Multiple approaches needed to stop diphtheria

High rate of death coming from cases of diphtheria should be worrisome enough to warrant top-notch focus on it by all levels of government in the country. The recurring decimal of the disease in Nigeria is particularly alarming given that it is vaccine-preventable; requiring mass enlightenment campaign along with other multi-level approaches to combating it.

According to media reports Yobe State Government reported 30 deaths from 289 cases from six local councils of the state, while Kaduna State recorded 68 suspected cases and eight deaths. Again, the Nigeria Centre for Disease Control and Prevention (NCDC) announced an outbreak of diphtheria in the Federal Capital Territory (FCT) following the first case and death of a four-year-old child in June.

Similarly, early this year, the media reported 123 cases of diphtheria infections and 38 deaths spread across four states. Data released by the Nigeria Centre for Disease Control (NCDC) on the four states showed that Kano State recorded 100 confirmed infections and 32 deaths, followed by Yobe with 17 infections and three deaths. Also, Lagos State reported five cases with three deaths while Osun recorded a single infection with no fatality.

Summing up the recent cases of diphtheria in a recent statement, NCDC said there have been multiple outbreaks across the country since December 2022, with 798 confirmed cases from 33 Local Government Areas (LGAs) in eight states, including FCT. The NCDC added that 80 deaths have been recorded among all confirmed cases, with a case fatality rate of 10.0 per cent. On the prevalence among children, NCDC, stated that Kano state accounted for most of the confirmed cases, while other states are Lagos, Yobe, Katsina, Cross River, Kaduna, and Osun.

In some local government areas diphtheria affected mainly the zero-dose vaccination households. This suggests that children affected were not presented for a single dose of Pentavalent vaccine. which is administered to children as routine immunization at six, 10 and 14 weeks; and provides protection from life-threatening diseases – Diphtheria, Pertussis (whooping cough), Tetanus, Hepatitis B, and Hib (Haemphilus influenzae type B that causes bacterial meningitis and pneumonia).

It is unfortunate that not only has Nigeria not achieved full immunization coverage for diphtheria, there is generally low uptake of vaccines hence the recurring cases of diphtheria and Acute respiratory infections (ARIs) classified as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs) because it was also reported recently that about 10 children between the ages of three and 13 died from yet-to-be-identified suspected respiratory tract infection, which broke out in Kafanchan, Jama’a Local government area of Kaduna State.

Respiratory infections are not confined to the respiratory tract. They have systemic effects because of possible extension of infection, inflammation and reduced lung function. Specifically, 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. It is spread among people by direct contact or through respiratory droplets from coughing or sneezing.

The symptoms of Diphtheria 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. So, it is a highly contagious infection that can cause breathing difficulties and heart problems that can be fatal, particularly in children.

The five childhood threatening diseases – Diphtheria, Pertussis (whooping cough), Tetanus, Hepatitis B, and Hib (Haemphilus influenzae type B that causes bacterial meningitis and pneumonia) are vaccine-preventable diseases.

Generally, interventions to control childhood threatening diseases can be divided into four basic categories: immunisation, early diagnosis and treatment, improvements in nutrition, and safer environments. The first two fall within the purview of the health system, while the last two fall under public health and require multisectoral involvement. Therefore, 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. Government at all levels must recognize and work assiduously towards containing childhood diseases.

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! 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 jointly and scale-up preventive and curative interventions to prevent avoidable infections and deaths from diphtheria and other diseases. Achieving this requires joint planning by the federal and state governments; while states can draw their strategies and work plans from the federal strategy.

Sensitisation on vaccine prevention of diphtheria and various childhood diseases should be on a continuum; coordinated by the Federal Ministry of Health through the National Programme on Immunisation (NPI) and other relevant MDAs for synergy, and also to avoid misinformation. In particular, Ministry of Information and National Orientation Agency should embark on result-oriented advocacy, sensitisation and mobilisation of communities on the disease.

Importantly, sub-national governments should prioritise routine immunisation and ensure the availability of vaccines needed for children; while, parents and caregivers should be made to take personal responsibility for their children and wards’ health by ensuring that they are immunized. In response to this current outbreak of diphtheria in the country, the NCDC should support states by providing Diphtheria Antitoxin (DAT) for the treatment of confirmed cases and organise workshops for laboratory scientists in states to increase diagnostic capacity for response and effective management of the disease.

Every Nigerian should be enlightened on the nature of the disease and symptoms; and the need to quickly take suspected cases to the nearest health facilities for early diagnosis and treatment when they notice the symptoms Nigeria should get her priorities right, and human lives should be a priority at all levels of governance!