• Childhood deadly disease is here, watch out
By Doris Obinna
Diphtheria is one of most feared childhood diseases, characterised by devastating outbreaks. It is a serious infection caused by strains of bacteria called corynebacterium diphtheriae that make toxins. It can lead to difficulty breathing, heart rhythm problems and even death.
The World Health Organisation (WHO), said the most important virulence factor of C. diphtheriae is the exotoxin. In addition to this exotoxin, cell-wall components such as the O- and K-antigens are important in the pathogenesis of the disease. Humans are the only natural hosts for C. diphtheriae.
The Nigeria Centre for Disease Control and Prevention (NCDC) said it is aware of the death in June 2023 of a four-year-old with diphtheria in the Federal Capital Territory (FCT), Abuja. It had in December 2022 reported multiple diphtheria outbreaks in different states: “As of June 30, 2023, there have been 798 confirmed diphtheria cases from 33 local governments in eight states including the FCT.
“Most of the cases, 782, were recorded in Kano Satae. Other states with cases are Lagos, Yobe, Katsina, Cross River, Kaduna and Osun. The majority 71.7 per cent of the 798 confirmed cases occurred among children aged two to 14 years. So far, a total of 80 deaths have been recorded among all confirmed cases with a case fatality rate of 10.0 per cent.
“Diphtheria is a vaccine-preventable disease covered by one of the vaccines provided routinely through Nigeria’s childhood immunisation schedule. Despite the availability of a safe and cost-effective vaccine in the country, the majority i.e., 654 that is; 82 per cent of 798 confirmed diphtheria cases in this ongoing outbreak were unvaccinated.
“Unfortunately, this also includes this recently announced FCT case. Historical sub-optimal vaccination coverage is the main driver of the outbreak given the most affected age group two to 14-year-olds observed, and a national survey of diphtheria immunity that found less than half; 41.7 per cent of children under 15 years old are fully protected from diphtheria.”
Causes and transmission
NCDC said that diphtheria is caused by a toxin produced by the bacteria corynebacterium diphtheria. “It is the toxin that can cause people to get very sick.
It occurs through droplets and close physical contact. Although most infections are asymptomatic or run a relatively mild clinical course, many patients succumb to airway obstruction caused by laryngeal diphtheria or toxic myocarditis.
Spread to others
“Diphtheria bacteria spread from person to person, usually through respiratory droplets, like from coughing or sneezing. People can also get sick from touching infected open sores or ulcers.
“Those at increased risk of getting sick include: people in the same household, people with a history of frequent, close contact with the patient and people directly exposed to secretions from the suspected infection site (e.g., mouth, skin) of the patient.”
Signs and symptoms
According to NCDC, signs and symptoms may include a thick, gray membrane covering the throat and tonsils. A sore throat and hoarseness. Swollen glands; enlarged lymph nodes in the neck. Difficulty breathing or rapid breathing.
The NCDC said it had activated the multi-sectoral national Diphtheria Technical Working Group (TWG) as a mechanism for coordinating surveillance and response activities across the country. The response activities include coordination, surveillance, laboratory investigation, risk communication, case management and immunisation activities.
Diagnosis
The Centre for Disease Control (CDC) said doctors usually decide if a person has diphtheria by looking for common signs and symptoms. They can swab the back of the throat or nose and test it for the bacteria that cause diphtheria. A doctor can also take a sample from an open sore or ulcer and try to grow the bacteria.
“If the bacteria grow and make the diphtheria toxin, the doctor can be sure a patient has diphtheria. However, it takes time to grow the bacteria, so it is important to start treatment right away if a doctor suspects respiratory diphtheria.”
Treatment
“Diphtheria treatment involves: using diphtheria antitoxin to stop the bacteria toxin from damaging the body. This treatment is very important for respiratory diphtheria infections, but it is rarely used for diphtheria skin infections.
“Using antibiotics to kill and get rid of the bacteria. This is important for diphtheria infections in the respiratory system and on the skin and other parts of the body (e.g., eyes, blood).
“People with diphtheria are usually no longer able to infect others 48 hours after they begin taking antibiotics. However, it is important to finish taking the full course of antibiotics to make sure the bacteria are completely removed from the body. After the patient finishes the full treatment, the doctor will run tests to make sure the bacteria are not in the patient’s body anymore.
Prevention
“Vaccines are the best way to prevent diphtheria. “Several vaccines help protect against diphtheria, all of which provide protection against other diseases: DTaP helps protect against diphtheria, tetanus, and pertussis (whooping cough), DT helps protect against diphtheria and tetanus, Tdap helps protect against tetanus, diphtheria, and pertussis and Td helps protect against tetanus and diphtheria.
“CDC recommends diphtheria vaccination for people of all ages. The vaccine recommended for someone depends on his or her age. Children who should not get vaccines that contain whooping cough can receive DT for protection against diphtheria and tetanus. “Diphtheria vaccines are safe. Most people who get a diphtheria vaccine do not have any serious problems with it. However, side effects can occur. Most side effects are mild, meaning they do not affect daily activities,” CDC stated.
Coordination and surveillance
The NCDC disclosed that it has established a multisectoral National Diphtheria TWG that would bring together relevant stakeholders to regularly meet and monitor the disease trend and coordinate response activities in the country. “It has also deployed Rapid Response Teams (RRT) to some of the affected states: Kano, Katsina, Lagos, Osun, Yobe to support response activities in the states, and supported the establishment of a diphtheria IMS in the affected states.
“Also, development and dissemination of surveillance tools across the country – case definition, case investigation form (CIF), line listing template, etc. Support for active case finding across affected states and sensitization/training of clinical and surveillance officers on the presentation, prevention, and surveillance of diphtheria amongst others.”
Case management
“For the first time in over two decades, the country through NCDC and with support from WHO procured and prepositioned diphtheria antitoxin (DAT) in-country and distributed it to the affected states. Development and dissemination of Standard Operating Procedures for DAT use and with support from Medecins Sans Frontiere (MSF) and the Kano State Ministry of Health, established two isolation wards with a total capacity of over 80 beds at Murtala Mohammad Specialist Hospital (MMSH), Kano state.
Risk communication and community engagement
“Development and dissemination of public health advisories on diphtheria, media appearances/engagement on diphtheria with media stakeholders to create awareness, inform the public and bridge knowledge gaps, development and dissemination of diphtheria SBCC materials (Posters, FAQs, Flyers, and PSA) for dissemination to affect states.
“Also, coordinated the diphtheria Risk Communication and Community Engagement (RCCE) stakeholders’ coordination meetings both at the national and sub-national levels as well as webinar series to share knowledge and raise awareness of response activities in the country.
Immunisation
“Intensification of routine diphtheria immunisation and some catch-up vaccination campaigns by our sister agency, the National Primary Health Care Development Agency (NPHCDA), in states with high numbers of children who have not received any childhood vaccine at all (zero-dose)
“To reduce the risk of diphtheria, the NCDC reiterated that 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 should maintain a high index of suspicion for diphtheria, individuals with signs and symptoms suggestive of diphtheria should isolate themselves and notify their LGA, state disease surveillance officer (DSNO), their State Ministry of Health helpline, or the NCDC through our toll-free line on 6232. Individuals who have come in close contact with a confirmed case of diphtheria should be closely monitored, given antibiotics prophylaxis, and started on diphtheria treatment when indicated,” NCDC advised.
