Diphtheria, a vaccine preventable disease persists as public health concern due to poor immunisation coverage
in India.[3] Immunisation coverage rates are typically lower among migrants as seen in studies.[9,10]
In this study,migration was an integral part of these families. It is driven both by their tradition as well as livelihood issues.Providing secured livelihood is an important interventionbwhich can reduce their vulnerability if not migration. Both
the families were not much aware about the vaccine preventable diseases and this lack of knowledge is an
important social determinant of their behaviour. Investing in education and specifically health education would be
important means of countering the ignorance. It has been shown that personalised service provision by health care
system increases chances of a child receiving full immunisation. [9] There is need to develop health care
services specifically for migrant communities. If ignored, then it would lead to high risk susceptible areas in rural
India where children will be susceptible and in close proximity with each other. In such epidemiological
situation, disease agent will continue to transmit and result in periodic outbreaks. Families, in the study, preferred
private practitioners rather than government system even though the former is not affordable for them. Therefore,
health care delivery structure for migrants should include private practitioners. Since migrants will be highly mobile
population, it is important to have micro-plans to reach out to them. Along with these measures to prevent, a case of
diphtheria from occurring, need is to develop systems that would mount sufficient public health response. District
health authorities vaccinated all unimmunized children in one village. Since the two cases described, had been
travelling from one village to other; there was need of a coordinated effort of all authorities in both the districts.
This calls for need of a strong surveillance system which would not only trigger disease control activities but also
plan, implement and evaluate programmes