Atleast 31 People Killed in Diphtheria Outbreak in Nigeria's Plateau State

Plateau State, in north-central Nigeria, has recorded 31 deaths in a suspected diphtheria outbreak, with 469 suspected cases across 10 of its 17 local government areas, the state government said.

Only three of the 469 suspected cases have been confirmed by laboratory testing. Diphtheria can be fatal in around 30 per cent of unvaccinated people who do not receive proper treatment, according to the World Health Organization (WHO).

Jos North has recorded 370 of the 469 suspected cases, or about 79 per cent, according to a breakdown published by Channels Television, a Nigerian television news network.

Plateau Commissioner for Health Nicholas Ba’amlong gave the figures at a press briefing in Jos on September 24.

Ba’amlong said sporadic suspected cases had been recorded since the beginning of the year and that the situation became a major public health concern in August, Vanguard, a Nigerian national newspaper, reported.

The disease behind the deaths

Diphtheria is a bacterial disease that mainly affects the upper respiratory tract. Its toxin can damage the heart and nerves.

WHO says routine immunisation is the most effective way to prevent the disease and that protection requires multiple doses and boosters.

The disease can spread through respiratory droplets, including when an infected person coughs or sneezes, according to WHO's Eastern Mediterranean office.

Deaths counted, few cases confirmed

Ba’amlong said on September 1 that the state was struggling to confirm cases because it lacked specialised containers needed to collect and transport samples to laboratories.

He also cited late arrival at hospitals and difficulty obtaining diphtheria antitoxin as challenges, The ICIR, a Nigerian investigative journalism organisation, reported.

Only three of the 469 suspected cases have been laboratory-confirmed.

The state has not published a breakdown showing how the remaining suspected cases have been classified.

How the count has climbed

On September 1, Ba’amlong put the number of suspected cases at 143 and deaths at 23, according to The ICIR.

On September 9, The Frontier, a Nigerian news outlet, citing Daily Trust, reported that the state epidemiologist had put suspected cases at 303, up from 149, while deaths had risen from 23 to 27.

By September 24, the state was reporting 469 suspected cases and 31 deaths.

The 303 cases reported on September 9 were more than double the 143 reported on September 1.

Cases then increased by 166 between September 9 and September 24, while reported deaths rose by four.

Channels Television reported that the state had intensified active case searches and contact tracing, which can identify additional cases that had previously gone undetected.

The other nine areas

On September 9, the state epidemiologist said 99 per cent of the cases were in Jos North and identified the Rikkos community as one of the worst affected areas.

By September 24, the official breakdown showed 99 suspected cases across the other nine affected local government areas.

Wase had 29, Jos South 22, Barkin Ladi 16, Mangu 16, Pankshin five, Kanam four, Mikang four, Shendam two and Bassa one.

Ba’amlong said children aged two to 14 were the most affected and more likely to develop severe forms of the disease, Vanguard reported.

He also said some affected children had not been vaccinated or had not completed their immunisation schedules.

On September 1, Baks Bulus, the Disease Surveillance and Notification Officer for Jos North, told journalists that 117 people were suspected of having diphtheria and 15 had died.

He said the deaths occurred within three days of the outbreak, The ICIR reported. Two siblings aged between 12 and 17 were among those who died, Bulus said.

The response and vaccine shortage

Plateau has activated an Incident Management System and appointed Dr Maren Job Damala as Incident Manager, Vanguard reported.

Teachers in Jos North have been trained to identify early signs of the disease and respond appropriately, Channels Television reported.

Patients with suspected diphtheria are being treated at Jos University Teaching Hospital and Plateau Specialist Hospital, where isolation centres have been established, Premium Times, a Nigerian digital newspaper, reported.

Ba’amlong said more than 160,000 children had been reached with diphtheria and tetanus vaccines and more than 30,000 with pentavalent vaccines.

He also said the state needed another 250,000 doses to cover remaining parts of Jos North and other affected areas, Vanguard reported.

AIT Live, the news channel of Nigeria's African Independent Television, reported that the 160,000 children were vaccinated in Jos North and that available stocks had been exhausted.

The state has also alerted the National Primary Health Care Development Agency and requested additional vaccines, Premium Times reported.

In a statement issued on September 11, the Plateau government said all public and private primary and secondary schools across the state, which had been closed from September 7 as a precaution, would reopen on September 14.

One state inside a national outbreak

Michael Okali, an NCDC official, told Channels Television on September 5 that Plateau was one of eight states accounting for about 98 per cent of Nigeria's confirmed diphtheria cases.

He named Kano, Kaduna, Katsina, Borno, Bauchi, Plateau, Sokoto and Zamfara.

Okali also said about 68 per cent of confirmed cases were among people who had not been vaccinated.

For the week of August 24 to 30, he reported 69 suspected cases, 48 confirmed cases and four deaths nationally.

Nigeria's current diphtheria outbreak has roots in outbreaks reported in 2022.

WHO's Disease Outbreak News said the NCDC was notified of suspected outbreaks in Kano and Lagos states on December 1, 2022.

Kano has recorded 32,633 confirmed cases from 39,536 suspected cases and 1,747 deaths since December 2022, across all 44 local government areas, according to figures from the Kano State Centre for Disease Control reported by Vanguard.

Okali said vaccination is free at primary health centres and that children should receive routine doses.

He also said people who were unsure of their vaccination history could receive a booster.

What remains unknown

The state has not published a breakdown of the 31 deaths by age or vaccination status.

As of September 28, the latest Plateau figures remained 469 suspected cases and 31 deaths.