The Federal Ministry of Health & Social Welfare (FMOH&SW) is aware of the mounting concern regarding the recent Diphtheria outbreak across several states in Nigeria. Since the confirmation of the re-emergence of diphtheria in Nigeria in December 2022, the Federal Government of Nigeria through the Nigeria Centre for Disease Control and Prevention (NCDC) and National Primary Health Care Development Agency (NPHCDA) have continued to respond to diphtheria outbreaks across different states in the country. As of September 24th, 2023, there have been 11,587 reported suspected cases out of which 7,202 were confirmed cases from 105 Local Government Areas (LGAs) in (18) States including the FCT. Most (6,185) of the confirmed cases were recorded in Kano. Other States with cases are Yobe (640), Katsina (213), Borno (95), Kaduna (16), Jigawa (14), Bauchi (8), Lagos (8), FCT (5), Gombe (5), Osun (3), Sokoto (3), Niger (2), Cross River (1), Enugu (1), Imo (1), Nasarawa (1) and Zamfara (1). The majority (5,299 [73.6%]) of the confirmed cases occurred among children aged 1 – 14 years with those aged 5-14 years bearing most of the brunt of the disease. So far, a total of 453 deaths have occurred in confirmed cases giving a case fatality rate (CFR) of 6.3%.

Given the escalation of the outbreak and findings that 80% of confirmed cases in the ongoing outbreak are unvaccinated, the Honourable Coordinating Minister of the FMOH&SW, Professor Muhammad Ali Pate, set up a national emergency task team co-chaired by the Executive Director of the National Primary Healthcare Development Agency (NPHCDA) and the Director General of the Nigeria Centre for Disease Control and Prevention (NCDC) for higher level coordination of outbreak response efforts. This includes ensuring optimal collaboration of all relevant health stakeholders in this fight. Other prominent members of the task force include: Director of Public Health-FMOH, representatives from the Federal Ministry of Information, the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), USCDC, USAID, GAVI, the Vaccine Alliance, other non-governmental organisations and development partners.

Diphtheria, caused by a toxin produced by the bacteria Corynebacterium diphtheriae, is a vaccine-preventable disease covered by one of the vaccines provided routinely through Nigeria’s childhood immunisation schedule. A historical gap in vaccination coverage is a driver of the outbreak given the most affected age group (5–14year-olds) and results of the nationwide diphtheria immunity survey that shows only 42% of children under 15 years old are fully protected from diphtheria.

National Response to Diphtheria Outbreak in the Country

Since the confirmation of an outbreak, the FMOH&SW through her agencies has been coordinating surveillance and response activities across the country. These include response coordination, surveillance, laboratory investigation, vaccination, case management, and risk communication activities.

Coordination

• Establishment of the Diphtheria Emergency Task Team responsible for the overall coordination of all activities encompassing Government and Development Partners’ response activities at national and sub-national levels in the country.

• Implementation of an Incident Management System (IMS) through the activation of a National Diphtheria Emergency Operations Centre (EOC) at NCDC, tasked with orchestrating the coordinated efforts of multiple response pillars during the outbreak.

• Deployment of National Rapid Response Teams (NRRT) to affected states (Kano, Yobe, Bauchi, Kaduna, Katsina, Lagos, Osun and FCT) to support response activities in the states.

Surveillance

• Development of draft National Diphtheria Surveillance and Response guidelines.

• Sensitisation/training of clinical and surveillance officers on the presentation, prevention, and surveillance of diphtheria.

• Harmonisation of surveillance and laboratory data from across states and labs.

Laboratory

• Establishment and ongoing expansion of the Diphtheria Laboratory Network to strengthen laboratory confirmation of diphtheria at national and sub-national levels.

• Building capacity of state-owned public health laboratories for diphtheria diagnosis including training and skills transfer for sample collection, transportation, and laboratory confirmation for diphtheria.

Case Management

● For the first time for any diphtheria outbreak, the FMOH&SW through NCDC and with WHO support, procured diphtheria antitoxin (DAT) and more recently intravenous erythromycin and distributed them to the affected states.

● With support from partners and in collaboration with the State Ministry of Health, Diphtheria Treatment Centres/Wards have been established in affected States.

Immunisation

● Intensification of routine diphtheria immunisation and reactive vaccination campaigns in 33 local government areas (LGAs) across five (5) states - Bauchi, Katsina, Yobe, Kano, and Kaduna by the NPHCDA.

● Mobilised procurement of vaccines and essential logistics for three (3) large-scale Outbreak Response campaigns in 56 LGAs across seven (7) priority states – Bauchi, Borno, Jigawa, Kaduna, Kano, Katsina and Yobe.

Risk Communication and Community Engagement

● Dissemination of public health advisories on diphtheria, media appearances/engagement and webinar series on diphtheria with media stakeholders and professional groups to create awareness, inform the public and bridge knowledge gaps.

● Development and dissemination of diphtheria Social and Behaviour Change (SBC) materials (Posters, Frequently Ask Questions), Flyers, and Public Service Announcement) for dissemination to affect states.

● Coordinating the diphtheria Risk Communication and Community Engagement (RCCE) stakeholders’ coordination meetings at the national and sub-national levels.

● Sensitisation campaigns targeting health workers, grassroots opinion leaders, religious leaders, schools, and community members.

Advice

To reduce the risk of diphtheria, the following advice is offered to the public:

● Parents should ensure that their children are fully vaccinated against diphtheria with the 3 doses of diphtheria antitoxin-containing pentavalent vaccine given as part of Nigeria’s childhood immunisation schedule.

● Healthcare workers should maintain a high index of suspicion for diphtheria and practice standard infection prevention and control precautions while handling all patients in their care.

● All healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with a high level of exposure to cases of diphtheria should be vaccinated against diphtheria.

● Individuals with signs and symptoms suggestive of diphtheria should promptly present to a healthcare facility or designated diphtheria treatment centres and where possible they and/or healthcare workers should notify their LGA, State Disease Surveillance Officer (DSNO), their State Ministry of Health helpline, or the NCDC through our toll-free line on 6232.

● Close contact with a confirmed case of diphtheria should be closely monitored and managed according to guidelines.

The most effective protection against diphtheria is vaccination with the Pentavalent or TD vaccine. The Federal Government of Nigeria provides free, safe, and effective vaccines at all Primary Healthcare Centres nationwide. We invite the public to take advantage of the ongoing vaccination occurring in all states. Parents are kindly advised to take their children aged 0 – 14 years to the nearest Government health facility to get vaccinated in accordance with the routine immunisation schedule and ongoing reactive vaccination campaign in the affected Local Government Areas (LGAs) as applicable. Vaccination saves lives!!!!

Members of the public are advised to avoid rumour-mongering and share only verified information from FMOH&SW, NCDC, NPHCDA, SMOH, WHO, UNICEF and other verified sources.