The recent public health alert by the Nigeria Center for Disease Control and Prevention (NCDC) that Nigeria has recorded 80 deaths out of the 798 confirmed Diphtheria cases in the country since January this year is worrisome. The high number of deaths recorded so far has been giving some concerned citizens sleep-less nights; more disturbing is the high level of ignorance about this medical condition.
To know about the disease with a view to acquire knowledge and skills to prevent it therefore, many have been asking what the disease is all about. Diphtheria, an infection caused by Corynebacterium diphtheriae bacteria, is an acute and highly contagious bacterial disease causing inflammation of the mucous membranes, formation of a false membrane in the throat which hinders breathing and swallowing, and potentially fatal heart and nerve damage by a bacterial toxin in the blood.
The condition which presents as severe coughing so serious that an affected person has difficulty breathing, is now rare in developed countries owing to effective immunisation. Before now, diphtheria has also been eradicated in developing countries until recently when it re-emerged in Nigeria and other parts of Africa due to poor immunisation, said Bayo Onajole, a professor of community medicine and consultant public health physician.
Cases of Diphtheria have continued to be reported in the country and it is now regarded as a re-emerging infection despite ef- forts of governments to end it, he said. The consultant public health physician said this has led to inter- ventions by governments involving awareness on the need for proper immunisation and sanitation to reduce its spread. According to Prof. Onajole who is also an epidemiologist, identifying the infection on time was the key to timely detection, adding that mop-up immunisation exercises would help to control its spread in communities. “A lot of people have what we call acute immunity.
Some people have not been immunised and when they come in contact with persons that are infected with Diphtheria they could infect others based on the contagious nature of the disease.” Active immunity occurs when our own immune system is responsible for protecting us from a pathogen.
Transmission
Diphteria is passed from person to person by droplet transmission, usually by breathing in bacteria after an infected person has coughed, sneezed, or even laughed. It can also be spread by handling used tissues or by drinking from a glass used by an infected person.
People can also get sick from touching infected sores on persons with the skin form of Diphtheria. The Diphtheria bacteria make a toxin that sickens people. Diphthe- ria can lead to breathing problems, heart failure, paralysis, and some- times death.
Prevention
Speaking further, Onajole said, “If a person is not properly immunised as a child, he will be at risk. Normally, children are more at risk because they have not been exposed to it be- fore and that is why they need the vaccine to protect them.” According to the United States Centre For Disease Control and Prevention (CDC), vaccines used today against diphtheria and tetanus (i.e., DT, Td) sometimes also include protection against whooping cough or pertussis (i.e., DTaP, Tdap).
The Federal Ministry of Health’s Health Promotion Department, said three doses of the Pentavalent vaccine is administered to children to prevent five diseases namely Diphtheria, Tetanus, Pertussis (whooping cough), Hepatitis B and Haemophilus influenzae type B. “The three doses are given as follows: first dose at six weeks of age, second dose at 10 weeks of age and third dose at 14 weeks of age.
“However, Tetanus Diphtheria (Td) vaccine is also given to children two to five years old during immunisation campaigns, pregnant women during Antenatal Care and health workers that are involved in handling diphtheria outbreak vaccination response.”
Signs and symptoms
The signs and symptoms commonly associated with Diphtheria are sore throat, which can be mild or severe, scratchy and painful, with thick gray or white membrane that covers the back of the throat and tonsils. Others are swollen and tender lymph nodes in the neck, fever, which can be moderate to high fever, usually above 38°C (100.4°F), cough, difficulty swallowing, rapid breathing and difficulty in breathing, leading to blockage of the airway.
Some other symptoms are general weakness and fatigue and hoarseness or changes in voice when it affects the vocal cords. However, there is treatment for diphtheria but early diagnosis is key. The professor of community medicine told the New Telegraph that there are environments where there is a breakdown of the immunisation process, and noted that both children and adults could be at risk of Diphtheria in such communities.
“We thought we had controlled it with vaccines but we are now having people who have not been immunised. What we thought we had controlled is now coming back and that is why we are calling it the re-emerging disease. “Many countries were able to eradicate it in the past years through effective immunisation and most cases were detected early; that was why we were able to bring it under control before.” However, its re-emergence is due to poor immunisation,” he explained.
Hygiene & sanitation
Consequently, Onajole advised people to keep their environment clean as people needed to reside in a clean environment to prevent infections as well as curb their spread. The epidemiologist noted: “The appropriate tools to help reduce the spread of the infection are health education -for people to be aware of it and the maintenance of basic sanitation. The disease can be spread in dirty areas when people sneeze or cough.
“Another factor is to get people immunised in areas where cases are found. We call those mop-up immunisations. “We need to be aware that Diph- theria is present in our environment. We need to maintain an ideal environment; cut bushes and other things. If there is a case of Diph- theria, report it early enough so that relevant health officials can do mop-up immunisation in that area because you don’t know who might have the infection.
“We need to be aware that such a disease exists. We need to maintain appropriate sanitation. We need to allow our children to have their immunisation. We need to do what we call pop-up immunisation in areas where cases are detected,” he encouraged.” Similarly, Prof. Dayo Faduyile, a former President of the Nigeria Medical Association (NMA) said the incubation period for the Diphteria is typically from two to ten days and so people needed to work towards preventing the infection from spreading.
Faduyile who is a consultant pathologist and the current special adviser on Health to the Ondo State Governor, Rotimi Akeredolu, has urged Nigerians to maintain good hygiene practices and emphasised the importance of vaccination. “Get vaccinated because Diphtheria can be primarily prevented through vaccination. Cover your mouth and nose with tissue and cough or sneeze into your bent elbow. “Dispose of used tissues im- mediately in a covered bin. Avoid close contact with sick individuals, and refrain from sharing personal items,” he said.
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