NIGERIA—The WHO reported approximately 15,569 suspected (9,772 confirmed) cases of diphtheria in Nigeria between May 9, 2022, and October 25, 2023. Unfortunately, 547 of those impacted have died.
Confirmed cases have been documented in 19 states, with the Federal Capital Territory (FCT), Kano, Yobe, and Bauchi states experiencing the most severe impact.
Diphtheria is caused by Corynebacterium diphtheriae, a vaccine-preventable bacterium that leads to the development of a thick grayish membrane in the throat.
This highly contagious bacterium primarily affects the respiratory system but can also spread to other systems.
Transmission occurs through direct contact with respiratory droplets.
Those most at risk include unvaccinated or partially vaccinated children, adults in crowded and unsanitary environments, healthcare personnel, and caregivers supporting confirmed cases.
Key symptoms of diphtheria include fever, sore throat, difficulty breathing, and skin sores.
According to Dr Abubakar Labaran Yusuf, Kano State Commissioner of Health, it is critical to interrupt transmission in areas such as Kano State to reduce the risk of community-level spread.
To strengthen the outbreak response, WHO has allocated US$1.3 million to enhance critical outbreak control measures, including disease surveillance, laboratory testing, contact tracing, case investigation, treatment, training, and community collaboration.
Kano State has conducted three rounds of reactive regular vaccination campaigns in February, April, and August 2023, with the assistance of WHO and the United Nations Children’s Fund. These campaigns involve the use of a combination of tetanus-diphtheria and pentavalent vaccines.
It’s worth noting that diphtheria prevention requires all three doses. WHO has also provided and facilitated the acquisition of medicines to treat the illness.
In Kano alone, approximately 75,000 zero-dose children under the age of two have received the first dose of the pentavalent vaccination.
Additionally, about 670,000 eligible children aged 4 to 14 have been immunized with the tetanus-diphtheria vaccine in 18 high-burden local government districts in Kano State.
According to Dr. Walter Kazadi Mulombo, WHO Representative in Nigeria, WHO has increased its commitment to curb the diphtheria outbreak, with the assistance of the Government of Nigeria and partners, to respond quickly and in a coordinated manner.
He also asked parents to bring their children in for routine childhood vaccines.
Diphtheria cases are not restricted to Nigeria. According to the Africa CDC, on August 17, 2023, an outbreak was declared, resulting in 865 cases and 37 deaths recorded throughout nine areas, particularly in the Matameye district bordering Nigeria.
In Guinea, 483 suspected cases and 58 deaths have been recorded, primarily in the Kankan region. Meanwhile, Algeria has confirmed 80 cases and 10 deaths in the southern city of Tamanrasset. All of these cases have affected immigrant nationals with no immunization history.
Over 65% of recorded diphtheria cases in Africa had no vaccination history, and over 60% of those affected are under the age of 15, with females accounting for more than 62% of cases.
Some cases have been documented among babies, with the spread of the outbreak attributed to inadequate herd immunity due to suboptimal vaccination rates.
In response to these outbreaks, Algeria, Guinea, Niger, and Nigeria are organizing emergency coordination meetings, engaging in risk communication, involving communities, conducting mass immunizations, managing cases, and strengthening surveillance efforts.
However, they are encountering logistical challenges in procuring laboratory supplies, vaccines, Diphtheria Antitoxin (DAT), and laboratory confirmatory tests.
To assist in the response, the Africa CDC and partners such as Médecins Sans Frontières are providing information and capacity-building measures.
Additionally, initiatives are underway to train over 50 healthcare workers in case management across Nigeria’s affected states.
According to the Africa CDC, which promotes cross-border cooperation and enhances surveillance and information exchange among its Member States, addressing the diphtheria outbreak requires coordinated actions that tackle behavioral change, access issues, and gender equity.
As a result, the Africa CDC recommends that partners enhance access to immunizations and essential medical supplies. The global shortage of antitoxins, particularly diphtheria antitoxin, is of significant concern.
Members are also encouraged to bolster surveillance of other vaccine-preventable diseases and increase access to and adoption of vaccines.
To effectively manage the diphtheria outbreak in Africa, rapid action is essential, with a focus on immunization, access to medical resources, and collaborative efforts
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