Resurgence of Diphtheria: A Growing Public Health Concern

Resurgence of Diphtheria: A Growing Public Health Concern

Diphtheria, A preventable disease once largely controlled through vaccination has re-emerged, sparking a significant public health concern. A resurgence has been reported after a substantial decline in cases, highlighting the importance of maintaining high vaccination rates.

World Health Organization (WHO) describes diphtheria as a disease caused by a bacterium that affects the upper respiratory tract and less often the skin. The bacterium Corynebacterium diphtheria causes diphtheria. There are two main types of diphtheria, nasopharyngeal which affects the throat and respiratory system, and cutaneous diphtheria, which involves the skin. The bacteria produce a toxin that can cause severe respiratory problems, heart failure, and nerve damage.

According to the National Library of Medicine in the United States, diphtheria dates back to the 18th century when Edwin Kellen demonstrated that Corynebacterium diphtheria was the causative agent of diphtheria. It was a major public health concern in the 19th and 20th centuries leading to widespread outbreaks and high mortality rates. The introduction of vaccines in the 1920s and 1930s led to a significant decline in the case and now unfortunately, the disease has made a concerning comeback in regions where vaccination coverage has waned.

As of October 9, 2023, a total of 14,587 diphtheria cases have been reported across Algeria, Guinea, Niger, and Nigeria with a case fatality rate of 4.1%. Nigeria alone accounts for over 90% of these cases highlighting the severe impact of the outbreak in this region according to the Africa Center for Disease and Control (Africa CDC).

Nigeria has experienced a significant surge in diphtheria cases with 13,145 cases and 493 deaths. The outbreak has spread across eight states in Nigeria with Kano state being the epicenter because a significant portion of the population is not receiving the recommended doses of the vaccine leaving them vulnerable to these preventable diseases which includes protection against diphtheria.

Diphtheria spreads through respiratory droplets when an infected person coughs or sneezes, it can also be spread by contact with contaminated objects or surfaces and those at higher risk include unvaccinated individuals, people living in crowded conditions, and those with compromised immune systems.

Diphtheria typically begins with symptoms such as sore throat, fever, swollen neck glands, and weakness, followed by the formation of a thick, grey coating in the respiratory tract within 2-3 days, which can lead to severe complications, including difficulty breathing and swallowing, heart and nerve inflammation, and potentially fatal outcomes, especially in unvaccinated children under 5 years old, with a mortality rate of around 30% if left untreated.

In many African countries, vaccination rates have not reached the levels necessary to maintain herd immunity. Dr. Rownak Khan, a UNICEF representative has said that “the devastating impact of this diphtheria outbreak is a grim reminder of the importance of vaccination, Nigeria is home to a staggering 2.2 million children who haven’t received even a single dose of the vaccine- the second largest such cohort in the world. We must collectively take urgent actions to drastically reduce this number. Every child deserves protection from preventable diseases. This is not negotiable”.

The resurgence of diphtheria is a stark reminder of the importance of maintaining high vaccination coverage and a very effective public health system. Diphtheria can be treated with antitoxins as well as antibiotics. They stop bacteria replication and toxin production, speed up getting rid of the bacteria, and prevent transmission to others.

WHO advises that anyone who has had diphtheria should also receive a vaccine after the acute phase of the illness is over.

Regarding vaccination, WHO has worked effortlessly since 1974 to foster immunization and has prevented over 90% of cases of disease between 1980 and 2000. They have also worked with member states in outbreak response and strengthened routine immunization programs to improve and sustain immunization coverage to prevent diphtheria infections.

Africa CDC has also emphasized the need for enhanced surveillance of other vaccine-preventable diseases and promote vaccine access and uptake, they also accentuated the crucial role of partnerships, collaboration, and accountability in addressing this crisis.

While international organizations and governments play a crucial role in promoting public health, at the end of the day, the onus lies with individuals to prioritize their well-being. It is only when citizens recognize the value of their health and take conscious steps to protect it that we can say that true progress has been made.

As Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation states, “It’s about a child who gets to see adulthood or about a parent who watches their child survive and thrive. It’s about a community living disease-free or an entire country or region that’s better prepared for health emergencies or climate change.”. When we acknowledge the importance of our health and take action to safeguard it, I hope we realize that we can create a ripple effect that inspires others to do the same. Stay safe.