Diphtheria outbreak in Nigeria: A grim reminder

In a frantic race against the ticking clock, Nigeria finds itself entangled in a fierce battle with the resurgence of diphtheria outbreaks, setting off deafening alarm bells for the nation’s health guardians.

Disease outbreaks have always posed a significant threat to public health, and the recent diphtheria outbreak in Nigeria serves as a harrowing reminder of the devastating consequences that can arise.

Diphtheria, a once-forgotten foe, has resurfaced with a vengeance, stealthily spreading its menacing tendrils across the northern states of Jigawa, Borno, Bauchi, and Kano.

Like a relentless predator, it prowls, leaving a trail of devastation in its wake.The clarion calls of urgency have been fervently echoed by Médecins Sans Frontières (MSF), a valiant international health organization, who bear witness to the staggering numbers of thousands infected and hundreds tragically lost to this insidious disease.

This is no time for complacency; it demands swift action and synchronised efforts on a grand scale, transcending borders and uniting nations in a collective crusade against this invisible enemy.

Last Saturday, Jigawa recorded 91 suspected cases of diphtheria in 14 local government areas. Tragically, it is suspected that 10 children have already lost their lives to this childhood infection. The situation is dire, and action must be taken swiftly to prevent further loss of life.

The northern parts of Nigeria, particularly Kano, Yobe, Katsina, and Bauchi states, have been hit hardest by this outbreak. The disease has found fertile ground in these areas, spreading like wildfire.

MSF’s teams have treated over 6,700 suspected and confirmed cases in Kano alone, with 110 in Borno and 21 in Bauchi. Thousands more suspected cases are under surveillance across Nigeria. It is impossible to ignore the fact that around 4,000 suspected cases have been recorded nationwide. These statistics should serve as a wake-up call to the urgency of the situation.

The National Reference Laboratory in Abuja has confirmed two of the 91 suspected samples sent to them as positive for diphtheria. This is a clear indication that the situation is not under control and that urgent measures are needed to contain the outbreak.

We cannot afford to be complacent in the face of this crisis. Diphtheria is a deadly disease that can cause severe complications if left untreated. It is imperative that the Nigerian government, in collaboration with international health organisations, takes immediate action to halt the spread of this disease.

Recall that the Nigeria Centre for Disease Control and Prevention (NCDC) was swiftly notified of suspected cases in Kano and Lagos States in December 2022, marking the beginning of a battle against this highly contagious and potentially fatal disease.

Since May 2022, a staggering 1,439 suspected cases have been reported across 21 states in Nigeria. Of these, 557 cases have been confirmed, with a devastating 13 per cent case fatality ratio resulting in 73 deaths.

Its ability to affect individuals of all age groups makes it a formidable adversary. However, the NCDC remains steadfast in its commitment to curbing the outbreak’s impact. Drawing from past experiences, Nigeria has encountered diphtheria outbreaks before, with a significant incident reported in 2011 that affected rural areas in Borno State.

The lessons learned from that crisis have laid the groundwork for a more proactive response this time around.The key to combating diphtheria lies in early detection and swift intervention. The NCDC’s surveillance systems have been instrumental in identifying and tracking suspected cases, allowing for timely containment measures. The number of confirmed cases peaked in January 2023, with over 150 cases reported in a single week.

However, a glimmer of hope emerged as a decreasing trend has been observed since then. Efforts to combat the outbreak have been concentrated in the most affected states, with Kano, Yobe, Katsina, Lagos, Sokoto, and Zamfara bearing the brunt of the outbreak. These regions have become the epicenter of a relentless battle, where healthcare workers tirelessly administer diphtheria antitoxin and antibiotics to those affected. Vaccination campaigns have played a pivotal role in reducing the mortality and morbidity associated with diphtheria.

The NCDC, in collaboration with other health agencies, has intensified efforts to ensure widespread immunisation coverage. By targeting unimmunised children, they aim to create a shield of protection that can halt the disease’s progression.

As the nation grapples with this silent killer, Nigeria’s resolve remains unyielding. The NCDC continues to work tirelessly, collaborating with local communities, healthcare professionals, and international partners to combat the outbreak.

The outbreak, which has been reported in Kano, Lagos, Kaduna, Katsina, and Osun states, has seen a significant drop in the case fatality rate (CFR) due to improved access to diphtheria antitoxin (DAT).This is not the first time Nigeria has faced such a crisis.

Back in 2011, a major outbreak occurred in the rural areas of Borno State, resulting in 98 reported cases. The severity of the current situation is exacerbated by several factors, including low national vaccination coverage, leaving a large portion of the population vulnerable to this preventable disease.

Additionally, the global shortage of antitoxin, a life-saving treatment for diphtheria, poses a serious threat. Without this crucial resource, the outbreak could escalate further, leading to more suffering and loss of life.

Dr. Hashim Juma Omar, a medical doctor working on an emergency project for Médecins Sans Frontières (MSF), paints a grim picture of the situation in Kano State.

With over 700 individuals seeking medical attention for suspected diphtheria and more than 280 patients being admitted weekly to the state’s two treatment centers, the healthcare system is under immense strain. Furthermore, the United Nations Children’s Fund (UNICEF) has highlighted that Kano State is responsible for 80 per cent of the diphtheria outbreak in Nigeria.

Among the most vulnerable are women and children under the age of five, who are bearing the brunt of this crisis.It is imperative for the international community to come together and support Nigeria in its efforts to combat this outbreak.

Vaccination programs must be intensified, and resources must be mobilised to provide adequate medical care to those affected. This outbreak serves as a stark reminder that our health systems are not infallible.

We must remain vigilant and proactive in our efforts to prevent the resurgence of diseases we thought were long gone. The lives of thousands of Nigerians are at stake, and it is our collective responsibility to ensure their safety and well-being.

Also to address this critical issue, comprehensive public awareness campaigns are crucial. Access to accurate information is essential for individuals to make informed decisions about their health and the well-being of their children.

Engaging communities and empowering local leaders to dispel myths and promote vaccination are vital steps towards overcoming these obstacles.

Lives are at stake, and we must act swiftly to prevent further tragedy. In order to combat the diphtheria outbreak in Nigeria, immediate action is required. It is essential to prioritise the dissemination of accurate information to counteract the spread of misinformation.

Communities play a crucial role in overcoming vaccine hesitancy and dispelling myths surrounding diphtheria. Local leaders, including religious and community figures, hold significant influence and can help bridge the gap between misinformation and accurate information. By engaging these leaders and involving them in public awareness campaigns, we can foster trust and build a stronger foundation for vaccination efforts.

Urgent attention must be given to addressing the shortage of antitoxin, with countries and organisations contributing to the global supply. This is not merely an act of charity; it is a matter of global health security. Diseases do not recognise borders, and an outbreak in one part of the world can quickly become a global threat.