The recent outbreak and spread of diphtheria, a highly contagious and potentially life-threatening disease, in some parts of the country has continued to heighten health concerns. KAZEEM BIRIOWO, in this report, writes on the causes, mode of transmission, symptoms, and treatment options available, among others.
Nigerians is currently witnessing firsthand devastating effects of diphtheria, a highly infectious and potentially life-threatening disease. Despite being a vaccine-preventable illness, diphtheria continues to pose a significant public health concern in Nigeria, particularly among children.
Diphtheria is a preventable yet deadly disease that continues to pose a threat in Nigeria due to low immunization rates.
One of the diphtheria recent outbreak happened on February 22, 2025, when a 12-year-old student at King’s College presented with a sore throat and fever.
According to reports, he was promptly referred to the Lagos University Teaching Hospital (LUTH), where he received appropriate antibiotics and a full dose of diphtheria antitoxin.
Despite these interventions, the student developed myocarditis, a severe complication of diphtheria affecting the heart and he tragically passed away on March 6, 2025.
Following this incident, health authorities identified 34 close contacts of the deceased student.
Out of these, 14 developed symptoms consistent with diphtheria and were admitted to LUTH for treatment. All symptomatic students are reportedly responding well to treatment.
Diphtheria data according to NCDC
According to the Nigeria Centre for Disease Control and Prevention (NCDC) situation report, Nigeria has recorded 1,319 diphtheria deaths as of March 9, 2025.
The breakdown showed that the country recorded a total of 25,812 confirmed cases of diphtheria out of the 42,642 suspected cases reported across 36 states, the Federal Capital Territory, and 350 local government areas.
The spread of the confirmed cases cut across 184 LGAs in 26 states detailing the situation report of the disease from week 19 of 2022 to week 10 of 2025 (March 9, 2025).
The data also revealed that Kano has 24,239, cases Yobe (5,330), Katsina (4,237), Bauchi (3,066), Borno (3,058), Kaduna (777), and Jigawa (364) account for 96.3 of suspected cases reported.
Out of the 42,642 suspected cases reported, 25,812 (60.5 per cent) were confirmed cases (396 lab-confirmed; 216 epid linked; 25,200 clinically compatible), 7,769 (18.2 per cent) were discarded, 3,591 (8.4 per cent) are pending classification, and 5,470 (12.8 per cent) were unknown.
The confirmed cases were distributed across 184 LGAs in 26 states. Kano (18,108), Bauchi (2,334), Yobe (2,408), Katsina (1,501), Borno (1,161), Jigawa (53), Plateau (119), and Kaduna (44) accounted for 99.7 of confirmed cases reported.
Majority [16,234 (62.9 per cent)] of the confirmed cases were among children aged one to 14 years. Only 4,981 (19.3 per cent) out of the 25,812 confirmed cases were fully vaccinated with a diphtheria toxoid-containing vaccine. A total of 1,319 deaths (CFR: 5.1 per cent) were recorded among confirmed cases.
World Health Organization(WHO)has defined diphtheria as a bacterial infection caused by Corynebacterium diphtheriae. It primarily affects the throat and nose, but can also infect the skin. The bacteria produce a toxin that can cause severe damage to tissues and organs, leading to respiratory and cardiac complications.
Causes and transmission
Diphtheria is highly contagious and spreads through respiratory droplets when an infected person talks, coughs, or sneezes, they release droplets that can be inhaled by others.
Close contact can also transmit the disease by touching or sharing food and drinks with an infected person can also transmit the disease, and contaminated objects is another way by touching objects that have come into contact with the bacteria, such as toys or utensils, can also spread the infection.
Symptoms
The symptoms of diphtheria can vary depending on the severity of the infection and the individual’s overall health. Common symptoms include sore throat, which is severe and persistent sore throat is often the first symptom.
Another symptom that can develop is a high fever, usually above 38°C (100.4°F), and as the infection progresses, swallowing can become increasingly difficult.
Respiratory complications can lead to shortness of breath and difficulty breathing, and in some cases, diphtheria can cause skin lesions, which can be painful and tender.
Diagnosis
According to the World Health Organization (WHO), diagnosing diphtheria can be challenging, as the symptoms can be similar to those of other respiratory infections.
A diagnosis is typically made through a combination of physical examination in which healthcare provider will examine the patient’s throat and nose for signs of infection.
Laboratory tests can also be carried out. A throat swab or nasal swab can be taken to collect a sample of the bacteria and also imaging tests can be done in which chest X-rays or other imaging tests may be used to rule out other conditions.
