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Diphtheria cases in Nigeria on an ‘unusual’ climb: WHO

Nigeria has recorded an “unusual” rise in diphtheria with 5,898 cases being reported during three months ended August.

HQ Team

September 14, 2023: Nigeria has recorded an “unusual” rise in diphtheria with 5,898 cases being reported during the three months ended August.

A majority of the suspected cases or 99.4% were from Kano state, followed by Katsina, Yobe, Bauchi, Kaduna and Borno, according to a WHO statement.

 In the week ending August 27, 2023, 234 suspected cases have been reported from 20 local government areas (LGAs) in five states.

One case of the 22 samples collected was confirmed in the laboratory. Eighteen of these cases were “epidemiologically linked” and 141 were classified as “clinically compatible.”

Weekly reports

Nigeria has been reporting diphtheria cases to the WHO. Since the last Disease Outbreak News on diphtheria on April 27, 2023, the country has reported suspected cases of diphtheria on a weekly basis.

“However, between June 30 and August 31, 2023, Nigeria recorded an unusual increase in the number of confirmed diphtheria cases. From June 30 to August 31, 2023, a total of 5,898 suspected cases were reported from 59 LGAs in 11 states across the country.”

Diphtheria is a highly contagious vaccine-preventable disease which can be fatal in 5-10% of cases, with a higher mortality rate in young children.

The WHO’s most recent risk assessment of the diphtheria outbreak in Nigeria has maintained the risk as high at the national level, and low at the regional and global levels. 

Early case detection

Public health measures such as vaccination response and enhanced surveillance for early case detection are being implmented, according to the WHO.

The WHO in collaboration with the Nigeria Centre for Disease Control is coordinating case management and risk communication.

Of the cumulative 8353 suspected cases reported since the outbreak was first reported in 2022, 56.5% cases were confirme by the laboratories.

Of the total only 1,074 (22.8%) of the confirmed cases were fully vaccinated against diphtheria and 6.3% were partially vaccinated. More than half of the cases, 2,801 or 59.4% were unvaccinated. 

The disease spreads among people mainly by direct contact or through the air through respiratory droplets. The disease can affect all age groups; however, unimmunized children are most at risk.

Sore throat, fever

Symptoms often come on gradually, beginning with a sore throat and fever. In severe cases, the bacteria produce a toxin that causes a thick grey or white patch at the back of the throat.

This can block the airways, making it hard to breathe or swallow, and also creates a barking cough. The neck may swell in part due to enlarged lymph nodes.

Treatment involves administering diphtheria antitoxin (DAT) as well as antibiotics. Vaccination against diphtheria has been effective in reducing the mortality and morbidity from diphtheria dramatically. 

Nigeria has recorded diphtheria outbreaks in the past, notably in 2011 and 2022. In 2023, a previous outbreak of diphtheria was recorded between January and April 2023 affecting 21 of the 36 states.

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