A new disease called diphtheria has surfaced in some parts of Nigeria and it is lethal.

Last week, Aminu Tsanyawa, the Kano commissioner for health, said 25 confirmed death cases, mostly children, of diphtheria were recorded in the state.

The disease is gradually spreading across the country, raising concerns among health officials and Nigerians.

According to the Nigeria Centre for Disease Control and Prevention (NCDC), Kano recorded the first suspected cases; Lagos has also registered confirmed cases, while probable cases in Yobe and Osun states are under observation.

Though the NCDC said it is working with state ministries of health and partners to enhance surveillance and response to the outbreak, it also warned that the infection is contagious and most cases have been laboratory confirmed.

Unlike COVID-19 awareness rate, many Nigerians have no idea what this new infection is about, what the symptoms are, whether it is deadly, transmissible or preventable. These and more will be looked into in this explainer.

What is diphtheria and its possible symptoms?

The NCDC defined diphtheria as a serious bacterial infection caused by a bacterium called corynebacterium species that affects the nose, throat and sometimes skin of an individual.

Corynebacterium is a genus of gram-positive bacteria and the disease comes in two types – respiratory and cutaneous.

When an individual is infected with respiratory diphtheria, a sore throat with low-grade fever will surface and the membrane attached to the tonsils, pharynx, or nose will be affected. Simply put, the disease is capable of infecting the breathing organs of its victim.

However, each kind of diphtheria, after it has reached a severe level, can be identified through its symptoms.

Respiratory diphtheria, in severe cases, can lead to neck swelling, serious breathing problems, blood disorders, paralysis, coma and even death.

But in the case of cutaneous diphtheria, which is considered a rare kind of disease, it affects the skin and can cause wounds which may become swollen, reddened and painful.

Is diphtheria a new disease?

According to the Centers for Disease Control and Prevention (CDC), the bacterium was discovered by Edwin Klebs in 1883 when the disease was considered one of the most dreadful infections in the world.

It was said to have caused an overwhelming epidemic that majorly affected children.

Diphtheria started in ancient Egypt and Greece when vaccines were unavailable, and one in every ten children under the age of five was said to have died from the disease until possible treatment surfaced in the 1920s.

How diphtheria can be spread

The NCDC said people living in a crowded condition, unhygienic environment, including children, and adults who have not received any or a single dose of the pentavalent vaccine (a diphtheria toxoid-containing vaccine) are capable of transmitting the infection.

It added that healthcare workers who are exposed to suspected or confirmed cases are also carrier agents of the disease.

Diphtheria is transmissible during direct contact with infected people, contaminated clothing, objects or even coughing and sneezing from a disease-ridden person can get an individual infected.

How soon do symptoms appear?

A person who has been infected with diphtheria and left untreated can be contagious for up to four weeks.
But how long will it take an infected person to realise he/she has been infected with diphtheria?

As you watch out for signs such as fever, runny nose, sore throat, cough, red eyes, and neck swelling, it is important to know that the symptoms will start appearing from 2-10 days after you got exposed to the bacteria.

In case an individual notice these signs and wants to ignore them, it is important to note that untreated diphtheria has severe complications. It requires immediate medical attention as delay in treatment can lead to death.

Is there a cure for diphtheria –- and how can it be prevented?

Diphtheria is curable if an infected person is quickly diagnosed and treated. To curtail the infection, the Nigeria childhood immunisation schedule recommends three (3) doses of pentavalent vaccine (diphtheria toxoid-containing vaccine) for children in the 6th, 10th and 14th week of life.

The Centers for Disease Control and Prevention (CDC) said diphtheria antitoxin can be used to stop the bacteria from harming the body.

According to CDC, “this treatment is very important for respiratory diphtheria infections, but it is seldom used for diphtheria skin infections”.

It added that the antibiotics are effective for killing the bacteria in the respiratory system, the skin and other parts of the body including the eyes and blood.

People infected with diphtheria are usually unable to infect others 48 hours after they start treatment with antibiotics.

It is advised that patients finish taking the full course of antibiotics to completely get rid of the bacteria.

The NCDC has suggested the following preventive measures to suppress the widespread of diphtheria in the country.

“Parents should ensure that their children are fully vaccinated against diphtheria with three (3) doses of the pentavalent vaccine as recommended in the childhood immunisation schedule. Healthcare workers should maintain a high index of suspicion for diphtheria i.e., be vigilant and look out for symptoms of diphtheria,” the NCDC said.

“Individuals with signs and symptoms suggestive of diphtheria should isolate themselves and notify the local government area (LGA), state disease surveillance officer (DSNO) or the NCDC through our toll-free line (6232).

“Close contacts with a confirmed case of diphtheria should be closely monitored, given antibiotics prophylaxis and started on diphtheria antitoxin treatment when indicated.

“All healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with higher exposure to cases of diphtheria should be vaccinated against diphtheria.”

What are the best ways to curb diphtheria outbreak?

The NCDC, as of January 23, recorded a total of 34 death cases of diphtheria. According to WHO recommendation, increased awareness and improved vaccination coverage can help in ending the disease outbreak.

“Health-care workers in endemic settings and outbreaks may be at greater risk of diphtheria than the general population. Therefore, special attention should be paid to immunising health-care workers who may have occupational exposure to C. diphtheriae,” WHO said in its 2017 epidemiological report.

“All health-care workers should be up to date with immunisation as recommended in their national immunisation schedules.

“Travellers are generally not at special risk of diphtheria, unless they travel to an endemic country or outbreak setting. They should follow the vaccine recommendations for the general population and ensure they are up to date with their diphtheria vaccinations before travelling.”

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