Experts decry govt inaction as diphtheria spreads to 18 states

Diphtheria has so far killed 453 persons, infected 7,202, and spread to 18 states across the country, the federal government said yesterday. 

This is amid calls by experts on the need for government at all levels and other stakeholders to work towards curbing the spread of the disease in the country. 

While expressing divergent views on measures put in place since the current outbreak was confirmed in December 2022, they said there is need to do more as the disease has continued unabated rather than reduced. 

Diphtheria is a highly contagious vaccine-preventable disease caused by the bacterium Corynebacterium diphtheriae, mainly spread through direct contact with an infected person or exposure to airborne droplets. 

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A joint statement yesterday from the Federal Ministry of Health and Social Welfare, in collaboration with the National Primary Health Care Development Agency (NPHCDA) and the Nigeria Centre for Disease Control (NCDC) said “As of September 24th, 2023, there have been 11,587 reported suspected cases out of which 7,202 were confirmed cases from 105 local government areas in 18 states including the Federal Capital Territory (FCT).” 

The federal government said most (6,185) of the confirmed cases were recorded in Kano.

It said other states with cases are Yobe (640), Katsina (213), Borno (95), Kaduna (16), Jigawa (14), Bauchi (8), Lagos (8), FCT (5), Gombe (5), Osun (3), Sokoto (3), Niger (2), Cross River (1), Enugu (1), Imo (1), Nasarawa (1) and Zamfara (1).

It said the majority (73.6%) of the confirmed cases occurred among children aged 1 – 14 years with those aged 5-14 years bearing most of the brunt of the disease. 

“So far, a total of 453 deaths have occurred in confirmed cases giving a case fatality rate (CFR) of 6.3%,” the statement said.

Disease preventable 

The Executive Director of the National Primary Health Care Development Agency (NPHCDA, Dr Faisal Shuaib, said diphtheria is totally preventable through vaccination. 

He, however, said despite efforts by the federal government to provide safe and cost-effective vaccines, a significant number of children remain unvaccinated or partially vaccinated, thereby compromising the country’s goal of achieving population immunity. 

Speaking to Daily Trust in Kano, the epicentre of the outbreak, an epidemiologist, Dr. Shuaib Sani Shuaib said diphtheria being a communicable disease needs a collaborative approach among government, public and other stakeholders to arrest the situation. He said the reason why Kano had the highest number of cases was as a result of congestion of the environment and poor sanitation, hygiene, and water. 

He said while the government should intensify funding and policy implementation to address the problem, the general public should also contribute through tracing the suspected cases and also sanitising their environment. 

“When we are talking about issues that have to do with an outbreak, we do look at issues of priorities, issues of control and then issue of management. In the case of diphtheria, we can look at it from the issue of overcrowding and Kano is a known crowded area in Nigeria.” 

He said among the measures to be taken in addressing the problem involved coordination and support among the various stakeholders. 

“Not just the government, not just the people affected. We all need to be involved. Secondly, when we are talking about controlling diphtheria, we need to look at the area of funding. The issue is not getting necessary attention. There should also be an actionable plan and approach that are targeted towards controlling the outbreak. 

“It is also very important to undergo an actionable search for diphtheria. Because there are differences between cases that are clinically confirmed and cases that are confirmed from the laboratory. We should also be able to confirm active cases from the communities in order to intensify the fight against the disease.” 

Dr. Shuaib said other areas that need to be considered are emergency operations, “We are talking about 90 per cent of the cases in Kano. On an average, the case fatality rate for diphtheria is 5 to 10 per cent, but in the case of the outbreak that we are having presently, we are looking at a 21 per cent case fatality rate. That is two people out of 10 that have diphtheria are bound to die. So I think an emergency response can address that.

“We should also intensify efforts for water sanitation, environmental sanitation and hygiene. We have to look at rapid testing to address the challenge. 

“Lastly, which is very important is vaccination. We should make sure that people below the age of 18, elderly people, people with disabilities and frontline workers are vaccinated,” he said. 

A medical consultant and environmentalist at the Specialist Hospital in Yobe State, Dr. Babangida Usman said diphtheria is affecting majorly zero-dose vaccination households, especially children under two years. 

“The symptoms include fever, coughing, weakness of the body among others. 

“Unfortunately, some families are not complying with the immunisation vaccine, which is why it is mostly affecting children that were not taken to health facilities.” 

 He added that as a result of the rainy season, cases of malaria are also feared to complicate the diphtheria outbreak thus the need for massive sensitisation of the communities.

Trace children that missed vaccination – UNICEF 

UNICEF Nigeria Chief of Health, Eduardo Celades, had earlier called on government and other stakeholders to ensure “A big catch up”, meaning ensuring that children who missed on vaccination during COVID-19 are vaccinated. 

He said some of the children missed during COVID-19 are now getting diphtheria and transmitting to others. 

He said 70% of children affected by diphtheria in the country are over two years old and 80% are either not vaccinated or have not completed vaccination. 

The joint statement issued by the Federal Ministry of Health and Social Welfare, NPHCDA and the NCDC yesterday said the Coordinating Minister of the Federal Ministry of Health and Social Welfare, Professor Muhammad Ali Pate, has set up a national emergency task team co-chaired by the Executive Director of the NPHCDA and the Director General of the NCDC for higher level coordination of outbreak response efforts following  findings that 80% of confirmed cases in the ongoing outbreak are unvaccinated.

Other prominent members of the task force include; Director of Public Health-FMOH, representatives from the Federal Ministry of Information, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), USCDC, USAID, GAVI, the Vaccine Alliance, other non-governmental organisations and development partners. 

“Since the confirmation of an outbreak, the FMOH&SW through her agencies has been coordinating surveillance and response activities across the country. These include response coordination, surveillance, laboratory investigation, vaccination, case management, and risk communication activities,” the statement said. 

The federal government advised parents to ensure that their children are fully vaccinated against diphtheria with the 3 doses of diphtheria antitoxin-containing pentavalent vaccine given as part of Nigeria’s childhood immunisation schedule. 

It also advised healthcare workers to maintain a high index of suspicion for diphtheria and practice standard infection prevention and control precautions while handling all patients in their care.