By Hassan Zaggi
The rising cases of Diphtheria in Nigeria in recent times, especially, since December last year, have the capacity to keep every well-meaning Nigerian awake all night. The cases have, indeed, taken a worrisome dimension.
So far, 453 people have died in confirmed cases giving a Case Fatality Rate (CFR) of 6.3%.
Diphtheria, a disease caused by bacteria is vaccine-preventable. Luckily enough, the disease is covered by one of the vaccines provided routinely by the Federal Government through Nigeria’s childhood immunization schedule.
The recent re-emergence in December last year and the rising cases of the disease, according to the federal government, is due to, what it described as ”historical gap in vaccination coverage given the most affected age group (5–14year-olds) and results of the nationwide diphtheria immunity survey that shows only 42% of children under 15 years old are fully protected from diphtheria.“
According to recent updates by the Federal Ministry of Health and Social Welfare: “As of September 24, 2023, there have been 11,587 reported suspected cases out of which 7,202 were confirmed cases from 105 Local Government Areas in 18 States including the Federal Capital Territory (FCT).
“Most (6,185) of the confirmed cases were recorded in Kano.
“Other States with cases are Yobe (640), Katsina (213), Borno (95), Kaduna (16), Jigawa (14), Bauchi (8), Lagos (8), FCT (5), Gombe (5), Osun (3), Sokoto (3), Niger (2), Cross River (1), Enugu (1), Imo (1), Nasarawa (1) and Zamfara (1).
“The majority (5,299), which is equivalent to 73.6% of the confirmed cases occurred among children aged 1 – 14 years with those aged 5-14 years bearing most of the brunt of the disease.
“So far, a total of 453 deaths have occurred in confirmed cases giving a case fatality rate (CFR) of 6.3%.”
The most worrisome dimension is that following the escalation and fast spread of the disease in affected states, findings have shown that 80% of confirmed cases in the ongoing outbreak are unvaccinated.
As a proactive move to halt further spread, the Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, quickly set up a National Emergency Task Team co-chaired by the Executive Director of the National Primary Healthcare Development Agency (NPHCDA) and the Director General of the Nigeria Centre for Disease Control (NCDC) to coordinate the outbreak responses efforts at a higher level.
This includes ensuring optimal collaboration of all relevant health stakeholders in this fight.
According to the recent updates by the Federal Ministry of Health and Social Welfare, since the confirmation of the outbreak, the Ministry through her agencies has been coordinating surveillance and response activities across the country.
These include response coordination, surveillance, laboratory investigation, vaccination, case management, and risk communication activities.
On the Coordination, the federal government said it established the Diphtheria Emergency Task Team which is responsible for the overall coordination of all activities encompassing government and Development Partners’ response activities at national and sub-national levels in the country; implementation of an Incident Management System (IMS) through the activation of a National Diphtheria Emergency Operations Centre (EOC) at NCDC, tasked with orchestrating the coordinated efforts of multiple response pillars during the outbreak and the deployment of National Rapid Response Teams (NRRT) to affected states (Kano, Yobe, Bauchi, Kaduna, Katsina, Lagos, Osun and FCT) to support response activities in the states.
On the effort towards surveillance, the Federal Government said it developed a draft National Diphtheria Surveillance and Response guidelines; sensitized/trained clinical and surveillance officers on the presentation, prevention, and surveillance of diphtheria and harmonization of surveillance and laboratory data from across states and labs.
While making efforts to build the capacity of laboratories in the country, the Federal Government established and is currently expanding Diphtheria Laboratory Network to strengthen laboratory confirmation of the disease at national and sub-national levels and build capacity of state-owned public health laboratories for diphtheria diagnosis including training and skills transfer for sample collection, transportation, and laboratory confirmation for diphtheria.
On Case Management, for the first time, for any diphtheria outbreak, the Federal Ministry of Health through NCDC and with World Health Organisation (WHO) support, procured diphtheria antitoxin (DAT) and more recently intravenous erythromycin and distributed them to the affected states and with support from partners and in collaboration with the State Ministry of Health, Diphtheria Treatment Centres/Wards have been established in affected States.
In the area of immunisation, the federal government is currently intensifying efforts at ensuring routine diphtheria immunization and reactive vaccination campaigns in 33 local government areas across 5 states – Bauchi, Katsina, Yobe, Kano, and Kaduna by the NPHCDA and also mobilized procurement of vaccines and essential logistics for 3 large-scale Outbreak Response campaigns in 56 LGAs across seven (7) priority states – Bauchi, Borno, Jigawa, Kaduna, Kano, Katsina and Yobe.
The Federal Government, therefore, advised that, to reduce the risk of diphtheria, parents should ensure that their children are fully vaccinated against diphtheria with the 3 doses of diphtheria antitoxin-containing pentavalent vaccine given as part of Nigeria’s childhood immunisation schedule, healthcare workers, on the other hand, should maintain a high index of suspicion for diphtheria and practice standard infection prevention and control precautions while handling all patients in their care.
It further counselled all healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with a high level of exposure to cases of diphtheria should be vaccinated against diphtheria; individuals with signs and symptoms suggestive of diphtheria should promptly present to a health care facility or designated diphtheria treatment centres and where possible they and/or healthcare workers should notify their LGA, State Disease Surveillance Officer (DSNO), their State Ministry of Health helpline, or the NCDC through our toll-free line on 6232 and that close contact with a confirmed case of diphtheria should be closely monitored and managed according to guidelines.
The Federal Government further insisted that the most effective protection against diphtheria is vaccination with the Pentavalent or TD vaccine.
“The Federal Government of Nigeria provides free, safe, and effective vaccines at all Primary Healthcare Centres nationwide.
“We invite the public to take advantage of the ongoing vaccination occurring in all states.
“Parents are kindly advised to take their children aged 0 – 14 years to the nearest Government health facility to get vaccinated in accordance with the routine immunization schedule and ongoing reactive vaccination campaign in the affected Local Government Areas (LGAs) as applicable.
“Members of the public are advised to avoid rumour mongering and share only verified information from FMOH&SW, NCDC, NPHCDA, SMOH, WHO, UNICEF and other verified sources,” the federal government said.
Since the federal government has shown considerable efforts to tackle and halt the rising cases of Diphtheria and its accompanied fatality, it is therefore, pertinent to join in calling on all Nigerians to support the current vaccination exercise by bringing out our children to uptake the vaccination.
We cannot allow our children to die from a disease that we have the capacity to protect them from. The over 400 deaths so far recorded is enough pain in our hearts.