Official Statement following the first reported confirmed case of Diphtheria in FCT Abuja

Thursday, July 06, 2023

06 July 2023 | Abuja - Official Statement following the first reported confirmed case of Diphtheria in FCT Abuja

The Nigeria Centre for Disease Control and Prevention (NCDC) is aware of the death in June 2023 of a four-year-old with diphtheria in the Federal Capital Territory (FCT), Abuja. The NCDC, since December 2022, has reported multiple diphtheria outbreaks in different states across the country. As of June 30th, 2023, there have been 798 confirmed diphtheria cases from 33 Local Government Areas (LGAs) in eight (8) States including the FCT. Most of the cases (782) were recorded in Kano. Other States with cases are Lagos, Yobe, Katsina, Cross River, Kaduna, and Osun. The majority (71.7%) of the 798 confirmed cases occurred among children aged 2 – 14 years. So far, a total of 80 deaths have been recorded among all confirmed cases (case fatality rate of 10.0%).

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. Despite the availability of a safe and cost-effective vaccine in the country, the majority i.e., 654 (82%) of 798 confirmed diphtheria cases in this ongoing outbreak were unvaccinated. Unfortunately, this also includes this recently announced FCT case. Historical sub-optimal vaccination coverage is the main driver of the outbreak given the most affected age group (2-14-year-olds) observed, and a national survey of diphtheria immunity that found less than half (41.7%) of children under 15 years old are fully protected from diphtheria.

Just like in other States reporting cases, we are working with the FCT Health and Human Services Department to implement control measures and avert the further spread of the disease. We urge the public to remain vigilant and ensure persons with symptoms of diphtheria present early to health facilities for prompt diagnosis and treatment. Early diagnosis and institution of effective treatment are key predictors of a favourable outcome. Healthcare workers are urged to immediately notify LGA disease surveillance officers once they see a suspected case.

Update on Diphtheria Outbreak in FCT

The FCT Health and Human Services Secretariat has activated the diphtheria Incident Management System (IMS) to coordinate outbreak response activities. The key activities include but are not limited to active case finding in health facilities and communities, and risk communication and community engagement (RCCE) activities to raise awareness of diphtheria. Sample collection is also ongoing among suspected cases of diphtheria. As of 3rd of July 2023, only 1 confirmed case has been detected, with 7 suspected cases testing negative while others are awaiting laboratory results. No other death was recorded apart from the laboratory-confirmed case.

NCDC’s Response to Diphtheria Outbreak in the Country

In response to the outbreak in December 2022, NCDC activated a multi-sectoral national Diphtheria Emergency Operations Centre as a mechanism for coordinating surveillance and response activities across the country. The response activities include coordination, surveillance, laboratory investigation, risk communication, case management and immunisation activities.

Coordination

● Establishment of a multisectoral National Diphtheria Technical Working Group (TWG), bringing together relevant stakeholders to regularly meet and monitor the disease trend and coordinate response activities in the country.

● Deployment of Rapid Response Teams (RRT) to some of the affected states (Kano, Katsina, Lagos, Osun, Yobe) to support response activities in the states.

● Supported the establishment of a diphtheria IMS in the affected states.

Surveillance

● Development and dissemination of surveillance tools across the country – case definition, case investigation form (CIF), line listing template, etc.

● Support for active case finding across affected states.

● Development of draft diphtheria surveillance and response guidelines.

● Sensitization/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

● Building capacity of state-owned public health laboratories for diphtheria diagnosis.

● Strengthen the capacity of states for sample collection, transportation, and laboratory confirmation for diphtheria with the support of the United Kingdom Health Security Agency through the following:

â—‹ Training of laboratory physicians and scientists from selected states across the country at the National Reference Laboratory (NRL), Abuja, on laboratory methods for diphtheria confirmation

â—‹ Supply of diphtheria laboratory and sample collection consumables (transport media, reagents, sample collection materials etc.) to states across the country.

â—‹ Supply of biosafety cabinets to some of the affected states.

â—‹ Supporting the States in confirming cultures and toxin production testing (ELEK test and PCR) at the NRL on specimens sent in from States.

â—‹ Performing drug susceptibility testing (DST) at NRL on isolates sent in from States.

Case Management

● For the first time in over two decades, the country through NCDC and with support from World Health Organization, procured and prepositioned diphtheria antitoxin (DAT) in-country and distributed it to the affected states.

● Development and dissemination of Standard Operating Procedures for DAT use.

● With support from Medecins Sans Frontiere (MSF) and the Kano State Ministry of Health, established two isolation wards with a total capacity of over 80 beds at Murtala Mohammad Specialist Hospital (MMSH), Kano State.

Risk Communication and Community Engagement

● Development and dissemination of public health advisories on diphtheria.

● Media appearances/engagement on diphtheria with media stakeholders to create awareness, inform the public and bridge knowledge gaps.

● Development and dissemination of diphtheria SBCC materials (Posters, FAQs, Flyers, and PSA) for dissemination to affect states.

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

● Webinar series to share knowledge and raise awareness of response activities in the country.

Immunisation

● Intensification of routine diphtheria immunisation and some catch-up vaccination campaigns by our sister agency, the National Primary Health Care Development Agency (NPHCDA), in states with high numbers of children who have not received any childhood vaccine at all (zero-dose).

NCDC ADVISE

To reduce the risk of diphtheria, the NCDC offers the following advice:

● 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.

● Individuals with signs and symptoms suggestive of diphtheria should isolate themselves and notify their LGA, State disease surveillance officer (DSNO), their State Ministry of Health helpline, or the NCDC through our toll-free line on 6232.

● Individuals who have come in close contact with a confirmed case of diphtheria should be closely monitored, given antibiotics prophylaxis, and started on diphtheria treatment when indicated.

● Healthcare workers should practice standard infection prevention and control precautions while handling patients and body fluids.

● 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.

For more information on Diphtheria visit the link attached below

https://www.ncdc.gov.ng/diseases/factsheet/68

About NCDC

The Nigeria Centre for Disease Control and Prevention (NCDC) is the country’s national public health institute, with the mandate to lead the preparedness, detection, and response to public health emergencies. The Bill for an Act to establish NCDC was signed into law in November 2018 by President Muhammadu Buhari. The mission of the NCDC is to protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response, using a One Health approach, guided by research, and led by a skilled workforce.

Contact

NCDC Toll-free Number: 6232 | SMS: 08099555577 | WhatsApp: 07087110839 Twitter: @NCDCGov | Facebook: @NCDCgov | Instagram: @NCDCgov | NCDC Media Releases

Signed:

Dr Ifedayo Adetifa

Director General

Nigeria Centre for Disease Control and Prevention.

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