Why diphtheria is upon us!

There is growing panic over the outbreak of the disease known as diphtheria in different parts of Nigeria. Diphtheria, also recognised as one of the six killer diseases of children, was thought to have largely come under control due to what was perceived to be the effectiveness of the national programme of immunisation, which was launched in 1974, and renamed the Essential Programme on Immunisation, a massive vaccination campaign re-launched in 1983 to provide a government-mandated access to life-saving vaccines that were targeted at those six-killer childhood infections. Those diseases are tuberculosis, measles, pertussis, tetanus, poliomyelitis and diphtheria. As part of that massive effort, teams of healthcare workers were deployed to schools, places of worship and even markets to ensure that babies and children were reached and immunised. Diphtheria is a serious bacterial infection caused by a small bacterium known as Corynebacterium diphtheriae. It is a gram-positive bacterium, meaning it has a thick and complex configuration in its cell wall. They are rod-shaped organisms, typically very small in dimension and unable to move on their own. This means that the bacteria have to be transported in ways we shall describe later. They cause a serious and potentially life-threatening infection if diagnosis is delayed.

Corynebacterium diphtheriae, also called C. diphtheriae, produces a toxin that damages tissues and causes the symptoms of diphtheria. These bacteria adhere to the cells of the host, such as epithelial cells in the throat, and produce the characteristic toxin. The bacteria can evade the affected person’s immune system, allowing it to establish a specific infection. At the onset of the infection, it produces a cough, which seems to be relatively indolent and irritating, with an itchy throat. The cough is often dry as well, without producing much mucus. Then, the cough can become quite persistent and worsen over time, especially if left untreated. In some cases, the cough may be accompanied by a high-pitched sound, often described as a “barking” or “croupy” cough. In addition to cough, other respiratory symptoms may include sore throat, hoarseness of the voice, and difficulty with swallowing or painful swallowing, shortness of breath and a high-pitched sound heard during the in-breathing phase of breathing known as respiratory stridor. Fever often develops in addition. Children who are found in the hospital in this state of affairs are a compelling, scary sight to behold. They develop red eyes, breathe with their mouths open and have no interest at all in their environment. It is usually evident that they are fighting for their lives.

The transmission of this disturbing infection is by respiratory droplets. That means that when somebody who has got the infection coughs or sneezes, they produce an aerosol of fine saliva, mucus and bacteria into the immediate environment, some of which can travel up to five metres directly in front of the sick person. The rest is suspended in the air for some time while the heavier particles settle on furniture, especially dining tables and glassware. C. diphtheriae is transmitted through such respiratory droplets and also through close contact as is possible in homes with poor ventilation, like is common in many tenement homes around the country, schools and dormitories. This has been amply demonstrated in the case of King’s College. Lagos. The outbreak in that institution has gained traction in the press because it is a prominent institution attended by the offspring of the elite. But supposing this happened at some remote secondary school in Kwakuti in Niger State? To begin with, the children of the high and mighty would be unlikely to be in such a school so that an outbreak of that nature will not command the attention of the press. Without a doubt, the bacteria can be transmitted through close contact with an infected person. So if you or someone you know is experiencing these symptoms, it is essential to seek medical attention promptly.

Diphtheria can lead to serious complications, such as respiratory failure, if left untreated. The outbreak thus far has primarily affected children, with more than 70 per cent of confirmed cases occurring among those aged between 2-14 years. Unfortunately, just over one-third of the confirmed cases had received their routine childhood immunisations, highlighting the need for improved vaccination coverage. The number of fatalities for this outbreak is just shy of 7 per cent, which is relatively high, especially among young children. This underscores the need for prompt medical attention and effective case management. This outbreak has put a strain on Nigeria’s healthcare system, with concerns about the availability of diphtheria antitoxin and other essential medical supplies. For starters, the Lagos State government has responded aggressively by putting together a team of experts to explore ways of containing the disease. This includes a roll-out of vaccines to help protect those who are considered vulnerable but have not yet been exposed. However, what is the response of other states in the country? It is mostly a case of masterly inactivity, with healthcare facilities essentially waiting to offer treatment to those who are brought to the hospital. One major reason this has become a public health emergency is that many health facilities offering childhood immunisation cannot boast of the quality of their cold-chain storage.

