection [ 14 , 24 ].

There were some limitations in this study, it was conducted in a small district and the majority of participants were females and the results may not be generalizable for all Yemeni governorates. Furthermore, however, this study was a matched case control, the match was for age and residency since it was difficult to find the matched gender for some cases that were from very remote areas or located in the front area of the war, and the immunization status might be affected by recall bias, particularly for older people who were lived at those areas. Nevertheless, this study provides information health programmers and policymakers could use to formulate vaccination policies as well as for further related research.

In conclusion, poor vaccination and contact with a case of diphtheria were the main identified factors that contributed to the occurrence of diphtheria outbreak in the Damt district particularly among females who are mostly the caregivers for patients at home and are at higher risk of household contact. Increasing the vaccination coverage against diphtheria either by DPT in general or Td for females of childbearing age. Moreover, increasing community awareness regarding home care protection measures and isolation of diphtheria cases could reduce the spread of the disease. Underline factors such as cold chain, vaccine delivery and other factors related to the vaccination services as well as gender barriers related to Td vaccination should be investigated.

The unexpected finding that females, particularly of childbearing age, are at higher risk of diphtheria despite being expected to have received the Td vaccination underscores significant gender-related disparities in healthcare access. These disparities, driven by cultural norms, limited mobility, and ongoing conflict in Yemen, highlight the critical need for targeted public health interventions that address the unique challenges women face in accessing healthcare.

For public health practice, this finding emphasizes the importance of integrating gender-sensitive approaches into vaccination programs. Ensuring that women have equal access to vaccinations, addressing vaccine hesitancy, and providing education tailored to their needs are essential steps to prevent future outbreaks and improve overall health outcomes. Public health strategies must also consider the broader social determinants of health, such as literacy and mobility, to effectively reduce the disease burden among vulnerable populations, particularly women in conflict zones.

Availability of data and materials

All relevant data are presented in this paper, and more information can be provided upon reasonable request from the corresponding author.

Abbreviations

Adjusted Odds Ratio

Crude Odds Ratio

Confidence Interval

Diphtheria-Tetanus-Pertussis Vaccine

Electronic Integrated Diseases Early Warning System

Interquartile Range

Likelihood Ratio Test

Tetanus-Diphtheria Vaccine

World Health Organization

Yemeni Rial

Diphtheria Fact Sheet https://www.who.int/health-topics/diphtheria#tab=tab_1 .

Factsheet about diphtheria https://www.ecdc.europa.eu/en/diphtheria/facts .

Diphtheria https://www.cdc.gov/diphtheria/index.html .

Dureab F, Al-Sakkaf M, Ismail O, Kuunibe N, Krisam J, Muller O, Jahn A. Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system. Confl Health. 2019;13:19.

Article   PubMed   PubMed Central   Google Scholar  

Dureab F, Müller O, Jahn A. Resurgence of diphtheria in Yemen due to population movement. J Travel Med. 2018;25(1). https://doi.org/10.1093/jtm/tazy094 .

Moghalles SA, Aboasba BA, Alamad MA, Khader YS. Epidemiology of Diphtheria in Yemen, 2017–2018: Surveillance Data Analysis. JMIR Public Health Surveill. 2021;7(6):e27590.

Diphtheria – Yemen  https://www.who.int/emergencies/disease-outbreak-news/item/22-december-2017-diphtheria-yemen-en .

Dureab F, Al-Sakkaf M, Ismail O, Kuunibe N, Krisam J, Müller O, Jahn A. Diphtheria outbreak in Yemen: the impact of conflict on a fragile health system. Confl Heal. 2019;13:1–7.

Google Scholar  

Attal B, Dureab F, Abbara A. Yemen: current peace talks must also prioritise health. BMJ. 2023;381:1242.

Article   PubMed   Google Scholar  

Epidemiological situation in Yemen: diphtheria https://www.emro.who.int/yemen/news/epidemiological-situation-in-yemen-diphtheria.html#:~:text=Cases%20have%20risen%20gradually%20since,in%20the%20whole%20of%202022 .

WHO Yemen: Diphtheria in Yemen-situation and response https://yemen.un.org/en/253142-who-yemen-diphtheria-yemen-situation-and-response .

Badell E, Alharazi A, Criscuolo A, Almoayed KAA, Lefrancq N, Bouchez V, Guglielmini J, Hennart M, Carmi-Leroy A, Zidane N, et al. Ongoing diphtheria outbreak in Yemen: a cross-sectional and genomic epidemiology study. Lancet Microbe. 2021;2(8):e386–96.

Article   CAS   PubMed   Google Scholar  

Al-Dar AA, Al-Qassimi M, Ezzadeen FH, Qassime M, Al Murtadha AM, Ghaleb Y. Diphtheria resurgence in Sada’a-Yemen, 2017–2020. BMC Infect Dis. 2022;22(1):46.

Nassar AAH, Abdullah Al-Amad M, Ghaleb YA. Risk factors for diphtheria in Sana’a, Yemen, 2019: a matched case-control study. IJID Reg. 2022;2:40–4.

