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Diphtheria outbreak in Nigeria

Nigeria is facing an unprecedented and devastating diphtheria outbreak that requires urgent action to control. The highly contagious bacterial respiratory infection is spreading rapidly across multiple regions, posing a severe public health threat.


Understanding diphtheria and its severe impact

Diphtheria is a serious bacterial infection that can have devastating health consequences. Understanding what causes it and how it impacts the body is critical to combating the outbreak in Nigeria.

What is Diphtheria?

Diphtheria is caused by the Corynebacterium diphtheriae bacteria and leads to the formation of a grayish-white membrane coating in the nose and throat that can block airflow. The bacteria secrets toxins that invade and damage tissue in the respiratory system and other organs.

How Diphtheria damages the body

The diphtheria bacteria’s toxins cause local tissue destruction at the site of infection and get taken up into circulation to cause systemic problems. The diphtheria toxin specifically attacks human cells by blocking protein synthesis, which leads to cell death. This mechanism of infecting respiratory epithelial cells and releasing toxins that inhibit protein synthesis leads to the devastating symptoms of diphtheria.

Consequences of infection

If left untreated, the infection can obstruct the airways leading to suffocation. The bacteria’s toxins can also get into the bloodstream where they damage organs like the heart and nervous system, sometimes causing heart failure, paralysis, and death.

Those most vulnerable are unimmunized children and individuals with weakened immunity who cannot fight off the infection and its harmful toxins. Timely vaccination is critical to prevent the bacterial colonization, membrane formation, toxin production, and potentially fatal outcomes of a diphtheria infection.

How Diphtheria is spreading across Nigeria

The diphtheria outbreak has reached unprecedented levels across Nigeria. Understanding the scale and scope of transmission is vital for targeting response efforts.

The Outbreak’s unprecedented scale

The diphtheria outbreak in Nigeria has reached an unprecedented scale, with spiking infection rates being reported across many states. Lagos, Kano, and Oyo states are at the epicenter, but concerning rises have also been seen in Rivers, Enugu, Bauchi, Kaduna, and more.

Alarming statistics

In Lagos state alone, health officials have reported over 963 suspected cases and 28 deaths so far. The staggering numbers represent a 5000% increase compared to historical averages for the region. Similar dramatic spikes are being seen in Kano and other hard-hit states, indicating the outbreak is widespread rather than localized.

Overall, Nigeria has recorded over 3000 suspected diphtheria cases and over 100 deaths since the outbreak began in late 2022. These alarming statistics underscore the urgent need for infection control measures and improved vaccine coverage to halt the outbreak. With rising case counts combined with overcrowded urban areas and inadequate healthcare facilities, Nigeria is teetering on the brink of a public health disaster.

Combating the outbreak – prevention and control measures

With the scale of the outbreak clear, targeted strategies are needed to control further spread and boost population immunity. A multi-pronged approach is required.

Mass vaccination campaigns

To combat and control this explosive diphtheria outbreak, public health strategies must focus on rapidly increasing population immunity through mass vaccination campaigns. Particularly, improving childhood DTP vaccination coverage should be an urgent priority. The DTP vaccine provides protection against diphtheria as well as tetanus and pertussis. Special efforts are needed to reach underserved communities where immunization rates have historically lagged.

Logistics and resources required

Experts recommend deploying additional mobile vaccination clinics and temporary vaccination sites to accelerate coverage. Adequate supplies of vaccine, cold chain storage, transportation, and human resources are key logistical requirements for the effort. UNICEF, WHO, and other partners have supplied millions of doses of DTP vaccines to Nigeria in recent months to aid with response, but sustaining the effort will require substantial additional investments estimated at over $10 million.

Isolation, treatment, and surveillance

In addition to vaccination, strategies like thorough case identification, prompt isolation, antibiotic treatment, and contact tracing must be bolstered to break chains of transmission. Improving clinical screening protocols at healthcare facilities and within communities is essential to identify suspected diphtheria cases early so they can be confirmed with laboratory testing. Expanding the healthcare workforce, medical supplies, and isolation facilities will enable effective case management and reduce contagiousness.

Robust disease surveillance systems including detailed data on cases, transmission patterns, and immunity gaps can inform optimal resource allocation across most impacted regions. Clear communication with the public about prevention measures like hand washing, wearing masks indoors, and avoiding contact with infected individuals can further curb spread.

With the healthcare system already overstretched, Nigeria must urgently mobilize added capacity and outside aid to implement these outbreak control strategies.

Mobilizing government and citizens for decisive action

With the outbreak worsening, Nigeria must take decisive action at both governmental and societal levels to control spread. A coordinated emergency response is needed.

Emergency response measures

To address an outbreak of this massive scale, Nigeria must take extraordinary measures. The government must declare a national public health emergency and rapidly allocate emergency response funding. Creating an inter-agency diphtheria task force can centralize coordination of surveillance, vaccination, medical supplies, healthcare staffing, public education campaigns, and other outbreak response activities.

Accelerating vaccination coverage

Nigeria’s Expanded Programme on Immunization must launch statewide mass vaccination drives, leveraging schools, churches, markets, transit centers, and other community hubs as temporary vaccination sites. Prioritizing the fastest possible boost in childhood DTP vaccination should be the primary objective. Allocating funding for vaccine cold chain infrastructure and deploying mobile clinics can enable wider reach.

Individual responsibility and preparedness

Citizens also must take proactive steps by getting themselves and their families vaccinated, taking children for wellness checks, adhering to hygiene best practices, monitoring their health vigilantly, and reporting any suspected diphtheria cases immediately to health authorities. Parents should ensure their children’s immunizations are up to date, especially for diseases like diphtheria. Avoiding public gatherings and nonessential travel to outbreak hotspots can also limit exposure risk. Acting together through heightened vigilance, vaccination, hygiene, isolation of cases, and coordinated outbreak response, Nigeria can turn the tide against the escalating diphtheria outbreak.

Collaborative action to prevent future outbreaks

While responding urgently to the current crisis, Nigeria must also build long-term resilience against infectious disease. Robust prevention strategies are needed.

Sustaining high vaccination coverage

Alongside urgent efforts to mitigate the current crisis, Nigeria must strengthen its health systems and immunity to prevent similar outbreaks in the future. Continuing massive vaccination campaigns annually plus instituting school-based immunization requirements can sustain high coverage going forward. Investing in disease surveillance technology and training public health personnel will improve monitoring for the emergence of any outbreaks. Stockpiling vaccines and medications combined with expanded healthcare access will mean potential outbreaks can be contained swiftly.

Partnerships and collective health security

Global partners including the WHO, UNICEF, CDC, UNHCR, and Gavi have provided critical support with vaccine shipments, epidemiological modeling, financing, technical guidance, and more. For instance, UNICEF aided delivery of over 3 million doses of DTP vaccines in 2022. The WHO has supplied testing kits and played a key advisory role. Continued coalition-building among these agencies and international donors will maximize resource mobilization and collective health security.

With diligent work now to control the current crisis and build future preparedness, Nigeria can soon regain control over diphtheria and bolster population immunity. But sustained commitment from the government and full societal participation are indispensable to change the status quo. Tackling the outbreak and rising above to strengthen health systems will ultimately protect Nigeria’s people and economy over the long term. There is no time to lose in this fight.