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The Nigeria Centre for Disease Control and Prevention (NCDC) has blamed the current outbreak of diptheria in the country on poor immunisation coverage, while calling on relevant government agencies to scale up the vaccination of children with a view to curb diseases including diptheria. The Director General of NCDC, Dr. Ifedayo Adetifa who made this known during a Diphtheria Webinar Series 2, said vaccination is highly recommended for everyone, according to the National Primary Health Care Development Agency (NPHCDA) immunisation schedule for infants.
Diphtheria, a severe bacterial infection caused by a bacterium called Corynebacterium species that affects the nose, throat and sometimes, an individual’s skin, has claimed the lives of at least 61 people in Kano as of March 2 since its outbreak a few weeks ago, according to data from the NCDC.
The ongoing diphtheria outbreak and the associated high-case fatality which began in December 2022, are due to a combination of low vaccination coverage, and the absence of diphtheria antitoxin (DAT) during the early stage of the outbreak. So far, the infection has been confirmed in Kano, Yobe, Lagos, Osun, and Katsina states. While responding to a question on whether in tackling this disease vaccination is compulsory for everyone, Adetifa said although, there is no mandatory immunisation policy in Nigeria, “Infants expectedly require three doses of anti- Diphtheria containing vaccines at six, 10 and 14 weeks of age.
The theme of the Diphtheria Webinar Series 2 is ‘Diphtheria Outbreak in Nigeria: Vaccination Response’. According to Adetifa who noted that before this current outbreak there hasn’t been one for three years, the implication the country faces in the face of the poor immunisation coverage is immunity gaps on account of poor vaccination coverage. He said most confirmed cases of the infection are either not vaccinated or under-vaccinated.
“It is, however, important to document peculiar diphtheria cases so we can share it and it becomes a constant reference material,” Adetifa said. According to him, “The priority now is for strengthening routine immunisation, reactive campaigns now while we explore data on waning immunity, etc to determine the need for routine boosting. However, while explaining why most Diphtheria samples from Kano tested negative, the director general of NCDC, said, “A mixture of reasons are responsible early in the outbreak, specimens were not properly managed and transported in the right media.” In addition, he disclosed that available laboratories needed refreshers in specimen collections and technical issues.”
On her part, Dr. Adejoke Oladele of the National Primary Health Care Development Agency (NPHCDA) said the majority of the confirmed Diphtheria cases in the country occurred in children aged two to 14 years. She added that the NPHCDA was responding with vaccination and routine immunisation in at-risk states. While she admitted that there was improvement in immunization, but “we have not gotten to where we want to be.”
According to her, Nigeria has experienced low immunisation since 2016 up till 2021. Based on reports, she said the NPHCDA categorises states on immunisation coverage on performance. The Agency was already implementing the first round of immunisation and has supplied extra pentavalent vaccines. Pentavalent vaccine provides protection to a child from five lifethreatening diseases – Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib.
“We teach people in communities the importance of completing child immunisations.” Diphtheria spreads quickly between people through direct contact with infected people, droplets from coughing or sneezing, and contact with contaminated clothing and objects. The ongoing diphtheria outbreak and the associated Giving an update on the state of the disease since the first record in Kano State, the state case Manager, Dr. Salma Suwaid, said that a total of 783 patients have been on admission so far. Out of these 360 were females, and 423 were males. Suwaid who is a consultant paediatrician, noted that the patients’ average hospital stay is four days. She said: “Eighty-three per cent of deaths occurred in patients with the onset of symptoms greater than three days and an average of 15 admission days.
“Sixty-eight per cent of patients have been discharged, 1.66 per cent absconded and 12.2 per cent died.” On the preliminary assessment of patients, she said the space which is dedicated to triaging is adequately staffed and equipped with the necessary equipment for resuscitations. “Crowd control personnel are stationed, suspected cases are identified, cases are categorised according to severity, swabs are taken and all healthcare workers adhere to safety precautions,” she noted, adding that DAT administration is done only once as early as possible.
“As DAT is of equine origin, there is a risk of rare but severe anaphylaxis reaction and a frequent risk of mild reaction. Therefore, several measures are taken to mitigate the risks. The first is that DAT must be given in a hospital setting,” Suwaid mentioned. Furthermore, the paediatrician said there is a need to strengthen surveillance to ensure early detection of diseases of public health importance to mitigate their propagation at early stages. She also recommended, “Handson skill training of doctors at the Diphtheria Treatment Unit by cardiologists with expertise in pacemaker insertion, bedside electrocardiogram monitoring which will enable early detection of cardiac abnormalities, provision of IV erythromycin and setting up of intensive care unit which should be manned by an intensivist and to make available all the necessary equipment needed for fresh frozen plasma/platelets supply and storage.
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