What You Need To Know About Diphtheria: As 836 Cases, 83 Deaths Raise Concerns

Diphtheria, a vaccine-preventable disease caused by Corynebacterium diphtheria, has resurfaced in Nigeria. Despite its preventable nature, the country has reported 836 confirmed cases across several states, including Cross River, Kano, Katsina, Kaduna, Lagos, Osun, Yobe, and the Federal Capital Territory, within the past year.

Tragically, 83 deaths have been linked to these cases during the same period.

The Nigeria Centre for Disease Control’s (NCDC), director-general, Dr. Ifedayo Adetifa, highlighted the availability of a safe and cost-effective vaccine but expressed concern that over 80 percent of confirmed cases in this outbreak were unvaccinated individuals.

He said diphtheria is covered by one of the vaccines provided routinely through Nigeria’s childhood immunisation schedule.

He said “Historical sub-optimal vaccination coverage is the main driver of the outbreak given the most affected age group (2-14-year-olds) observed, and a national survey of diphtheria immunity that found less than half (41.7 per cent) of children under 15 years old are fully protected from diphtheria,” he said.

Similarly, the executive director of the National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, said diphtheria is totally preventable through vaccination, adding that in the country, pentavalent vaccines are used to protect against diphtheria and are administered to children at six weeks, 10 weeks, and 14 weeks of age, with additional doses being given during campaigns.

Faisal frowned that despite the efforts of the federal government to provide safe and cost-effective vaccines, a significant number of children remain unvaccinated or partially vaccinated, compromising the country’s goal of achieving population immunity.

He said suboptimal vaccination coverage has been the main factor contributing to these outbreaks, with the most affected age group being those between 2-14 years.

Transmission

Diphtheria spreads easily between people through direct contact with infected people, droplets from coughing or sneezing, contact with contaminated clothing and objects.

Symptoms

Symptoms of diphtheria include fever, runny nose, sore throat, cough, red eyes (conjunctivitis), neck swelling. In severe cases, a thick grey or white patch appears on the tonsils and/or at the back of the throat associated with difficulty breathing.

Who Is At Risk?

According to NCDC, children and adults who have not received any or a single dose of the pentavalent vaccine (a diphtheria toxoid-containing vaccine) are most at risk.

Also, people who live in a crowded environment, areas with poor sanitation, healthcare workers, and others who are exposed to suspected/confirmed cases of diphtheria are at risk.

Ifedayo, therefore, urged parents to ensure that their children are fully vaccinated against diphtheria with three doses of the pentavalent vaccine as recommended in the childhood immunisation.

He said “The Nigeria childhood immunisation schedule recommends three doses of pentavalent vaccine (diphtheria toxoid-containing vaccine). This is recommended for children in the 6th, 10th, and 14th week of life.”

He also advised that Individuals with signs and symptoms suggestive of diphtheria should isolate themselves and notify the appropriate authorities.

However, the DG said the centre was working with State Ministries of Health and partners to enhance surveillance and response to the outbreak.

Meanwhile, the World Health Organisation (WHO), said it had received a request from the Nigeria Centre for Disease Control (NCDC) to procure Diphtheria Antitoxin (DAT) and erythromycin IV for the case management of diphtheria cases in the country.

WHO representative in Nigeria, Dr. Walter Kazadi Mulombo, who disclosed this at a press briefing recently in Abuja, said the organisation was working with the NPHCDA to organise the first phase of a vaccination campaign targeting children from 0 to 14 years old in four states, and supporting the campaign with N92 million.

He said “This weekend, NCDC requested support from WHO for the deployment of 18 rapid response teams to support Bauchi, Kaduna and Katsina response,” adding that the deployment process was underway following the requested profile and a mix of the workforce from the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP).

‘WHO team is on the ground in Yobe and Kano, improving the surveillance at health facility and community level, supporting the active case search and supporting the decentralised isolation centers and referral to the state reference treatment centers, in alignment with State Ministry of Health request and NCDC guidance.

“WHO is supporting FCT in conducting an integrated Active Case Search and Household Sensitisation in the FCT, optimising the opportunity for the fIPV + nOPV2 RI intensification campaign.

‘WHO is supporting the procurement of laboratory commodities to increase the result turnaround time to support the case definition and management at an early stage.

In the same vein, the NPHCDA said it is collaborating with the Federal Ministry of Health, NCDC, the states, partners, and is mobilising all necessary resources to respond effectively to the ongoing outbreak.

NPHCDA boss said a comprehensive response plan has been activated to detect cases early, contain the spread, and prevent further transmission through a multi-phased strategy.

“To facilitate our immediate response plan, we are leveraging surveillance data from NCDC and direct information from the states to ensure effective planning and resource deployment. The Agency is working closely with partners to ensure adequate supplies of Tetanus Td for children 4 to 14 years and Pentavalent vaccines for children under 4 years.

“Currently, we are collaborating with the affected state teams and other stakeholders to conduct intensified mass vaccinations for identified at-risk populations in the affected states, administering pentavalent and tetanus and diphtheria vaccines. Additionally, we are conducting awareness campaigns to educate the public about the disease, its symptoms, and preventive measures.

“The response to the ongoing diphtheria outbreak will be carried out in two phases. Phase 1, the immediate response, will encompass 25 Local Government Areas (LGAs) across four States: Bauchi, Katsina, Yobe, and Kaduna. This phase is scheduled to begin on the 7th of August 2023 and will continue until the 11th of August 2023.”

According to Faisal, the Phase 2 will cover outbreak response in 171 LGAs. Six States (Kano, Katsina, FCT, Yobe, Kaduna, and Bauchi) will have a state-wide outbreak response, while there will be targeted outbreak responses in LGAs across eight States: Jigawa (8 LGAs), Borno (4 LGAs), Osun (4 LGAs), Lagos (3 LGAs), Zamfara (3 LGAs), Gombe (3 LGAs), Plateau (1 LGA), and Nasarawa (1 LGA). This phase is planned to be conducted in three rounds.

He said the first round will commence on 21st August 2023, followed by the 2nd and 3rd rounds tentatively set for 18th September 2023 and 16th October 2023, respectively.

Parents are caregivers are therefore urged to take their children, from birth to 14 years, to nearby health facilities for vaccination with the pentavalent or Td vaccines and other age-appropriate vaccines.