Recently, the Nigerian government has confirmed an outbreak of diphtheria in some parts of the country. The disease is a highly contagious infection caused by bacteria called Corynebacterium species that affects an individual’s nose, throat, and sometimes the skin.
The Nigerian Center for Disease Control and Prevention (NCDC) notify 38 people, mostly children, have died as a result of the disease, and there are 123 clinically suspected cases. In collaboration with state health ministries, the NCDC said “emergency response and monitoring of the outbreak is underway” situation in four states (Lagos, Kano, Osun and Yobe).
Worldwide, the incidence of diphtheria has decreased dramatically over the past five decades, thanks to widespread immunization using a vaccine containing diphtheria toxoid.
Number of diphtheria cases reported to the World Health Organization (WHO). reject From around 100,000 in 1980 to less than 10,000 cases in 2021.
Prevention of infection primarily controls diphtheria through high population immunity achieved by high vaccination coverage. NCDC said in a health counseling He sent health workers in Nigeria to “conclude that diphtheria outbreaks reflect inadequate vaccination coverage.”
What is diphtheria?
Diphtheria is a serious bacterial disease caused by the spread of Corynebacterium species, especially the toxin-producing Corynebacterium diphtheriae and rarely the toxin-producing strains of C. ulcerans and C. pseudotuberculosis, the NCDC explained.
When a person catches diphtheria, the bacteria release toxins, or poisons, into the person’s body. from America Center for Disease Control and Prevention (CDC) He said the toxin infects the upper respiratory tract and sometimes the skin, causing the windpipe to grow.
“This makes breathing difficult, and if the membrane completely blocks the trachea, it can lead to suffocation and death. The heart and nervous system can also be damaged,” the CDC notes.
Diphtheria manifests as laryngitis, pharyngitis or tonsillitis and is associated with an adherent membrane covering the tonsils, pharynx and/or nose.
Beyond respiratory symptoms, the NCDC said, about a quarter of cases can lead to heart problems (myocarditis). The mainstay of diphtheria treatment is antibiotics and diphtheria antitoxin (DAT).
transmission
Diphtheria is easily spread between people through direct contact or through the air and respiratory droplets from coughing or sneezing, the NCDC added.
“Contaminated clothing and objects can also spread. A person is infectious as long as the bacteria are present in respiratory secretions, usually two weeks without treatment and rarely longer than six weeks.
“In rare cases, chronic carriers may shed the organisms for six months or more. Effective treatment immediately stops shedding within a day or two,” NCDC he said.
According to the CDC, diphtheria can be spread by sharing items such as glasses, cutlery, clothing, or bedding with an infected person. It is possible to get diphtheria more than once.
Who is at risk of developing diphtheria?
Anyone who is not protected by the vaccine and is in close contact with an infected person can develop diphtheria, Cleveland ClinicAmerican non-profit academic medical center.
Symptoms
The most common type of diphtheria is classic respiratory diphtheria. An infected person usually shows signs of diphtheria about two to five days after exposure.
The time to show symptoms can be one to 10 days after exposure, said Tijjani Yakubu, a doctor at the Federal Medical Center Abuja. “The initial symptoms can be mild and include fever, runny nose, sore throat, cough and red eyes (conjunctivitis).”
In some cases, Mr. Yakubu said, infected people have “swollen neck glands, tissue obstructing the nose, throat, kidney, or heart problems (if the bacteria enters the bloodstream).”
In severe cases, the NCDC says the bacteria produce an exotoxin that causes a thick gray or white patch (pseudo-membrane) on the tonsils and/or back of the throat.
“This can block the airway, making it difficult to breathe or swallow and cause a barking cough. The neck may be partially swollen due to enlarged lymph nodes and often gives the appearance of a bull’s neck.
“The exotoxin produced by the bacteria can enter the bloodstream, causing inflammation and damage to the heart muscle, nerve inflammation, kidney problems and bleeding problems due to a decrease in the number of blood platelets.
“Damaged heart muscles can cause an abnormal heartbeat, and nerve inflammation can cause paralysis. The infection can also affect the skin (cutaneous diphtheria). Less commonly, it can affect mucous membranes in other non-respiratory areas, such as the genitals and conjunctiva,” the NCDC states.
The causes
Mr. Yakubu said diphtheria is a serious infection caused by strains of bacteria called Corynebacterium diphtheriae that produce a toxin.
“It’s a toxin that can make people very sick,” Mr Yakubu said.
For its part, the Cleveland Clinic the researchers diphtheria is caused by bacteria that adhere to the lining of the respiratory system.
