Why Diphtheria Outbreak Requires Urgent Action

Diphtheria is a serious bacterial infection caused by the bacterium called Corynebacterium species that affects the nose, throat and sometimes, skin of an individual.

Also, it is a highly contagious infection that can cause breathing difficulties and heart problems that can be fatal, particularly in children.

Diphtheria can have severe consequences for communities if there is a lack of awareness and preventive measures in place.

Without proper awareness, the spread of diphtheria can occur rapidly, leading to a significant number of cases and potential outbreaks.

Recently, the Nigeria Centre for Disease Control and Prevention (NCDC) has responded to reports of diphtheria cases in Lagos and Kano States and is monitoring the situation in Osun and Yobe States where cases are now being picked up.

NCDC was notified of suspected diphtheria outbreaks in Kano and Lagos States on 1 December 2022. In January 2023, the number of confirmed cases increased, peaking at over 150 cases in week 4 of 2023 (ending 28 January); since then, a weekly decreasing trend has been observed. From 14 May 2022 to 9 April 2023, 1439, suspected diphtheria cases were reported from 21 states in Nigeria, with the majority (83%) of cases reported from Kano (1188), Yobe (97), Katsina (61), Lagos (25), Sokoto (14) and Zamfara (13). Of the 1439 suspected cases, 557 (39%) were confirmed (51 were laboratory-confirmed, 504 clinically compatible and two epidemiologically linked), 483 (34%) were discarded, and 399 (28%) are pending classification.

Laboratory-confirmed cases were reported from Kano (45), Lagos (3), Kaduna (1), Katsina (1), and Osun (1) states. Among the 557 confirmed cases, 73 deaths were recorded, for a CFR of 13%.

The CFR has dropped significantly since the beginning of the outbreak due to, among other factors, increased access to diphtheria antitoxin (DAT).

In a statement last week Thursday, NCDC said there have been multiple outbreaks across the country since December 2022, with 798 confirmed diphtheria cases from 33 Local Government Areas (LGAs) in eight states, including FCT.

NCDC added that 80 deaths have been recorded among all confirmed cases, with a case fatality rate of 10.0 per cent.

Recalled in January this year, the NCDC Director -General, Dr. Ifedayo Adetifa who placed Nigerians on alert, following response to reports of diphtheria cases in Lagos and Kano states.

NCDC Response

The Nigeria Centre for Disease Control and Prevention (NCDC), coordination and monitoring of diphtheria surveillance and response activities in the country are ongoing through the weekly diphtheria National Technical Working Group meetings.

Rapid Response Teams (RRTs) have been deployed to Katsina, Osun and Yobe States and re-deployed to Kano and Lagos States to support response activities.

Harmonization of surveillance and laboratory data across states and laboratories is ongoing.

Sensitization/training of clinical and surveillance officers has taken place in states where RRTs were deployed, on the presentation, prevention, and surveillance of diphtheria.

Cascaded trainings were conducted in their respective states by some of the laboratory scientists/physicians trained at the NCDC National Reference Laboratory (NRL), Abuja.

Procurement for reagents and sample collection and transportation materials/media processes has been initiated.

Distribution of DAT to the affected states has been ongoing since December 2022.

Strengthening of routine immunization activities across the country continues.

Some steps the Nigerian government can take to prevent the spread of diphtheria

Vaccination campaigns

The NCDC should conduct widespread vaccination campaigns to ensure that the population is immunized against diphtheria. This includes providing free vaccinations to all citizens, especially children, as they are more vulnerable to the disease.

Strengthen healthcare infrastructure

The Nigerian Government needs to invest in healthcare infrastructure, particularly in rural areas, to ensure that people have access to proper medical care. This includes setting up vaccination centers, improving diagnostic facilities, and training healthcare workers to diagnose and treat diphtheria effectively.

Public awareness campaigns

NCDC should launch public awareness campaigns to educate the population about diphtheria, its symptoms, and prevention methods. This can be done through mass media, community outreach programs, and schools. Emphasizing the importance of vaccination and maintaining good hygiene practices can help prevent the spread of the disease.

Surveillance and monitoring

The government need to establish a robust surveillance system to detect and monitor cases of diphtheria. This includes timely reporting of cases, laboratory testing, and contact tracing to prevent further transmission. Data collected through surveillance can also help identify areas with high infection rates and target interventions accordingly.

Collaboration with international organizations

The Nigerian government should collaborate with international organizations such as the World Health Organization (WHO) and UNICEF to access technical expertise, resources, and funding. These organizations can provide support in terms of vaccination supplies, training programs, and technical guidance for effective prevention and control of diphtheria.

Strengthening laboratory capacity

The government should invest in strengthening laboratory capacity to ensure accurate and timely diagnosis of diphtheria cases. This includes equipping laboratories with necessary reagents, equipment, and trained personnel to conduct diagnostic tests.

Quarantine and isolation measures

In cases of outbreaks, the government should implement quarantine and isolation measures to prevent the spread of diphtheria. Infected individuals should be isolated and treated promptly, and close contacts should be monitored and provided with appropriate preventive measures.

Regular monitoring and evaluation

The government should establish a system for regular monitoring and evaluation of prevention and control efforts. This will help identify gaps, assess the effectiveness of interventions, and make necessary adjustments to the strategies in place.

However, Nigerian government can also effectively prevent the spread of diphtheria and protect the health of its population.