Diphtheria and public health response

The recent report of 123 cases of diphtheria infections and 38 deaths in Nigeria spread across four states is alarming, given that it is a vaccine-preventable disease. These cases are too many and suggest that Nigeria has not achieved full immunisation coverage for diphtheria. Although health authorities sounded the alarm, it would seem that they were caught napping by the outbreak. In any event, they cannot deny the deficit in immunisation, which may be attributed in part to the COVID-19 pandemic that practically relegated all other diseases to second fiddle while it lasted. However, two clear years after COVID-19’s first outbreak and with its relative containment, the government should devote due attention to other diseases including Lassa fever and diphtheria, particularly given the similarities of symptoms cutting across the ailments.

According to the latest data by the Nigeria Centre for Disease Control (NCDC), Kano State recorded the highest with 100 confirmed infections and 32 deaths, followed by Yobe with 17 infections and three deaths. Lagos State also reported five cases with three deaths while Osun recorded a single infection with no fatality.

Diphtheria is a serious bacterial infection caused by the bacterium called Corynebacterium species that affects the nose, throat, and sometimes, the skin of an individual. The symptoms include fever, runny nose, sore throat, cough, red eyes (conjunctivitis), and neck swelling. In severe cases, a thick grey or white patch appears on the tonsils and, or at the back of the throat associated with difficulty in breathing.

In response to this current outbreak of diphtheria in the country, the NCDC is supporting states by providing antitoxins for the treatment of confirmed cases and with the support of partners, it had organised a workshop for laboratory scientists in states to increase diagnostic capacity for the disease. Although this intervention by the NCDC is commendable, it appears reactive and episodic. It shows a nation with a health deficit that requires continuous credit to nil the account!

Against the backdrop that diphtheria is a vaccine-preventable disease, there should be continuous sensitisation of Nigerians to ensure that their children are fully vaccinated against diphtheria and other vaccine-preventable diseases with the prescribed doses.

Therefore, if Nigeria must nip the spread of diphtheria ravaging some states in the bud, all hands must be on deck and the health authorities, at the federal, state, and local government levels must act fast to avoid more deaths! Nigeria must be proactive on child health matters and in the handling of human lives; and must avoid a fire brigade approach to managing health issues, especially, child health.

As such, sensitisation on vaccine prevention of diphtheria and various childhood diseases should be on a continuum and coordinated by the Federal Ministry of Health and other relevant MDAs for synergy, and also to avoid misinformation. Achieving this requires joint planning by the federal and state governments, and states draw their strategies and work plans from the federal strategy.

Also, the authorities at the three distinct levels of the healthcare delivery system – federal, state, and LGA, in collaboration with all the stakeholders in the health sector, including the private sector, development partner agencies, Civil Society Organisations (CSOs), faith-based organisations (FBOs) and communities should work in collaboration and scale-up preventive and curative interventions to prevent avoidable infections and deaths from diphtheria and other diseases. To achieve this feat, all governments must recognize and work assiduously towards containing the nation’s health deficit.

Through the National Programme on Immunisation (NPI), governments at all levels and religious leaders should embark on massive enlightenment programmes to enlighten the citizenry on the prevention of diphtheria through the use of vaccines. Citizens should be enlightened on the nature of the disease and symptoms; and the need to quickly take suspected cases to nearby medical centres for early diagnosis and treatment when they notice the symptoms.

At the community level, the Ward Development Committees (WDCs), Facility Health Committees (FHCs), CBOs, CSOs, and other relevant platforms, have a key responsibility of ensuring that appropriate health information reaches the grassroots including holding the government responsible and advocating for universal vaccine coverage across the board.

Health-based NGOs will do well to similarly embark on massive sensitisation on the prevention and treatment of diphtheria and sensitising parents and caregivers on the need to vaccinate their children and wards; and seek prompt professional health care for suspected cases. Parents and caregivers should be made to take personal responsibility for their children and ward’s health by ensuring that they are immunised against diphtheria and other childhood-preventable diseases.

Where necessary, particularly in the absence of required cooperation by vulnerable Nigerians, school pupils should be made to present evidence of immunisation against diphtheria and other childhood diseases, and parental consent obtained to immunise those children who have not been vaccinated. As a country, Nigeria should get her priorities right, and human lives should be a priority at all levels of governance!