Choking Missed Children with Grey Matter: How the Zero-Dose Burden is Fueling the Diphtheria Outbreak in Nigeria

Nigeria is currently experiencing a surge in diphtheria cases, with over 11,500 suspected cases reported between December 2022 and September 2023. Among these, more than 7,200 cases have been confirmed, resulting in over 450 deaths. This alarming situation raises questions about the factors contributing to the outbreak and its connection to zero-dose children. To investigate this connection, it is essential to understand the most affected areas and their potential links to regions with a high burden of zero-dose children.

Which areas in Nigeria are most affected by the Diphtheria Outbreak?

The outbreak has affected numerous communities, spreading across 105 out of Nigeria's 774 Local Government Areas (LGAs). However, certain states have borne the brunt of this epidemic. Kano State leads with 6,185 confirmed cases, followed by Yobe (640 cases), Katsina (213 cases), Borno (95 cases), Kaduna (16 cases), Jigawa (14 cases), and Bauchi (8 cases). Notably, Kano, Katsina, Kaduna, and Jigawa States are in the North West geopolitical zone, while Borno, Yobe, and Bauchi States fall within the North East geopolitical zone.

Is there a connection to zero-dose children?

Diphtheria outbreaks are more common in communities with a high number of unvaccinated children. Therefore, it is not coincidental that the North West and North East geopolitical zones, known for their highest burden of zero-dose children in Nigeria, are experiencing the brunt of the diphtheria outbreak. This aligns with the Nigerian Health Ministry's revelation that 80% of confirmed diphtheria cases in this ongoing outbreak are among unvaccinated children, often referred to as zero-dose children (ZDC). Kano State, with the largest number of confirmed diphtheria cases, has over 300,000 zero-dose children, representing nearly 40% of the total unimmunized children in Nigeria. Katsina State, also deeply affected, has eight LGAs designated as zero-dose areas. These two states and eight LGAs are among the 18 states and 100 LGAs identified by the government of Nigeria and partners as high-priority areas with a zero-dose burden, home to a staggering 1.5 million of Nigeria's 2.2 million zero-dose children. This underscores the urgency of addressing the issue of unvaccinated children, not only in these areas but throughout Nigeria, wherever a child is missing out on life-saving vaccines.

How is diphtheria choking these missed children?

Diphtheria is a deadly bacterial infection primarily affecting the respiratory system and skin. In respiratory diphtheria, symptoms include the formation of a grey membrane in the throat and tonsils, a sore throat, hoarseness, and swollen neck glands. These symptoms lead to breathing difficulties. Diphtheria spreads through airborne droplets released when an infected person coughs or sneezes. Additionally, contaminated items such as tissues and towels can carry the bacteria. Some infected individuals are asymptomatic but can unknowingly transmit the disease. Unvaccinated children and adults living in crowded and unsanitary conditions face a higher risk of diphtheria transmission. This underscores the critical role of vaccination and social factors in preventing diphtheria and protecting against its devastating effects.

What is the way forward?

The diphtheria outbreak in Nigeria serves as a stark reminder of the urgent need to address the burden of zero-dose children. While the outbreak is a grave concern, it also presents an opportunity for decisive action. The targeted immunization intensification campaign in Nigeria to identify and vaccinate zero-dose children is a positive step that must continue. Efforts should focus on strengthening both the supply and demand sides of the immunization program to increase coverage. Active community involvement in vaccination campaigns, along with the influence of key figures, will build trust and promote immunization. The government must increase investment in healthcare infrastructure and services to ensure the availability and accessibility of vaccination and other health services. Raising awareness about the importance and safety of vaccination while dispelling myths and misconceptions is crucial.

In conclusion, the diphtheria outbreak in Nigeria underscores the pressing issue of zero-dose children that cannot be ignored. Addressing the root causes of unvaccinated children can not only contain this outbreak and prevent future ones but also secure a healthier and brighter future for Nigeria's children. It is time to act decisively and prevent more lives from being choked by this preventable disease.