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 these 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 between 2 and 14 years. So far, a total of 80 deaths have been recorded among all confirmed cases (case fatality rate of 10.0%). Historical sub-optimal vaccination coverage is the main driver of the outbreak given the most affected age group observed, and a national survey of diphtheria immunity found less than half (41.7%) of children under 15 years old are fully protected from diphtheria.
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.
The NCDC, whilst working together with the National Primary Health Care Development Agency (NPHCDA) and partners to control the outbreak, offers the following advice to members of the public:
• 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.
• 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 have a high index of suspicion and 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.
1. Information for this disease was retrieved from the Technical Working Group and Situation Reports
2. Case Fatality Rate (CFR) for this disease is reported for confirmed cases only
3. CFR for this disease is reported for total cases i.e. suspected + confirmed
4. Information for sentinel influenza was retrieved from the laboratory
Key points
? There were 108 suspected cases from five LGAs in four states. There were six laboratory-confirmed cases and no death was recorded.
Actions
To date:
? Multi-sectoral Public Health Emergency Operation Centres (PHEOC) activated at the National and affected States.
? Conducted one-day Accelerating Lassa fever Vaccine workshop with CEPI and key stakeholders, experts and policy makers.
? Deactivation of the IMS/EOC.
? Conducted Lassa fever risk assessment.
Planned:
? Finalise LF's five-year strategic plan.
Key points
? There were seven suspected cases of Cerebrospinal meningitis (CSM) reported from two LGAs in two states. There was no laboratory-confirmed case and no death was recorded.
Actions
To date:
? National CSM TWG meets weekly to review reports from states and plan appropriately
? Monitoring of epidemiological trends to guide plans for reactive vaccination campaigns,
? Implementation of CSM reactive vaccination campaign in high-burden LGAs/Wards in Jigawa state led by NPHCDA
Planned:
? Continue data collation and harmonisation.
? Enhanced surveillance (active case search and contact tracing) in affected states and LGAs,
? Deployment of SORMAS application to secondary and tertiary HFs.
Key points
- There were 31 suspected cases of Yellow Fever (YF) reported from 26 LGAs in 18 states. There was no laboratory-confirmed case and one death was recorded.
Actions
To date:
- National YF multi-partner Technical Working Group (TWG) continues to coordinate activities across states.
- Daily monitoring and analysis of surveillance data across the country to guide response activities.
Key points
? There were 35 suspected cases of Cholera reported from 13 LGAs in seven states. There was a laboratory-confirmed case and one death was recorded.
Actions
To date
? The National Cholera Multi-Sectoral Technical Working Group (TWG) is monitoring all states and supporting affected states.
? Ongoing surveillance in all states through the routine Integrated Disease Surveillance and Response (IDSR) and Event-Based Surveillance (EBS).
? Continuous construction of sanitation and hygiene facilities with boreholes in cholera hotspots • Conducted WASH Sector review workshop.
Planned:
? Cholera surveillance evaluation across states.
? Continue advocacy to State Governments to increase funding for WASH infrastructure.
? Continue review of the National Cholera Plan.
Key points
. There were 132 suspected cases of Measles reported from 81 LGAs in 20 states. There were 25 laboratory-confirmed cases and no death was recorded
Actions
To date
. National Measles TWG is closely monitoring measles surveillance data and providing feedback to relevant agencies and development partners.
. Ongoing weekly surveillance and laboratory data harmonisation.
Planned:
. Continue monthly measles surveillance data review.
Key points
? There was no case reported for the week.
Actions
To date
? The National Mpox Technical Working Group (TWG) is monitoring activities in all states.
Key points
? There were 86 suspected cases of AFP reported from 63 LGAs in 20 states and FCT. None was laboratory-confirmed and no death was recorded.
Actions
To date:
• Engagement meetings with state teams on the ongoing response, Sitrep reporting and Ag-RDT data harmonisation, challenges, and the way forward.
• Mainstreaming of COVID-19 response activities into routine public health interventions such as surveillance, risk communication, testing etc.
Planned:
? Conduct advocacy visits to the leadership of non-reporting States
? Begin implementation of the testing strategy to increase RDT uptake.
? Continue to monitor global trends on COVID-19.
? Enhance surveillance at points of entry.
? Strengthen quality data collection at the LGAs/states & ensure prompt reporting.
Key points
? There were 484 suspected cases of Diphtheria reported from 35 LGAs in 11 states. There were 167 confirmed cases and 13 deaths were recorded.
Actions
To date
? The National Diphtheria Technical Working Group (TWG) is monitoring activities in all states.
Key points
For the reporting week 27:
• 209 Calls were successfully routed to agents and answered.
• 216 calls not routed to agents (Failed call)
• 425 total number of calls (successful and failed)
• Percentage of failed to total inbound calls 50.8%
• 1 signal picked and escalated (suspected diphtheria case)
From week 1 – 27, 2023:
• 11,636 calls successfully routed to agents and answered.
• 2,094 calls not routed to agents (Failed call)
• 13,730 total inbound calls recorded.
• Percentage of failed to total inbound calls: 15.3%
• 20 Signals picked and escalated to 36 states and FCT
Categories of Calls
• Report of health conditions
• Health Declaration-related queries
• Yellow Fever Vaccine enquiries
• Travel advisory enquiries
• TB-related enquiries
• COVID-19 vaccine enquiries
• General enquiries
• Hoax call and others
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