Outbreak Alert: Panic as 25 die of Diphtheria in Nigeria

There is a diphtheria outbreak currently going on in Nigeria.

The Nigeria Centre for Disease Control and Prevention (NCDC) has reported a growing number of cases in states like Lagos, Kano, and Osun, amongst others. There have already been 25 confirmed diphtheria-related deaths across the country, and this figure is likely to rise if special precaution is not taken.

Keep reading to learn more about diphtheria.

What is diphtheria?

Diphtheria is a bacterial infection caused by an organism called Corynebacterium diphtheriae. The bacteria mostly affect the airway, but they can also affect the skin and cause non-healing ulcers.

The infection is not very common, but when it happens, it has the potential to spread quickly and cause an outbreak similar to what is happening right now in Nigeria. The disease can be deadly if prompt treatment is not given.

How is diphtheria spread?

The infection can easily be spread from person to person through respiratory droplets released during sneezing or coughing. Contact with any bodily secretions from an infected person can also transmit the infection.

Diphtheria can also be spread through contact or the use of objects that have been contaminated by secretions from an infected person.

Who is at risk of diphtheria?

• Although anyone can be affected, people younger than 5 years old, and the elderly are particularly at an increased risk of getting infected.

• Those who have not been fully vaccinated for diphtheria

• Close contacts of people with diphtheria

• People living in crowded unsanitary conditions

• People living with HIV/AIDs or other conditions that weaken the immune system

• Health workers and other caregivers of persons with the disease

What are the symptoms of diphtheria?

Once inside the body, Corynebacterium diphtheriae releases harmful substances called toxins. The toxins destroy nearby cells, or spread into the bloodstream and affect distant organs. The kidneys, heart and nervous system are very prone to damage from diphtheria toxins.

Diphtheria commonly affects the respiratory system and causes symptoms like:

• Sore throat

• Mild fever

• Runny nose

• Generalized body weakness

• Difficulty swallowing

• A feeling of unwellness (malaise)

• Grey patches at the back of the mouth, in the throat, nose and other parts of the airway. These patches are called pseudomembranes and they are the hallmark of diphtheria. The patches can peel off and fall into the lungs, causing aspiration which can immediately lead to death.

• Swelling of lymph nodes around the neck. This swelling can be so severe that it can cause difficulty breathing and suffocation.

Aspiration of pseudomembranes and suffocation from enlarged lymph nodes in the neck are the commonest causes of diphtheria-related deaths.

• Myocarditis, paralysis and kidney failure when toxins affect the heart, nerves and kidneys respectively.

• Diphtheria can also affect the skin and cause chronic non-healing ulcers which may also have a grey coating. These ulcers are highly infectious.

How can diphtheria be treated?

Once the infection is confirmed using the symptoms and laboratory culture results, treatment will involve the use of:

• Anti-toxins to bind and stop the diphtheria toxins from causing more harm.
• Antibiotics to kill the bacteria
• Vaccination: Those who have never been immunized against diphtheria will receive the vaccine. People who have previously been vaccinated will receive a booster dose.
• Household members and close contacts of an infected person will receive antibiotics treatment

Suspected or confirmed cases of diphtheria will be hospitalized and treated in an isolation ward to prevent the spread of infection.

Prevention of diphtheria

Vaccination is the single most important step in the prevention of diphtheria. The immunization schedule for diphtheria in Nigeria is as follows:

• Diphtheria vaccine is usually given in combination with tetanus, pertussis, hepatitis B and Hemophilus influenza type b (hib) vaccines in a single formulation called pentavalent vaccine (Penta) which is given to newborns
• Penta 1 is given at 6 weeks of life
• Penta 2 is given after 4 weeks, at week 10 of life
• Penta 3 is given after 4 weeks, at the 14th week of life.

Older children and adults can also get vaccinated for diphtheria. But instead of getting the Penta vaccine, they will be given tetanus-diphtheria toxoid (Td).

Td immunizes against tetanus and diphtheria only, and it is taken in 4 -5 doses for full immunization. The schedule is as follows:

• Dose 1 at contact
• Next dose after 4 weeks
• Next dose after 6 months
• Next dose after one year
• Additional dose one year after dose 4

Just like TT (vaccine against tetanus only), Td may also be given to pregnant women during their antenatal visits.

Vaccination against diphtheria does not confer lifelong immunity. Therefore, it is recommended that a booster dose is received every 10 years after the last dose, for both children and adults.

Maintaining good personal and environmental hygiene is also important for preventing diphtheria.

All suspected cases of diphtheria should first be isolated and taken to the hospital for immediate care. You can contact the NCDC through their toll-free line (6232) for assistance.

A word from Healthfacts

Diphtheria is a highly contagious, deadly but preventable infection. Vaccination is key in the fight against diphtheria. Stay vigilant.

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