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The recent death of a 12-year-old student from King’s College Lagos has sparked serious public health concerns as the state confirms a diphtheria outbreak.
With 14 students hospitalised and 34 close contacts under observation, health authorities are racing to contain the spread of this preventable but potentially deadly bacterial infection.
This highlights the deadly risk of this largely preventable disease.
In response to the growing concerns, health experts have emphasised that vaccination remains the most effective protection against diphtheria.
The Lagos State government has announced a mass vaccination campaign set to begin on Monday, with nearly 500,000 doses ready for deployment in high-risk areas.
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But what exactly is diphtheria, and why is it so dangerous? Understanding its nature, spread, and prevention is key to stopping further infections.
What is Diphtheria?
Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae. It primarily affects the mucous membranes of the nose and throat, leading to respiratory complications and, in some cases, severe damage to the heart and nervous system.
According to the Nigeria Centre for Disease Control and Prevention (NCDC), the bacteria produce a toxin that spreads through the tissues of the respiratory system, heart, and nerves.
This can cause difficulty breathing and swallowing and, in severe cases, life-threatening complications.
How Does Diphtheria Spread?
Diphtheria, if untreated, can lead to severe complications, including Heart damage (myocarditis), which can be fatal, and nerve damage, which can affect muscle function and swallowing.
Diphtheria has a fatality rate of 5% to 10%, with the highest risk in children under five and adults over 40.
Diphtheria is highly contagious and can be spread or transmitted through:
- Airborne droplets when an infected person coughs or sneezes
- Direct contact with infected wounds
- Touching contaminated objects (e.g., used tissues, shared utensils)
- Asymptomatic carriers, who show no symptoms but can still spread the disease
Symptoms of Diphtheria
Symptoms usually appear 2 to 5 days after infection. They may include:
- A thick, gray membrane covering the throat and tonsils
- Sore throat and hoarseness
- Swollen glands (enlarged lymph nodes) in the neck
- Difficulty breathing or rapid breathing
- Nasal discharge
- Fever and chills
- Tiredness and weakness
Some infected individuals may experience only mild symptoms or none, yet they can still spread the disease. These individuals are known as carriers of diphtheria.
Diphtheria can also affect the skin, causing painful, red, swollen sores or ulcers covered by a gray membrane.
While this form is more common in tropical climates, it has also been reported in areas with poor hygiene and crowded living conditions.
Diphtheria in Nigeria
The diphtheria outbreak at King’s College in Lagos has stirred concerns, but it’s not the first time Nigeria has faced such a challenge.
In 2011, Borno, in north-eastern Nigeria, was hit by a severe outbreak of diphtheria, recording 98 cases and 21 deaths, with a staggering case fatality ratio of 21.4% according to World Health Organization reports.
In December 2022, the Nigeria Centre for Disease Control and Prevention (NCDC) received notification of suspected outbreaks in Kano and Lagos states, prompting rapid response teams to investigate and confirm the spread of the disease.
By early 2023, confirmed cases had been reported across several states, with Kano, Yobe, and Lagos. Over 4,160 cases were reported between May 2022 and July 2023, spreading across 27 states and 139 Local Government Areas (LGAs).
By mid-September 2023, Nigeria had recorded 6,048 confirmed cases out of 10,077 suspected cases, with Kano State alone accounting for 85% of the total confirmed cases.
By the end of 2023, the outbreak had reached an alarming scale, with a total of 22,293 suspected cases reported across 36 states and 297 LGAs. Kano (14,126), Yobe (2,238), Katsina (1,734), Bauchi (1,376), Borno (1,148), Kaduna (573), and Jigawa (256) accounted for over 96% of all suspected cases.
67.6% of the cases were children aged 1 to 14, and only 25.2% of confirmed cases were fully vaccinated with a diphtheria toxoid-containing vaccine.
The outbreak led to 598 recorded deaths, with a case fatality rate (CFR) of 4.5%.
Nigeria’s vulnerability to diphtheria stems from persistently low vaccination coverage. UNICEF and WHO estimates show that the country’s Diphtheria-Tetanus-Pertussis (DTP3) vaccine coverage has remained below 80% for decades.
This makes Nigeria one of eight countries responsible for over 50% of unvaccinated children globally.
Prevention and Treatment
We outline some ways diphtheria can be prevented:
- Diphtheria can be prevented through vaccination, which is the most effective defence. The standard childhood vaccination schedule includes five shots: at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years.
- Adults should receive booster shots every 10 years.
- Good hygiene practices.
- Avoid crowded places and close contact with infected individuals.
What to Do If You Are Infected
If you experience symptoms such as sore throat, fever, difficulty breathing, and swollen neck glands, seek immediate medical attention, as early treatment is crucial.