Overall, the current diphtheria outbreak in Nigeria is a pressing concern due to its rapid spread, high transmission rate, and strain on the healthcare system. Large swathes of the country are under the control of armed gangs and all sorts of bandits, and people who live far from established healthcare facilities are further terrorised into not venturing onto the roads. It is, therefore, essential to note that treatment should be initiated promptly, as delays can lead to serious complications and increased mortality. Although diphtheria is relatively rare in developed countries, it remains a significant public health concern in areas with low vaccination coverage, conflict zones, and places with poor healthcare infrastructure, all of which complicate the Nigerian landscape because all three factors are present. Vaccination is the most effective way to prevent diphtheria. This outbreak has affected 27 states, with more than 11,000 suspected cases and nearly 7,500 confirmed ones, leading to more than 500 deaths. This indicates a high transmission rate, which can be attributed to the contagious nature of the disease. Our country suffers today from this and other preventable diseases because of adverse cultural and religious beliefs, vaccine hesitancy and non-adherence to proper environmental guidelines, not to mention vaccine denial.

Diphtheria is preventable with vaccination. The diphtheria toxoid vaccine is usually administered in combination with tetanus and pertussis (DTaP) vaccines, more commonly known as DPT. Vaccination is crucial to prevent diphtheria and its complications, especially in children. In addition, there are additional preventive measures taken to prevent and control the spread of infectious diseases, which include COVID-19, diphtheria, and others, without relying on medicines. These measures were found to be effective enough in recent disease outbreaks. Therefore, wearing face masks in public places to reduce transmission and maintaining physical distance of at least two metres from others are important to prevent close contact. Frequent handwashing with soap and water, or using hand sanitisers while practising good respiratory hygiene, such as covering the mouth and nose when coughing or sneezing, have been found useful. Ensuring good airflow in buildings and public spaces and avoiding unnecessary crowds are additional measures. All these measures play a crucial role in controlling the spread of infectious diseases in Nigeria, particularly in areas with limited access to healthcare services or where vaccine availability is limited. By implementing these simple things, individuals can reduce their risk of infection and help prevent the spread of diseases.

Antibiotics, such as erythromycin or penicillin, can be used to treat diphtheria, while diphtheria antitoxin can be used to neutralise the toxin produced by the bacteria. The current outbreak in the country can still be contained if these medications are made available. This is important because the toxin the bacteria produces can cause a thick, grayish membrane to form in the throat, leading to respiratory obstruction. If this is left untreated, the membrane can block the airway, causing asphyxiation. The toxin can damage the heart muscle, which can be fatal or lead to heart failure, especially in children. The toxin can damage the nervous system, leading to nerve-related symptoms such as numbness, tingling, and paralysis, or cause respiratory paralysis, leading to respiratory failure. Diphtheria can lead to sepsis, a life-threatening condition caused by the body’s response to an infection, while the toxin can also damage the kidneys, leading to kidney failure.

Questions and answers

Hello doctor. Thank you very much for your response to the question I asked about my granddad, who smokes a lot. He says you are a doctor who understands the psyche of an old man, and therefore, you are the best. He says he has no intention of giving up a habit he has nurtured for the past 40 years, and you should carry on your good work. In addition, he promised to continue reading your essays and answering the questions of readers in the Sunday PUNCH every week. Thank you, doctor, for what you are doing.                                            080514XXXXX

Thank you very much for your feedback, sir. We appreciate your grandpa’s acute sense of humour. We wish him all the best, and please endeavour to reach out to us on this page should you have any further concerns about his habit.

Hello, sir. Good evening to you, and happy Sunday. I am the widow who expressed my fears about the enormous amount of weight I lost since August 2024. A certain doctor you kindly linked me with paid for my treatment at the University of Port Harcourt Teaching Hospital, and I have started gaining weight again. Before my treatment started, I weighed 55kg, but as of the last time I checked my weight in the clinic, it was 63kg. I am very grateful to you and Sunday PUNCH for making my cry to be heard. God bless you all. Amen!                                                                      080347XXXXX

Thank you for your greeting, prayers and warm words of appreciation. Thank God for the assistance of that senior colleague, whose identity I am not at liberty to reveal. Hopefully, you will continue to improve and be fully restored back to your normal state of health and proper weight. Congratulations.

Good day, Doctor. What types of ailments can make people go blind? I just heard that the richest woman in Africa, who is also a Nigerian, recently went blind. How could this happen to somebody who has all the resources to afford the best care in the world?  Thanks.       080638XXXXX

This is something we have previously treated on this page. Some of the common causes of blindness are cataracts, glaucoma, injury to the eye caused by penetration and chemical burns, bacterial infections affecting the eyeball like panophthalmitis, trachoma and syphilis, and viral infections like optic neuritis and measles. Age-related macular degeneration and complications of chronic diseases like diabetes and stroke can also lead to blindness. The development of tumours in and around the eye can also cause the loss of vision. Detachment of the retina can also cause sudden blindness, just as surely as inappropriately developed eyeballs as seen in microphthalmia, in which the eyeball is abnormally small.

