Diphtheria Outbreak Raises Concerns in West Africa
West Africa battles a devastating diphtheria outbreak, particularly in Nigeria's northern state of Kano, posing a major threat to children's lives Vaccine mistrust adds to the challenges faced by doctors and medical workers fighting this deadly bacterial disease
In the northern state of Kano, Nigeria, doctors and health workers are facing one of the most severe diphtheria outbreaks in recent history. The country has been grappling with cases since May of last year, but the outbreak has rapidly intensified in the past few months. Health officials report that the bacterial disease has spread at an alarming rate, with 17,000 suspected cases in Nigeria. Efforts by local, federal, and international health organizations to contain the outbreak have been challenging.
The outbreak has spread to other West African countries, including Niger and Guinea, and Medecins San Frontieres (MSF) reports that these nations are currently experiencing some of the most severe outbreaks of this preventable disease ever documented on the continent. According to MSF health workers, the epicenter of the outbreak is Kano, where 9,310 cases and 368 deaths have been confirmed this year.
At its peak, MSF in Kano reported up to 700 cases a week. This rate dropped in September, but cases are slowly starting to rise again, currently at 500 weekly.
A bacterial disease
Diphtheria is a bacterial infection that produces a dangerous toxin which destroys tissues and targets cells in the respiratory system, resulting in difficulty breathing and swallowing for patients. If the toxin gets into the bloodstream, it can harm the nervous system, leading to heart and kidney damage or paralysis, even after recovery, as explained by MSF. Murjanatu Muhammad, a 30-year-old from Kano, has experienced all of her children, including 10-year-old Mohammed, eight-year-old Fatima, and five-year-old twins Jamila and Husseina, being hospitalized with diphtheria.
She told CNN, "If we hadn't brought these children in early, who knows what might have happened to them." Another mother, Firdausa Salisu, shared that her son, Auwal Nura, had been unwell since birth and was being treated by a traditional healer who opposed vaccines.
The traditional healer advised against vaccination while treating him. When he finally recovered and I wanted him to get vaccinated, I was informed that he was now too old to receive the vaccines.
A mother caring for her daughter who has recently recovered from diphtheria
Georg Gassauer/Medecins San Frontieres
High mortality in children
Thousands of children like Auwal have experienced the alarming range of symptoms caused by diphtheria, says Dr. Hashim Juma.
Dr. Juma, who has more than two decades of experience in the field, is currently located in Kano and serves as the emergency medical coordinator for MSF. "The situation is extremely grave. Patients are arriving with symptoms such as vomiting blood and paralysis in the legs... the mortality rate is high, especially among children."
Dr. Hashim Juma of Medecins Sans Frontieres expressed to CNN that he has never encountered an outbreak of this scale in terms of the high number of infections, mortality rates, and complications. He made the statement during a phone call from Kano.
Many diseases have complications, but this one is especially severe. Patients present with symptoms such as vomiting blood and paralysis in the legs, leading to high mortality rates, especially among children. Medical workers have been facing challenges in effectively treating patients, in part due to a shortage of diphtheria anti-toxins (DAT).
MSF has only been able to supply 5,000 DAT doses to patients so far, which falls short of the amount needed. Each severe case requires eight to 10 vials, making the current supply insufficient. Dr. Dagemlidet Tesfaye Worku, emergency medical program manager for West and Central Africa at MSF, explained to CNN that patients face a roughly 50% chance of death without treatment, which decreases to 5% with proper treatment.
DAT doses and antibiotics are particularly hard to come by due to the lack of production, as well as the cost and time needed to manufacture.
A vial of diphtheria anti-toxin is prepared by a doctor at the treatment center in Kano
Georg Gassauer/Medecin San Frontieres
According to Dr. Dagemlidet, only three companies manufacture these doses, with two being approved by the World Health Organization (WHO). He emphasized that it takes four weeks for manufacturers to produce a batch of 1,500 DAT doses, and the cost of treating patients with DAT alone could amount to 350 Euros ($370). He stressed the urgent need for this situation to be addressed as soon as possible.
Dr. Dagemlidet emphasizes the need to enhance the production capacity of anti-toxins in the short term, while also stressing the importance of investing in research and development for the long term. He underscores the significance of global health security, pointing out that in our interconnected world, a health crisis can occur anywhere, making it a pressing global issue.
Vaccine mistrust
The ongoing outbreak has been significantly impacted by vaccination efforts. Despite some success in preventing infections, there remain several obstacles to increasing vaccine uptake.
In November, only 30% of patients in Kano had full vaccine protection, with the rate dropping to just 6% in the northwestern state of Sokoto, according to MSF. In response, WHO and UNICEF have launched a vaccination campaign in 14 states across Nigeria.
Dr. Juma attributes the low vaccination rates in Kano to mistrust and lack of awareness about vaccines. He explains: "There is significant vaccine hesitancy here due to past negative experiences with side effects. During our initial intervention, we encountered a lack of enthusiasm from the community towards the vaccination team."
Fragment
In West Africa, the majority of diphtheria patients, 65%, have never received a single vaccine dose, indicating a lack of vaccination coverage in the region. In a recent update, WHO highlighted the significance of high vaccine uptake in combating the diphtheria outbreak, emphasizing the need for babies to receive six vaccine doses at six weeks old for long-term protection.
On December 4, GAVI, an alliance program for vaccines, announced that eligible countries can now request to incorporate diphtheria vaccines into their healthcare systems. Dr. Juma has witnessed an improvement in vaccine uptake as the outbreak has intensified since July. To control the diphtheria surge and prevent future outbreaks, it is crucial for this positive trend to persist.
Parenting staying with their children whilst they are treated for diphtheria, with some in hospital for up to two weeks.
Georg Gassauer from Medecins San Frontieres expressed concern about the lack of adequate equipment and vaccination coverage in neighboring Niger, especially considering the high level of movement between Kano and Niger, where the disease is now present. Dr. Juma emphasized the urgency of the situation.
The clear message to address the outbreak is that vaccination must be improved, according to Dr. Juma. "We emphasize the importance of strengthening the routine vaccination system in order to control the outbreak."
Dr. Dagemlidet also notes lessons learned about the doses of antitoxins and antibiotics. "It is crucial to have a minimum quantity of antitoxins in each country to ensure that adequate resources are available to help local areas when the first cases occur."
"The best way of responding to emergencies is anticipation and prevention."
