Diphtheria outbreak: Children most at risk as vaccination coverage lags

The low vaccination coverage against diphtheria in Nigeria has increased the vulnerability of a significant number of children to the respiratory illness caused by the bacterium Corynebacterium diphtheria, the National Primary Health Care Development Agency (NPHCDA) has said raising an alarm over poor vaccine uptake across the country.

The NPHCDA said lagging vaccination rates among this group have been fuelling a rise in outbreaks predominantly among children between ages two and 14, as they remain unvaccinated or partially vaccinated, compromising the country’s goal of achieving population immunity.

According to the World Health Organization (WHO), an estimated 2.7 million children under one were not vaccinated against diphtheria in Nigeria in 2020, marking 33 percent of the target population.

Data from the NPHCDA shows that an estimated 2,455 suspected cases were reported in 26 states between May 2022 and July 2023.

836 of these cases were confirmed in eight states including Cross River, Kano, Katsina, Kaduna, Lagos, Osun, Yobe, and FCT, as of July 27, 2023.

Out of these 836 cases, 83 deaths occurred.

Action Plan

Faisal Shuaib, executive director of NPHCDA in an official statement released on Monday, the agency has collaborated with the Federal Ministry of Health, the National Centre for Disease Control (NCDC), states, and partners to mobilise resources to for effective response to the outbreak.

“A comprehensive response plan has been activated to detect cases early, contain the spread, and prevent further transmission through a multi-phased strategy,” Shuaib said.

“To facilitate our immediate response plan, we are leveraging surveillance data from NCDC and direct information from the states to ensure effective planning and resource deployment.”

He noted that the agency is also working with partners to ensure adequate supplies of Tetanus Td for children between four and 14 and Pentavalent vaccines for children under four years.

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He explained that NPHCDA is collaborating with the affected state teams and other stakeholders to conduct intensified mass vaccinations for identified at-risk populations in the affected states, administering pentavalent and tetanus, and diphtheria vaccines.

In addition, it will embark on an awareness, and preventive measures campaign, with the immediate response, scheduled to begin from August 7 to 11.

Besides efforts from the NPHCDA, the World Health Organisation (WHO) says Nigeria will receive 1,800 vials of diphtheria antitoxin on August 2.

Walter Mulombo, WHO country representative on Monday said Nigeria will also receive erythromycin IV in two weeks’ time, pending authorisation by the government.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) has donated over N100 million to support Nigeria’s mass vaccination campaign against Diphtheria. The support facilitated by National Primary Healthcare Development Agency (NPHCDA) is to commence from August to September.

Cost of Diphtheria

The cost of a diphtheria outbreak that is not contained can be significant, both in terms of human lives and financial resources, according to studies.

In terms of human cost, diphtheria is a highly contagious disease that can be fatal, especially in young children. In the absence of vaccination, the case fatality rate can be as high as 10 percent.

It spreads through direct contact with an infected person or exposure to airborne droplets. It poses a severe risk to people of all ages, particularly our children.

The disease primarily affects the respiratory system, and symptoms include fever, cough, runny nose, sore throat, neck swelling, and breathing difficulties. If left untreated, these symptoms can lead to death, with a higher risk for partially vaccinated or unvaccinated children in crowded and unsanitary areas.

The financial cost can also be significant, including the cost of treating patients, providing vaccinations, and conducting public health interventions.

In addition to the human and financial costs, a diphtheria outbreak can also have a significant impact on a community’s social and economic well-being. For example, schools may have to close, businesses may have to shut down, and families may have to isolate themselves.

Prevention

According to NPHCDA, diphtheria is a vaccine-preventable disease. Pentavalent vaccines are used to protect against diphtheria and are administered to children at six weeks, 10 weeks, and 14 weeks of age, with additional doses being given during campaigns.

The agency has called for increased adherence to proper hygiene practices which is crucial in preventing the spread of diphtheria.

“Simple yet effective measures like hand hygiene, maintaining good cough etiquette, environmental cleaning, eating nutritiously balanced meals, and isolating and quarantining of suspected cases can significantly reduce the risk of infection,” Shuaib said.

Also, it is important to identify and report cases of diphtheria as early as possible. This will help to prevent the spread of the disease and to initiate appropriate public health interventions.