Diptheria outbreak overview
Diphtheria is a highly contagious bacterial infection that primarily affects the throat and nose. It is caused by Corynebacterium diphtheriae, a bacterium that produces a toxin that forms a thick grayish-white coating in the back of the throat.
In recent years, Nigeria has experienced a concerning outbreak of diphtheria, leading to a significant number of deaths and posing a severe public health threat.
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What is Diphtheria?
Diphtheria is a highly contagious vaccine-preventable disease caused by exotoxin-producing Corynebacterium diphtheriae It spreads between people mainly by direct contact or through the air via respiratory droplets.
The disease can affect all age groups, however, unimmunized children are particularly at risk. It is potentially fatal. Symptoms often come on gradually, beginning with a sore throat and fever.
In severe cases, the bacteria produce a poison (toxin) that causes a thick grey or white patch at the back of the throat. This can block the airways, making it hard to breathe or swallow, and also creates a barking cough.
The neck may swell in part due to enlarged lymph nodes. Treatment involves administering diphtheria antitoxin as well as antibiotics. Vaccination against diphtheria has reduced the mortality and morbidity of diphtheria dramatically.
Diphtheria is fatal in 5 – 10% of cases, with a higher mortality rate in young children. However, in settings with poor access to diphtheria antitoxin, the CFR can be as high as 40%.
The Nigeria Centre for Disease Control and Prevention (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 were 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).
Nigeria had recorded diphtheria outbreaks in the past. The most significant outbreak reported was between February and November 2011 in the rural areas of Borno State, north-eastern Nigeria, where 98 cases were reported.
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Causes of the Diphtheria Outbreak in Nigeria
Several factors contribute to the diphtheria outbreak in Nigeria. Inadequate immunization coverage, especially in marginalized communities, leaves a significant portion of the population susceptible to the disease. Limited access to healthcare facilities and delays in seeking medical attention exacerbates the situation. Poor sanitation and hygiene practices also contribute to the spread of the bacteria.
Diphtheria Transmission and Symptoms
Diphtheria spreads through respiratory droplets when an infected person coughs or sneezes. It can also spread through direct contact with items contaminated by an infected individual. The symptoms of diphtheria include sore throat, fever, difficulty breathing, swollen glands in the neck, and the characteristic grayish-white membrane in the throat.
Diptheria Diagnosis and Treatment
Prompt diagnosis is crucial in managing diphtheria cases. A healthcare professional may collect a throat swab to identify the presence of the bacterium or its toxin. Treatment involves administering antibiotics to kill the bacteria and antitoxin to neutralize the toxin. Supportive care, such as maintaining airway patency and providing fluids, is also essential.
Diphtheria Vaccination Efforts
Vaccination plays a vital role in preventing diphtheria outbreaks. In Nigeria, the government, along with international organizations, has implemented vaccination campaigns to improve coverage. The diphtheria vaccine is typically given as part of routine childhood immunization schedules, and booster doses are recommended for adolescents and adults.
Importance of Public Awareness
Raising public awareness about diphtheria is crucial for prevention and control. Educating communities about the importance of vaccination, personal hygiene, and early medical intervention can help mitigate the spread of the disease.
Public health authorities and NGOs work together to disseminate information through various channels, including mass media and community outreach programs.
Collaboration and Prevention Strategies
Addressing the diphtheria outbreak requires a collaborative effort from multiple stakeholders. Governments, healthcare providers, non-governmental organizations, and international agencies must work together to strengthen vaccination programs, improve healthcare access, and enhance surveillance systems. Preventive measures, such as promoting good hygiene practices and early detection, are crucial in controlling the outbreak.
Challenges Faced
Several challenges hinder efforts to combat the diphtheria outbreak in Nigeria. These include limited healthcare infrastructure, vaccine hesitancy, logistical difficulties in reaching remote areas, and addressing cultural and social barriers.
Overcoming these challenges requires sustained commitment, investment in healthcare systems, and targeted interventions to reach vulnerable populations.
The Impact of Diphtheria Outbreak
The diphtheria outbreak in Nigeria has had a significant impact on public health and society. It has resulted in a high number of deaths, especially among children and individuals with weakened immune systems.
The loss of lives and long-term complications caused by the disease underscores the urgency of addressing the outbreak effectively.
Steps Taken by the Government
The Nigerian government has taken several steps to address the diphtheria outbreak. This includes intensifying vaccination campaigns, improving access to healthcare services, and strengthening surveillance systems to detect and respond to cases promptly. Collaboration with international partners and organizations has also been instrumental in providing support and resources.
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In conclusion, the diphtheria outbreak in Nigeria presents a significant public health challenge that demands urgent attention. Through collaborative efforts, including robust vaccination programs, public awareness campaigns, and improved healthcare infrastructure, the country can effectively control and prevent future outbreaks.
Timely diagnosis, prompt treatment, and a comprehensive approach are essential to save lives and protect the population from the devastating effects of diphtheria.
