Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms usually start 2 – 5 days after exposure and range from mild to severe. Symptoms often come on gradually, beginning with a sore throat and fever. In severe cases, the bacteria produces a poison (toxin) that causes a thick grey or white patch at the back of throat. This can block the airway making it hard to breathe or swallow and also create a barking cough. The neck may swell in part due to enlarged lymph nodes.
The poison may also get into the blood stream causing complications that may include inflammation and damage of the heart muscle, inflammation of nerves, kidney problems, and bleeding problems due to low blood platelets. The damaged heart muscles may result in an abnormal heart rate and inflammation of the nerves may result in paralysis.
Diphtheria spreads easily between people by direct contact or through the air though respiratory droplets, like from coughing or sneezing. It may also be spread by contaminated clothing and objects.
Since the outbreak of Diphtheria in January 2023, the Nigeria Centre for Disease Control (NCDC) has continued to record new infections and fatalities in the country.
NCDC in its latest situation report from weeks six to eight shows that a total of 377 suspected cases were reported from seven states across the country.
Of the 377 suspected cases reported, NCDC noted that 102 were confirmed, 113 (30 per cent) were discarded; 148 (39.3 per cent) are pending classification and 14 (3.7 per cent) were unknown.
The disease control centre added that six deaths with a case fatality ratio (CFR) of 5.8 per cent were recorded from the confirmed cases during the weeks under review.
Kano State, North-west Nigeria, has maintained the lead on the Diphtheria infection chart since the NCDC announced the outbreak in January.
The disease centre had confirmed in a public health advisory issued in the wake of the outbreak that not less than 25 people have reportedly died from the disease in Kano State.
The State Government subsequently confirmed the infection outbreak in 13 local government areas of the state, with 100 suspected cases and three deaths recorded as of 20 January.
In the latest situation report, Kano State recorded 96.8 per cent (355) of the 377 suspected cases reported from weeks 6 to 9 of 2023.
According to NCDC, Nigeria has recorded a total of 389 confirmed Diphtheria infections and 62 deaths across 24 local government areas in six states from week 19 of 2022 to week 9 of 2023.
NCDC noted that only 60 (15.4 per cent) of 389 cases were fully vaccinated with a diphtheria toxin-containing vaccine.
It added that the majority of 78.4 per cent of the confirmed cases occurred among children aged two to 14 years.
NCDC also noted that a total of 1,064 suspected cases were reported from 21 states. Six states: Kano (843), Yobe (86), Katsina (46), Lagos (22), Sokoto (14) and Zamfara (13) accounted for 96.2 per cent of these suspected cases.
Of the 1,064 suspected cases reported, 389 (36.6 per cent) were confirmed, 322 (30.3 per cent) were discarded, 201 (18.9 per cent) are pending classification, and 152 (14.3 per cent) are unknown, the disease centre noted.
We therefore urge all children in the country should be immunized against diphtheria. A 3-dose primary series during infancy is the foundation for building lifelong immunity to diphtheria. Further, immunization programmes should ensure that 3 booster doses of diphtheria toxoid-containing vaccine are provided during childhood and adolescence. At any age those who are unvaccinated or incompletely vaccinated against diphtheria should receive the doses necessary to complete their vaccination.
Recent diphtheria outbreaks in several countries reflect inadequate vaccination coverage and have demonstrated the importance of sustaining high levels of coverage in childhood immunization programmes. Those who are unimmunized are at risk regardless of the setting. An estimated 86% of children worldwide receive the recommended 3 doses of diphtheria-containing vaccine when they are infants, leaving 14% with no or incomplete coverage.
In endemic settings and outbreaks, health-care workers may be at greater risk of diphtheria than the general population. Consequently, special attention should be paid to immunizing health-care workers who may have occupational exposure to Corynebacterium diphtheriae.
