Diphtheria

The outbreak of diphtheria in Imo State about a fortnight ago reportedly killed six school children. This prompted the state gdovernment to order an immediate shutdown of all schools in Mbutu community of Aboh Mbaise Local Government Area,  still further notice.

In statement by his Chief Press Secretary, Mr Dike Godspower, the Executive Chairman of Aboh Mbaise LGA, Mr. Iheukwumere Henry Alaribe, said that the disease claimed the lives of six children, aged between one year and six years within seven days.

As a precautionary measure, he ordered the temporary closure of all nursery, primary and secondary schools in Mbutu for seven days.

Alaribe, further stated that the World Health Organisation (WHO) and the Department of Disease Prevention and Control in the Imo State Ministry of Health, along with health staff from Aboh Mbaise were actively working to investigate and stop the spread of this disease.

In Gregory University Uturu, I had to educate the staff whose children were below five years of age. Some of these did not know that diphtheria is among the vaccine-preventable six killer diseases.

  The six childhood vaccines included in the National Expanded Programme on Immunization (EPT), target six killer diseases, namely, tuberculosis, diphtheria, pertussis (whopping cough), tetanus , poliomyelitis (polio), and measles.

Actually, diphtheria is an infectious disease caused by Corynebacterium species of bacteria and is, most often associated with a sore throat, fever and the development of an adherent membrane on the tonsils and/or nasopharynx.

Severe infections can affect other organ systems, such as the heart and the nervous system. In addition, some patients with diphtheria can also have skin infections. Exotoxin, produced by the bacteria  is an important component in causing diphtheria’s more severe symptom.ms.

Diphtheria has been infecting humans for centuries. Hippocrates produced the first documented discription of diphtheria in the fifth century BC. The disease has been a leader in causing death, especially in children for many centuries.

The bacteria was first identified in the 1880s by F. Loffter. In the 1890s exotoxins were discovered.

The first diphtheria toxoid vaccine was produced in the 1920s.

Vaccination  programmes like the EPI have decreased the incidence worldwide, however, when vaccination rates drop, like during the terrorist attacks in Northern Nigeria, sit at home in south East Nigeria, infection rates rise and,  occasionally, serious outbreaks of the disease, like the one in Imo State occur.

For example, in the 1990s, an epidemic in Russia caused about 5,000 deaths according to the World Health Organisation (WHO) statistics, and from about 1993 – 2003, Latvia reported 101 deaths from diphtheria.

Worldwide, diphtheria is still endemic in many areas. In the early 1990s, a large infection of diphtheria occurred in the States of the former Soviet Union after immunisation programs were interrupted due to political upheavals. Epidemics in Central Asia, Algeria and Ecuador have also occurred. Those epidemics mostly affected adolescents and adults rather than children.

This is partly explained by the fact that adults in those areas lacked primary immunity to  Corynebacterium diphtheria in their vaccinated communities, and low rates of booster vaccination lead to a decline in diphtheria antitoxin concentration with age.

Widespread immunisation efforts by WHO, have resulted in a significant decrease in the number of diphtheria cases worldwide. Despite these efforts, it is still endemic in areas such as Africa, Caribbean and Latin America.

Because Human carriers or symptomatic individuals are the main reservoir for infection, situations such as overcrowding-dormitories, classrooms, institutional housing; poor living conditions, incomplete immunisation , and people who are immuno -compromised are at higher risks for getting diphtheria.

Diphtheria is transmitted by inhalation of airborne droplets or by direct contact with infected patients by mucous secretions or skin ulcerations. Some people may carry the bacteria in their respiratory tracts- termed carriers, but do not exhibit the disease. However, such individuals can still transmit the organisms to uninfected individuals.

Diphtheria bacteria most commonly infect your nose and throat, once you are infected; the bacteria release dangerous substances called toxins. The toxins spread through your blood stream, and often cause a thick, grey coating to form in the nose, throat, and tongue airway.

In some cases these toxins can also damage other organs, including the heart and kidneys. This can lead to potentially life threatening complications such as myocarditis, paralysis or kidney failure.

Initially the symptoms of diphtheria may be similar to a viral upper respiratory tract infection, but symptoms worsen over about two to five days.

The symptoms may include a sore throat, fever, difficulty swallowing, weakness, headache, enlarged lymph nodes, producing a thick or bull neck (resembling mumps), cough and difficulty in breathing.

As the disease progresses an adherent membrane (pseudo membrane) may begin to cover the tonsils, pharynx, and/or nasal tissues. If untreated, the pseudomembrane, can extend into the larynx and trachea and obstruct the airway, this can lead to death. 

Cutaneous diphtheria symptoms include initial  reddish lesions, that are painful and  may develop into non healing ulcers. Some ulcers may be covered by a grey-coloured membrane.

The first line if treatment is an anti-toxin injection. This is used to counteract the toxin produced by the bacteria.

Antibiotics crystapen (crystal penicillin) is  also administered.

  Diphtheria is preventable with the use of antibiotics and vaccines. The vaccine for diphtheria is called DTaP.

It is usually given in a single shot with vaccines for pertussis and tetanus. The DTaP vaccine is administered in a series of five shots.

It is given to children at the following ages

2 months

4 months

6 months

15  to 18 months

4 to 6 years

  Vaccines only last for 10 years, so your child will need to vaccinate again around age 12, especially if there is an epidemic outbreak. Like we have in Imo State

   For adults, it is recommended that during an outbreak, you get a combined diphtheria and tetanus booster shots. This is known as the tetanus- diphtheria (Td) vaccine. Taking these steps can help prevent you and your child, from getting diphtheria the future.

Always be medically guided.

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