Posted on: Fri 15-09-2023

Nigeria is currently facing a second wave of a diphtheria outbreak after a first wave of the outbreak was recorded between week 52 in 2022 and May 2023, The PUNCH reports.

This is according to the situation report of the disease obtained from the World Health Organisation on Thursday, as there is an increase in the affected population with a rise in the number of confirmed cases and related deaths.

The report showed that no fewer than 4,717 diphtheria cases out of the 8,353 suspected cases have been reported in Nigeria since the outbreak was first reported in 2022.

It said the majority of suspected cases were reported from Kano, Katsina, Yobe, Bauchi, Kaduna, and Borno states.

The report revealed that between June 30 and August 31, 2023, Nigeria recorded an unusual increase in the number of confirmed diphtheria cases from 59 Local Government Areas in 11 states across the country.

Diphtheria is a highly contagious vaccine-preventable disease caused mainly by the bacteria Corynebacterium Diphtheriae which can be fatal in five to 10 per cent of cases, with a higher mortality rate in young children.

WHO’s most recent risk assessment of the diphtheria outbreak in Nigeria has maintained the risk as high at the national level, and low at the regional and global levels.

However, public health measures such as vaccination response, enhanced surveillance for early case detection, case management, and risk communication coordinated by the Nigeria Centre for Disease Control and Prevention, in collaboration with WHO and other partners, are being implemented in response to the outbreak.

“Of the cumulative 8,353 suspected cases reported since the outbreak was first reported in 2022, 4.717 (56.5 per cent) cases were confirmed (lab confirmed 1 (169; 3.6 per cent), epidemiologically linked (117; 2.5 per cent) and clinical compatibility (4,431; 93.9 per cent)). While 1,857 (22.2 per cent) were discarded as not compatible with diphtheria, 1,048 (12.5 per cent) cases are pending classification, and 731 (8.8 per cent) cases had unknown diagnoses.

“The case fatality ratio dropped slightly from 6.7 per cent during the last update to 6.1 per cent. Of the 4,717 confirmed cases, 3,466 (73.5 per cent) were aged one to 14 years, of these 699 were aged zero to four years, 1,505 were aged five to nine years, and 1,262 (aged 10 – 14 years. More than half of the cases (2,656; 56.3 per cent) were females.

“Only 1,074 (22.8 per cent) of the confirmed cases were fully vaccinated against diphtheria, 299 (6.3 per cent) were partially vaccinated. More than half of the cases (2801; 59.4 per cent) were unvaccinated,” the report read in part.

Treatment involves administering diphtheria antitoxin, as well as antibiotics. Vaccination against diphtheria has been effective in reducing the mortality and morbidity from diphtheria dramatically.

Nigeria has recorded diphtheria outbreaks in the past, notably in 2011 and 2022.

“Nigeria is currently facing a second wave of diphtheria outbreak after a first wave of the outbreak was recorded between epidemiological week 52, 2022 (January 1, 2023) and week 20, 2023 (May 22, 2023). There is an increase in the affected population with a rise in the number of confirmed cases and related deaths reported in epidemiological weeks 31-33.

“There is an increased risk of transmission, with clusters and outbreaks reported in newly affected LGAs, with currently 27 LGAs reporting one clinically compatible case in the last three reporting weeks relative to 15 LGAs that had active cases in the preceding three weeks.

“The low national coverage (57 per cent) of the Pentavalent vaccine (Penta 3) administered in routine immunisation, and the sub-optimal vaccination coverage in the paediatric population—with 43 per cent of the target population unvaccinated—underscore the risk of further spread and the accumulation of a critical mass of susceptible population in the country with sub-optimal herd or population immunity,” WHO said.

WHO advised that the control of diphtheria is based on primary prevention of disease by ensuring high population immunity through vaccination, and secondary prevention of spread by the rapid investigation of close contacts to ensure prompt treatment of those infected.

Meanwhile, the Coordinating Minister of Health and Social Welfare, Prof Ali Pate, has constituted an emergency task force to curb the diphtheria outbreak in the country.

This was disclosed on Thursday in a press statement signed by the minister’s Special Assistant on Media and External Relations, Tashikalmah Hallah.

The task force is to be co-chaired by the Executive Director of the National Primary Health Care Development Agency, Dr Faisal Shuaib, and the Director General of the Nigeria Centre for Disease Control and Prevention, Dr Ifedayo Adetifa.

Other members of the task force include the Director of Public Health in the Federal Ministry of Health and Social Welfare, Dr Anyaike Chukwuma, representatives from WHO, the United Nations Children’s Fund, the Federal Ministry of Information and the Northern Traditional Leaders Committee on Primary Healthcare Delivery.

Diphtheria is a highly contagious vaccine-preventable disease caused mainly by the bacteria Corynebacterium diphtheriae which can be fatal in five to 10 per cent of cases, with a higher mortality rate in young children.

The minister said the task force is to operate in an emergency mode in order to forestall further spread to other states and bring succour to the populace.

He was quoted as saying, “There should be massive mobilisation and sensitisation. This is where the NTLC is critical. Our people should be aware of the disease, the dangers inherent in and what they need to do. We must mount a rapid response as our children are returning to school.

“I am also glad that the ED of NPHCDA has shelved his trip to the United Nations General Assembly meeting in New York, to lead the rapid response team to Kano the epicentre of the crisis.”

The statement noted that diphtheria cases have been detected in 14 states, with Kano as the epicentre.

The 14 affected states are Lagos, Osun, Federal Capital Territory, Nasarawa, Kaduna, Katsina, Yobe, Bauchi, Gombe, Borno, Zamfara, Jigawa, Plateau, and Kano.

Pate also urged the task force team to liaise with the Governors of the 14 affected states for counterpart funding, ownership and mass mobilisation.

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