Lagos - Sometime in February, Kazeem Ade, age seven, was recuperating from diphtheria on a hospital bed in the children's ward at the Lagos University Teaching Hospital (LUTH), in Lagos Southwest Nigeria.  

His mother, Mrs Ade, can now smile after enduring a nerve-racking week at the hospital where her son including dozen other children have been receiving treatment for diphtheria – a vaccine-preventable disease that has killed 62 people (mostly children) in the country. 

Mrs Ade says she had never heard about diphtheria until her son contracted the disease. 

She is, however, glad that her son received all his childhood vaccines as the doctor attributed his survival to him completing his childhood immunization and the treatment received at the hospital.

“I ensured all my children completed their childhood immunization schedule though I did not believe in it.  Nurses at the health centre in my area usually tell us to make sure our child completes the Routine Immunization (RI) schedule,” she explains. 

Now with a better understanding of the importance of immunization, Mrs Ade reassures that she will encourage other mothers to make sure their children complete their RI schedule. 

Diphtheria is an infection that is caused by a strain of bacteria known as Corynebacterium diphtheriae that releases tissue-killing toxins and spreads through exhaled droplets. 

Nigeria began reporting the Diphtheria outbreak in May 2022.  From then till March 2023,  389 confirmed cases have been reported in 6 states across the country. 

The commercial states of Kano and Lagos are currently the epicentre of the diphtheria outbreak which has led to the death of 62 people (CRF: 15.9%) and hospitalized many more. 

Diphtheria causes difficulty in breathing and heart rhythm issues and without good medical care, 50% of diphtheria patients die from the disease.

Meanwhile, Lagos state has reported 24 suspected cases and 6 deaths from eight Local Government Areas (LGAs). 

A medical consultant, Dr Patricia Akintan, involved in case management at LUTH says, the high mortality rate (over 60%) among managed cases was due to under-vaccination. 

“Diphtheria is treatable. With early presentation, use of Diphtheria Antitoxin (DAT), and timely intervention, such as tracheostomy improved outcomes,” She says. 

Dr Akintan explains that vaccinating a child with pentavalent vaccines containing diphtheria toxoid at week six, ten and 14  as well as at 15-18 months is an effective means of preventing diphtheria.

She also advised that booster doses should be administered between ages 4-7, then at age 10, and subsequently every 10 years.

The vaccine to prevent diphtheria is usually packaged with tetanus and pertussis as the  (Diptheria, Tetanus and Pertussis) DTP jab.
Likewise, Mrs Bolanle Osho, a Community Health Extension Worker at Anjorin PHC in Lagos, attributes the outbreak of the vaccine-preventable disease to vaccine hesitancy and non-compliance among some parents.

She states that as a healthcare worker, she educates mothers on the significance of following the Routine Immunisation schedule.

“We still have some challenges convincing some parents of the importance of vaccines. This leads to hesitancy and non-compliance with immunization schedules. To combat non-compliance among parents, we follow up with those with eligible children for vaccinations regularly. With continuous sensitization, I believe that perception would change,” she says.

As part of the strategies to interrupt the outbreak, the Lagos State government in collaboration with Nigeria Centre for Disease Control (NCDC) and WHO, embarked on sensitization campaigns to raise awareness about the disease among the state health workforce and affected communities. 

During the sensitization exercise, the capacity of 366 health workforce was built on diphtheria management across five tertiary and secondary health facilities.
Commending the efforts by the Nigerian health authorities to respond to the outbreak, the WHO Country Representative, Dr Walter Kazadi Mulombo, says WHO in the last 75 years is committed to the attainment of all peoples the highest possible level of health.

“WHO is willing to collaborate with the government to roll out the three major programs that enhance health emergency preparedness, response, and resilience while adhering to the new pandemic treaty. 

 “In addition, we will continue to provide support through the Federal Ministry of Health by establishing efficient structures for rapidly mobilizing human resources and supplies in the event of an emergency,” he adds. 

To further stop the transmission of the disease, reduce the morbidity and mortality related to the infection, WHO has been supporting Nigeria with the acquisition and placement of Diphtheria Antitoxins (DAT) in states where the disease burden is significant. 

To improve case detection and reporting, WHO deployed technical experts, trained healthcare workers, and enhanced surveillance.

Technical contacts:

Dr Marcus Oluwadare; Email: marcuso [at] who.int (marcuso[at]who[dot]int)

Dr Bassey Enya Bassey; Email:basseyb [at] who.int (basseyb[at]who[dot]int)