Doctor, good evening to you. I hope you are well. I am a 34-year-old single man. Lately, I have been noticing some thick areas of blackish growth on different parts of the soles of my feet. I don’t feel any form of discomfort around the feet, and there is no pain, but the things look really ugly, and I want a solution. I will send you pictures on WhatsApp. Please, what do you think is the cause of this ugly thing? And what is your advice? Thank you, and God bless.                                             081224XXXXX

I am well, thank you very much. The pictures you sent showed some callouses and irregular areas of thickening, especially around the heels. It is likely that you developed these lesions over several months due to the kind of footwear you were or are still putting on. When you have areas of irregular pressure around the foot because of poorly made shoes or footwear made from poor materials, you can develop problems like this. The solution should be fairly straightforward. You should engage in warm soaks of your feet for 15-20 minutes every evening before bedtime. That gives a soothing feeling, but more importantly, it makes the soles softer, and you can then gently use a rough-hewn stone called foot scrub to remove the irregular surfaces and the abnormal colours. While you are advised to do these warm soaks every evening for seven to 10 days, the foot scrub can be performed on alternate days until the soles become smooth.

Many thanks for all the explanations to enquiries in your weekly column, Sunday Doctor. Yesterday, I started feeling pain in my right testicle up to the groin. There is a little swelling in both the testicle and the groin and the loop that links the two. The pains disappeared, only for them to surface at about 11am. I hope it is nothing serious. Help me, please. 070406XXXXX

Thank you very much for your comments and question, sir. There are a couple of explanations for this development. It could be a hernia which will require an operation to help treat, or it could be an infection involving the testis known as orchiitis. It is important to know which one it is, and for that reason, you must see a doctor for a proper examination so that a diagnosis can be made and you can get the treatment you need. That is very important, depending on your age, which you did not disclose. Either way, treatment is possible and, hopefully, affordable too.

Dear doctor, your good works are appreciated. I am a 32-year-old woman currently experiencing cough, catarrh, sore throat, headache and fever. The problem now is that I cannot eat or sleep, and this has been going on for more than one week. I bought Ampiclox capsules from a chemist down my street, and I have been using one capsule two times a day with Paracetamol. But there was no improvement, and although I didn’t have enough money to go to the hospital, I just knew that something is not right. For example, this morning, I looked at my throat using a mirror and saw that the inner part of my mouth was just red. I feel pain also at the sides of the neck. Sir, what should I do?  Please, kindly advise.                   080272XXXXX

Thank you very much for your kind words. Well, there are problems with the way you are using the Ampiclox, to start with. The minimum number of times you should use that antibiotic is three times a day if it is taken every eight hours. But it should ideally be taken every six hours, considering the severity of the infection which you described. That means you should use it four times a day. What your question helps to demonstrate is that you went to a chemist with no pharmacist or nurse in attendance and did not get your money’s worth of advice. You should begin to use this medication properly right away, and provided it is not also fake or expired, you should experience some improvement. Otherwise, you will still have no choice but to see a doctor for examination and treatment based on a proper diagnosis of your condition. It is not every kind of infection involving the throat that Ampiclox can treat. You need to be aware of this fact.

Good evening, Sunday Doctor. Please, I always feel the urge to vomit, especially after eating. I end up not vomiting, but after some time, I find that I am hungry again. I eat at that time and start feeling the same way. I am 47 years old, and I am not pregnant. In recent tests I was asked to do, the ova of parasites was found in my stool, and my blood sugar was 104. Now, if I divide 104 by 18, what is the result? And what should be done about the thing that was seen in my stool? Please, help me. Thank you.        090970XXXXX

Thank you very much for the puzzling questions you asked. Since you mentioned pregnancy, it is safe to assume that you are a woman. The first puzzle is why you found it necessary to divide your blood sugar result by 18. When blood sugar is expressed in millimoles per litre, it is multiplied by 18 to get the figure in milligram per cent, which perhaps, many people are more comfortable with. It is not divided. The result you shared is vague due to a lack of clarity about which unit expresses your result, but if it was in millimoles per litre, you would probably be dead, and if you divide your result by 18, the reading will be so low that death would also result. So this result is likely to be in milligram per cent, and I can say that the result is normal. However, there is a need to treat you with a worm expeller, several of which are available. Please go over to the person who asked you to do those tests for proper guidance about the proper one to use and how to use it.  Best of luck!