Quick ML, Sutter RW, Kobaidze K, Malakmadze N, Nakashidze R, Murvanidze S, Wooten KG, Strebel PM. Risk factors for diphtheria: a prospective case-control study in the Republic of Georgia, 1995–1996. J Infect Dis. 2000;181(Suppl 1):S121-129.

Clarke KE, MacNeil A, Hadler S, Scott C, Tiwari TS, Cherian T. Global epidemiology of diphtheria, 2000–2017. Emerg Infect Dis. 2019;25(10):1834.

Medugu N, Musa-Booth TO, Adegboro B, Onipede AO, Babazhitsu M, Amaza R. A review of the current diphtheria outbreaks. Afr J Clin Exp Microbiol. 2023;24(2):120–9.

Article   Google Scholar  

Vidal Fuertes C, Johns NE, Goodman TS, Heidari S, Munro J, Hosseinpoor AR. The Association between Childhood Immunization and Gender Inequality: A Multi-Country Ecological Analysis of Zero-Dose DTP Prevalence and DTP3 Immunization Coverage. Vaccines (Basel). 2022;10(7):1032. https://doi.org/10.3390/vaccines10071032 .

Völzke H, Kloker K, Kramer A, Guertler L, Dören M, Baumeister S, Hoffmann W, John U. Susceptibility to diphtheria in adults: prevalence and relationship to gender and social variables. Clin Microbiol Infect. 2006;12(10):961–7.

Sutan R, Batarfi SA, Ismail H, Bin-Ghouth AS. Vaccine hesitancy from parents and healthcare providers perspectives in Hadhramout Governorate, Yemen: a mixed-method study protocol. BMJ Open. 2022;12(2):e055841.

Ikejezie J, Adebusoye B, Ekezie W, Langley T, Lewis S, Phalkey R. Modifiable risk factors for diphtheria: a systematic review and meta-analysis. Global Epidemiol. 2023;5:100100.

Allam RR, Uthappa CK, Duerst R, Sorley E, Udaragudi PR, Kampa S, Dworkin MS. A case-control study of diphtheria in the high incidence city of Hyderabad. India Pediatr Infect Dis J. 2016;35(3):253–6.

Rahma VA, Purnomo W. Factor affecting of the Diphtheria in East Java: scoping review. Indian J Public Health Res Development. 2019;10(10):2709–12.

Ghazali MRSPL. The determinants of diphtheria outbreak in Cirebon City. 2021.

Rintani A, Mintarsih T, RBM YM, Siregar JS, Widodo AP. Risk Factors Associated to Diphtheria Outbreak in Developing Countries. Jurnal Ilmu Kesehatan Masyarakat. 2018;9(2):83-95. https://doi.org/10.26553/jikm.2018.9.2.83-95. https://ejournal.fkm.unsri.ac.id/index.php/jikm/article/download/249/197 .

Download references

Acknowledgements

We would like to thank the data collectors and study participants

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author information

Authors and affiliations.

Health Office of Damt District, Al Dhalea Governorate, Damt City, Yemen

Sameer Shedaiwah

Health Office of Sana’a Governorate, Sana’a City, Yemen

Hamood Alsharabi

Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Sana’a City, Yemen

Labiba Anam

Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a City, Yemen

Mohammed Abdullah Al Amad

You can also search for this author in PubMed   Google Scholar

Contributions

SS contributed to the conception, design of the study, and methodology, supervised the data collection, analyzed the data, wrote the study report, and participated in manuscript writing. HA contributed to the conception and participated in data analysis and review of the study report.  LA made significant conception in reviewing the overall study, finalizing the study report, and reviewing the manuscript. MA revised the analysis of data, wrote the draft manuscript, and finalized the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Sameer Shedaiwah or Mohammed Abdullah Al Amad .

Ethics declarations

Ethics approval and consent to participate.

This study followed the Declaration of Helsinki guidelines and was approved by the research ethical committee of the Ministry of Public Health and Population, Sana’a, Yemen (Letter no152 date 8/8/2023. An official approval from health authorities in the governorate was obtained. Informed consent was obtained from all subjects and/or their legal guardian(s). The authors confirm that all methods were performed based on the relevant guidelines and regulations in the county. The study did not involve experiments on human subjects or human participants. No human studies are presented in this manuscript.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary material 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reprints and permissions

About this article

Cite this article.

Shedaiwah, S., Alsharabi, H., Anam, L. et al. Risk factors of diphtheria outbreak in damt district of Al Dhalea Governorate, 2023 -Yemen: a case–control study. BMC Infect Dis 24 , 1034 (2024). https://doi.org/10.1186/s12879-024-09932-7

Download citation

Received : 07 May 2024

Accepted : 13 September 2024

Published : 27 September 2024

DOI : https://doi.org/10.1186/s12879-024-09932-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Risk Factors
• Diphtheria outbreak
• Damt district

BMC Infectious Diseases

ISSN: 1471-2334

• General enquiries: [email protected]