Tackling the outbreak of diphtheria

Recent report by the Nigeria Centre for Disease Control (NCDC) to the effect that thousands of cases of the deadly vaccine-preventable disease, diphtheria, have been rampant in with eight states namely Kano, Kaduna, Katsina, Borno, Bauchi, Plateau, Sokoto and Zamfara accounting for 98 percent of the confirmed cases should give the federal, state and local governments serious concern and the urgent need for health authorities to fast track the vaccination coverage in children who bear the brunt of the disease.

We strongly demand that the Federal Government should through the NCDC, immediately intervene in procuring and supplying the diphtheria antitoxin to the affected states to tackle the increasing mortality from the disease since the subnational governments rely solely on the centre for the life-saving medication to tackle the ailment.

According to statistics, Kano state the epicentre of the current outbreak, has recorded 32,633 confirmed cases and 1,744 deaths, between December 2022 and now, while Zamfara state recorded 44 fatalities this year alone, bringing the death toll in the two states to 1791 so far. The disease is currently ravaging all the 44 local government areas of Kano.

Diphtheria is an airborne and droplet-transmitted bacterial infection that affects the respiratory tract and also can be transmitted from person to person, while poor vaccination coverage has been identified as the major cause.

Also, the World Health Organizaion, WHO, recommends that children be immunized thrice at age 6; 10 and 14 weeks against the killer disease and estimates that between 35 to 40 percent of Nigerian children are not fully vaccinated thereby exposing the unvaccinated ones to attack by the micro-organism. The symptoms include cough, sore throat, fever, drooling, pain in the neck and difficulty in swallowing.
Simply put, those battling for survival from the highly infectious disease are certainly victims of low vaccine immunization coverage at the nation’s primary and secondary health institutions probably due largely to inadequate supply of doses of the vaccine or the reluctance of some parents to submit their children for the all important three doses of the triple vaccine.

It is worthy of note that among the identified factors responsible for low immunization coverage across the country range from weak health systems, geographic barriers, and socio-cultural factors, ineffective leadership, shortage of trained health workers, poor tracking of data which weaken service delivery, unreliable cold chain equipment, vaccine shortages, and poorly planned vaccination campaigns reduce availability to long wait times, unfriendly staff behaviour, and illegal fees charged at clinics by health workers that discourage repeat visits.

Similarly, families in rural areas, experience has shown faced long travel distances to reach the nearest health facility while poorer households struggle with high transportation costs to the few available primary health centres across the states.

Also, children born at home rather than in health institutions, are less likely to receive routine vaccinations while religious and cultural beliefs, misinformation and religious objections, particularly in the northern region have over several decades led to outright vaccine refusals even as skepticism regarding vaccine safety and rumours about side effects had reduced community participation.

Consequently, it is not surprising that the northern states where the enumerated factors are dominant are the hardest hit when compared with states in southern Nigeria, because of the very low vaccine coverage which can partly be attributed to inadequate supply of the vaccine by the NCDC.

Recall that the procurement and delivery of vaccines and essential logistics for Nigeria’s routine immunization programmes are primarily co-funded by the federal government alongside a coalition of international donor agencies and development partners. While these agencies pool funds, purchase the vaccines globally, and provide technical and logistical assistance, Gavi operates on a co-financing model with the National Primary Health Care Development Agency (NPHCDA).

But for a critical care doctor and neuro-rehabilitation expert based in the United States, Dr. Chindima Okogwu, children are more vulnerable to the disease because their immune system is vaccine dependent for support while a child who is not fully vaccinated becomes a more vulnerable to infection because his immune system is not yet strong. Those from age 1-14 years can be infected too, if they did not receive the full immunization against diphtheria.

It is against this backdrop that we are deeply worried by recent alarm by the Kano State Centre for Disease Control, KSCDC) that it lacked sufficient stock of the vaccine to deal with the current health emergency. Its Director-General, Dr Muhammad Abbas, who lamented that the disease had spread to all the 44 local government areas of the state, revealed that close to 9 million doses of the vaccine were needed to conduct mass vaccination against diphtheria statewide.

‘’We need a very huge number, close to nine million doses of this vaccine, to do what we call ‘mass campaigns. The state currently had enough vaccines mainly for reactive vaccination in communities where cases were detected. The federal government had supplied Kano with 500,000 vials of diphtheria vaccine for people above four years and 150,000 doses for children below four. Diphtheria antitoxin is not easy to come by. It is being supplied by the federal government to the NCDC,” he noted thus revealing a huge shortfall in supply.

Therefore, in our view, the health authorities in charge of immunization coverage nationwide should urgently work in synergy with the NCDC to procure the necessary doses of the vaccine from producers to vaccinate children who have not been vaccinated or partly vaccinated at the primary health centres and secondary health institutions closer to them.

It also means that deliberate efforts should be made by the state and local government to recruit additional health care workers to cater for the surge in the disease and reduce the increasing deaths therefrom.

Besides, states that are yet to suffer the outbreak of diphtheria should activate precautionary measures aimed at preventing the risk of imported infections through constant movement of people from affected areas.

Again, health facilities with adequate qualified personnel and doses of the vaccine should be designated to manage suspected cases and possible complications while the government and the media should embark on public enlightenment of the symptoms of the disease, its prevention and the urgent need for Nigerians to adopt appropriate respiratory hygiene practices to reduce transmission of the infection since ‘prevention is better than cure’.

More importantly, there should be a substantial increase in budgetary allocation to the health sector in 2027 by government at levels to meet up with its peculiar challenges considering the fact that ‘health is wealth’ just as we advocate that 100 percent vaccination coverage as the first and best way to prevent avoidable deaths from preventable disease like diphtheria.

Furthermore, the introduction of personal hygiene in the curriculum of primary and secondary schools has become very imperative because hand washing technique and proper cough etiquette among others, should be inculcated in children early enough and shouldn’t be an emergency response to outbreak of preventable diseases. Good ventilation in residences, classrooms and public places must also be encouraged in the affected states to contain further spread of diphtheria.