Treatment
Treatment for diphtheria typically involves a combination of antibiotics, such as erythromycin or penicillin, to kill the bacteria, as well as the administration of an antitoxin to neutralize the toxin produced by the bacteria.
Additionally, patients may require supportive care, including oxygen therapy, to manage respiratory complications that may arise from the infection.
Prevention
Prevention is key in controlling the spread of diphtheria. The most effective way to prevent diphtheria is through vaccination. The diphtheria toxoid vaccine is typically administered in combination with tetanus and pertussis (whooping cough) vaccines.
Why is diphtheria a public health concern in Nigeria?
According to the Field Epidemiologist, African Field Epidemiologist Network (AFENET) and Health Services Research Student at the Old Dominion University, Norfolk, Virginia, USA, Dr. Salam Samson Polycarp, the reason is the same with why other vaccine preventable diseases still present themselves in Nigeria’s communities
“For Diphtheria, a child is supposed to take 3 PENTA shots in the 1st year of life. Parents/guardians default, because it’s injectable (PENTA), children often cry, making their parents not go back for completion.”
Dr Polycarp also said there is vaccine hesitancy in the communities brought about by vaccine and religious theories and so on, all these mount up to reduce herd immunity, ultimately leaving a population of unimmunized that would feel the wrath of the infection when it comes around.
Vaccine transportation and logistics issue
Dr Polycarp said, vaccines should ideally be preserved at a range of temperature from the manufacturer until when they are administered to a client.
“From USA/UK/ which are original sources to Nigeria to States down to the Local Government Area(LGA) to the ward to the facility and finally to the child.”
“Most often between +2 – +8°C. At any of these points when the temperature drops or increases due to vaccine handling(light, broken fridges, inefficient geostyl/cold boxes ect), it may render the vaccine invalid when administered to the child even if the doses were completed.”
Wrong route administration of vaccines
According to him, another issue could be due to the wrong route of administration for example, if it’s meant to be intramuscular and the health worker mistakenly gives subcutaneous, it alters with the calculated dose for this route of administration.
He said diphtheria remains a significant public health concern in Nigeria due to a multitude of factors.
“The country has struggled with low vaccination rates, particularly in rural areas, leaving many children vulnerable to the disease. Furthermore, inadequate healthcare infrastructure, including a shortage of healthcare workers and facilities, can hinder the diagnosis and treatment of diphtheria.’
“Limited awareness about diphtheria and its prevention also contributes to the spread of the disease, while ongoing conflict and displacement in some parts of the country disrupt vaccination efforts and increase the risk of outbreaks.”
“Additionally, overcrowding and poor sanitation create an environment conducive to the spread of the disease. Weak disease surveillance systems also hinder efforts to detect and respond to outbreaks.”
“Moreover, increased population movement facilitates the spread of the disease across different regions. These interconnected factors underscore the complexity of the challenge posed by diphtheria in Nigeria population movement.” He added.
Boosting Nigeria’s defenses against diphtheria
To combat the resurgence of diphtheria in Nigeria, Dr Polycarp said, it is essential to strengthen immunization programs, particularly in high-risk areas.
This, he said, can be achieved by increasing vaccine availability, improving cold chain management, and enhancing the skills of healthcare workers.
“By doing so, Nigeria can reduce the number of susceptible individuals and prevent the spread of the disease.”
“Combating vaccine hesitancy is also crucial in the fight against diphtheria. Misinformation, disinformation, and malinformation about vaccines can lead to decreased vaccination rates, creating an environment conducive to outbreaks.
“To address this, the government and healthcare professionals must engage in effective communication and education strategies to dispel myths and promote the benefits of vaccination.”
“Additionally, strengthening healthcare infrastructure, especially in rural and underserved populations, is vital to ensure that everyone has access to quality healthcare services.”
Improving disease surveillance and rapid response is also critical in controlling diphtheria outbreaks.
“This can be achieved by enhancing laboratory capacity, strengthening disease reporting systems, and ensuring that healthcare workers are trained to detect and respond to cases promptly.”
Dr Polycarp also said, improving sanitation and hygiene practices, such as providing clean water supply, promoting health education, and ensuring proper waste management, can also help reduce the transmission of diphtheria.
“Addressing security challenges affecting healthcare access is also essential, as insecurity can disrupt vaccination efforts and hinder access to healthcare services.”
“Ultimately, strengthening health policies and government commitment is vital in the fight against diphtheria.
“This can be achieved by providing adequate funding for immunization and disease control programs, implementing strict vaccination mandates for school enrollment, and ensuring that healthcare workers are trained and equipped to respond to outbreaks.
“By taking a multi-faceted approach, Nigeria can boost its defenses against diphtheria and protect the health and well-being of its citizens.”
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