Nation
Fresh outbreak worsens Nigeria’s effort at Diphtheria eradication
By Tumininu Ojelabi Hassan
The Nigeria Centre for Disease Control and Prevention (NCDC) has reported 836 confirmed diphtheria cases with 83 deaths in eight states across 33 Local Government Areas in the country this year. In June 2023, 160 cases of diphtheria were confirmed.
According to data from NCDC, 819 (37.7%) cases have been confirmed in Kano state, 3 (3.2%) cases were confirmed in Yobe, 2 (3.3%) cases in Katsina, 8 (27.6%) cases in Lagos, one case was confirmed in FCT, Osun, Kaduna and Cross river state respectively.
An outbreak of diphtheria, a severe bacterial infection that is, especially harmful to children, was announced by NCDC in December 2022. Diphtheria is a highly contagious disease caused by a bacteria called Corynebacterium Diphtheria, which affects all age groups largely in children. It has been reported in many countries like Italy, Germany, Austria, France, Norway, Switzerland, United Kingdom and Netherlands.
Dr. Tobi Sanya speaks on the symptoms and prevention of diphtheria while discussing with our correspondent.
“First of all, I will say no one expected this outbreak because this disease is vaccine preventable. Nevertheless, it is important to note that this disease can affect all age groups, however unvaccinated children are at a higher risk of being infected.
“Some of the symptoms to look out for, especially in children is fever, sore throat, cough, swollen neck due to enlarged lymph nodes, blood from nose, red eyes (Conjunctivitis), weakness and headache. These symptoms can last for 2-10 days. If untreated, it can extend to the body system thereby causing heart problems, diarrhoea, encephalitis, pneumonia, which is a major cause of death.
“This is because it produces chemicals called toxins, which are usually grayish-white patch in the throat. These toxins can block the airways, thereby making it difficult to breathe and swallow. They can also travel from the blood to other organs, which can cause inflammation of the heart and nervous system,” he said.
He spoke about the deadly nature of the disease and the way it spreads.
“Diphtheria is communicable and it is mostly spread by contact with infected individuals or objects, airborne respiratory droplets from coughing and sneezing. It is so deadly that in some cases people can have the bacteria without showing symptoms. Also, it spreads faster amongst people with poor hygiene, that’s why we usually advise people to take environmental sanitation seriously and maintain proper hygiene,” he added.
Based on Dr. Tobi’s suggestion, the best preventive measure to adopt to stop the spread of diphtheria in the country is to ensure the adequate vaccination of children.
“The pentavalent vaccine is taken to prevent diphtheria. This vaccine is given to children in three doses, at 6th, 10th and 14th week and it prevents children from five childhood vaccine-preventable diseases, which includes Diphtheria, Tetanus, Hepatitis B infection, Haemophilus influenzae type B and Pertussis (Whooping cough).
“Parents should ensure that their children receive this vaccine as it is the best way to prevent diphtheria. The vaccine has been included in immunisation schedules and it is free at all public health centres in the country.
“Most importantly, when the signs and symptoms of diphtheria I stated earlier are detected whether in children or adults, the next step is to call the NCDC Toll free line to report the case and isolation should begin immediately to avoid the spread of the disease. It is also advisable to treat people, who have had close contact with an infected person to avoid the spread of the disease,” he advised.
Dr. Faisal Shuaib, the executive director of National Primary Health Care Development Agency, told the media in January 2023 that the outbreak indicated poor immunisation coverage in the affected states. He said diphtheria is a vaccine- preventable disease, adding that receiving the recommended vaccines adequately is the best way to prevent it.
Furthermore, he advised parents and caregivers in the affected states and other parts of the country to ensure that their children below one year are fully vaccinated with P awwentavalent vaccine and other childhood vaccines like polio vaccine, measles vaccine, rota virus vaccine, yellow fever vaccine, meningitis vaccine, Bacille Calmette -Guerin (BCG) vaccine and inactivated polio vaccine (IPV).
To curtail the spread of the disease, NCDC has advised the public and healthcare workers to ensure that children are fully vaccinated against diphtheria with the prescribed three doses of a Pentavalent vaccine as recommended by WHO. Also, healthcare workers should maintain a high index of suspicion for diphtheria, that is, they should be vigilant and lookout for symptoms of diphtheria.
In addition, once a clinical diagnosis of diphtheria is carried out, a laboratory test should be done immediately to confirm the suspected cases.
“Please send samples to your State and/or NCDC National Reference Laboratory campuses in Abuja or Lagos for diagnosis. Cases of individuals with signs and symptoms suggestive of diphtheria should be notified to the appropriate surveillance officer and managed in an isolation ward,” NCDC instructed.
The public health institute further suggested preventive measures on its website.
“Practice standard precautions always while handling patients and body fluids i.e., always wear Personal Protective Equipment (PPE) irrespective of the patient’s provisional diagnosis. All healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with a high level of exposure to cases of diphtheria should be vaccinated against diphtheria,” NCDC advised.
The first outbreak of diphtheria in Nigeria was reported in 2011 in Borno state and 98 cases were reported, which led to 21 deaths (21.4%). This outbreak and the associated high rate of fatality were due to a combination of low vaccination coverage, delayed clinical recognition and laboratory confirmation and the absence of antitoxin and antibiotics for treatment.
In response to the current outbreak, which was reported in December 2022, NCDC said it activated a multi-sectoral National Diphtheria Technical Working Group as a technique for coordinating surveillance and response activities across the country.
“The response activities include coordination, surveillance, laboratory investigation, risk communication, case management and immunisation activities,” it revealed.
In addition, NCDC said it deployed Rapid Response Teams (RRT) to some of the affected states: (Kano, Katsina, Lagos, Osun and Yobe) to support response activities in the states, also to facilitate the development and dissemination of surveillance tools across the country to support active cases across affected states.
