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How Immunization gaps fuel diphtheria cases

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By Timothy Akintola

Despite improvement, diphtheria remains a health concern in Nigeria.

Diphtheria is a major acute bacterial disease which is caused by toxigenic strains of Corynebacterium diphtheriae was being curbed across the world via persistent childhood vaccination programs and with the use of the diphtheria toxoid-filled vaccines. Recently, the World Health Organization disclosed that there was an evident decline in the cases from 100,000 in 1980 to less than 10,000 in 2021. However, due to the huge bridge in the coverage of immunization, Nigeria still faces outbreaks of this disease which has caused 62 deaths and also affected about 21 states according to the reports of the Nigeria Center for Disease Control and Prevention (NCDC).

Whilst the first case was discovered in Nigeria, it sounded strange but it continually grew until it had to be added to the infectious disease list plaguing the country such as Monkeypox, Lassa Fever, Yellow Fever. Presently, over 1,064 suspected cases and 389 confirmed cases have been recorded across the country. Another statistic acquired by Good Health Weekly from the latest NCDC update indicated about 377 suspected cases reported from only seven states, most of which were from Kano state.

Experts urge for consistent immunization to curb problem.

With experts hinging on the need for a consistent immunization program to curb this disease, the National Primary Health Care Development Agency’s statistics showed that the poor and inconsistent immunization coverage, despite recorded improvements over the last five years. Since 2020 however, there has been a significant decrease in coverage due to the disruption of the (covid-19) Corona Virus, as well as the response activities to other surfacing diseases. With children losing out on appointments for vaccination as a result of these hindrances, adding to the spread of the disease surges. The NCDC report has thus indicated Kano state as the epicenter with about 843 cases, followed by Yobe state with 86 cases.

The reports further showed the distribution of these cases across 24 local governments in six states, with 78.4 percent (305) occurring amongst children within the age range of 2-14 years. Also, 62 deaths were recorded among the confirmed cases and only 60 of the 389 confirmed cases were said to have been vaccinated with the diphtheria toxin-contained vaccine. With Kano being the state hit with the most cases, the State Case Manager, Dr. Salma Ali Suwaid noted that out of the 843 suspected cases in Kano state, 360 were females and 423, males.

Low coverage in 2016 led to the declaration of the State of Emergency.

With Diphtheria being one of the most feared childhood diseases, surveys have shown the huge reduction in the mortality and morbidity of the disease due to the vaccination. However, it still remains a health concern in most developing countries like Nigeria. Survey from the National Primary Health Care Development Agency (NPHCDA) pointed out the fact that Nigeria experienced an immensely low routine immunization and coverage up to 2016. The 33 percent coverage in 2016 led to the declaration of a State of Emergency in Routine Immunization (RI) in 2017. This also led to the establishment of NERICC, SERICC and LERICC across the 18 underperforming states.

In 2019, the SMART survey showed a significant improvement of about 71 percent. Unfortunately, the coverage percentage plunged by 57 percent in 2021, according to MICS. Dr. Bassey Okposen noted that 33 out of the 36 states in Nigeria including the Federal Capital Territory recorded an improvement in the Penta 3 coverage, especially in Yobe, Ebonyi and Kebbi states. Contrarily, four states witnessed a significant decline in the coverage, with Borno recording the most significant decline of about 18 percent. Experts have suggested that this disease will continue to pose a huge threat to the health status in the country unless the immunization is adequately improved.

Government urged to invest in improving childhood vaccination coverage.

Professor Dimie Ogoina, an Infectious Disease Physician at the Niger Delta University Teaching Hospital, Bayelsa State, noted that the inadequacy or failure at procuring vaccination programs in the country has further worsened the situation. He also warned that a resurgence of the disease was inevitable, unless the coverage challenge is resolved quickly. In addressing this challenge, he urged the government to take full ownership and invest in the improvement of the childhood vaccination coverage.

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