“These bacteria produce a toxin that damages the cells of the respiratory tissue. Within two to three days, the tissue left behind forms a large, gray coating. This coating has the potential to cover the tissues of your voice box, throat, nose, and tonsils. For the infected person, breathing and they become difficult to swallow.’
Complications
The NCDC said complications from diphtheria usually occur in the second to third week after infection.
“This includes corneal scarring (exacerbated by vitamin A deficiencies), encephalitis (more common in children and adults, 0.1 percent), diarrhea, pneumonia (the leading cause of death), and subacute sclerosing panencephalitis (a rare, delayed complication; associated personality). changes, seizures, motor disability, coma and death).
According to the NCDC, “mortality rates of up to 10 percent have been reported in diphtheria outbreaks and are higher where diphtheria antitoxin (DAT) is not available.”
Types of diphtheria
According to the CDC, there are two main types of diphtheria: classic respiratory and cutaneous.
Classic respiratory diphtheria is the most common type of diphtheria. It can affect the nose, throat, tonsils or larynx (voice box). “Symptoms can vary depending on where the damaged membranes are in the body. Some call this condition pharyngeal diphtheria (diphtheria of the throat),” the CDC added.
Cutaneous diphtheria “is the rarest form of diphtheria, which involves skin rashes, sores, or blisters that can appear anywhere on your body. Cutaneous diphtheria is more common in tropical climates or crowded places where people live in unsanitary conditions.”
Diagnosis
According to Mr. Yakubu, a doctor in Abuja, health providers will diagnose based on symptoms and a laboratory test.
“They’re going to use a sample from the back of the throat or a sore throat,” the doctor said, adding that it would be taken to a laboratory for diagnosis.
NCDC also explains diphtheria testing broadly, saying that the clinical diagnosis of diphtheria is usually based on the grayish/white membrane (pseudomembrane) that lines the throat (pharynx/tonsils).
Although laboratory investigation of suspected cases is recommended for case confirmation, treatment should be initiated before laboratory results are received, the center added.
“Two samples should be collected from each suspected case on first contact with the case – a pharyngeal swab and a nasal swab – and should be taken before antibiotics are started. However, samples should still be taken even if antibiotics have been started. Specimens in a suitable transport medium (Amies transport medium or Stuart medium) or placed in silica gel bags, if dry. Transport these to the laboratory immediately at 2-8oC,” NCDC said.
“If possible, a sample of the pseudomembrane should also be collected and placed in saline (not formalin). A culture taken from a wound must be handled like nose and throat swabs,” explained the center. “The most reliable method of ascertaining diphtheria is to demonstrate the growth and toxin production of the organism from any of the aforementioned specimens by an immunoprecipitation reaction (modified Elek test).”
“PCR can be performed directly on the swab material to detect the presence of the A and B subunits of the diphtheria toxin gene (tox). However, in some cases, the presence of toxin does not confirm toxin production; Therefore, positive PCR results should always be confirmed with the Elek test if there is an isolation,” NCDC said.
Treatment
Diphtheria infection is treated with diphtheria antitoxin (DAT) through an intravenous or intramuscular injection. Nigeria’s disease control agency said antibiotics could also be given to kill the bacteria, prevent transmission to others and the production of toxins.
“Close contact with the patient should be observed for signs and symptoms for ten days from the last contact with a suspected case. Also, health care workers exposed to the case’s oral or respiratory secretions or workers exposed to wounds should be monitored. Prophylactic antibiotics (penicillin) for seven days or erythromycin) is indicated for close contact.’
prevention
In the Nigerian child vaccination schedule, three doses of pentavalent vaccine (diphtheria toxoid vaccine) are recommended at 6, 10 and 14 weeks of life.
WHO recommends a three-dose series of diphtheria toxoid vaccine starting at 6 weeks of life in the first year of life and recommends 3 boosters of diphtheria toxoid vaccine in childhood and adolescence to ensure long-term protection.
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In endemic and outbreak settings, healthcare workers may be at greater risk of diphtheria than the general population. Consequently, NCDC has recommended that special attention be paid to immunizing health care workers (clinicians, laboratory scientists, etc.) who may have occupational exposure to Corynebacterium diphtheriae.
Diphtheria in Nigeria
He was in Nigeria outbreak in Borno, in the northeast of the country, in 2011, 98 cases and 21 deaths (the case-fatality ratio was 21.4%). The NCDC said this outbreak and associated high mortality were due to a combination of low vaccination coverage, delayed clinical recognition and laboratory confirmation, and lack of antitoxin and antibiotics for treatment.
The researcher conducted this fact-checking with the Dubawa 2023 Kwame Karikari Fellowship in partnership with Premium Times to facilitate the ethos of truth in journalism and improve media literacy in the country.
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