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Nigeria - Human - Diphtheria - Nigeria - Jan 2023 (UPDATE Jan 25)
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Nigeria CDC has recently released a Public Health Advisory following the occurrence of diphtheria cases in the states of Lagos, Kano, Osun and Yobe. The document was not including details on the number of cases however several media were reporting additional information, in particular that Kano is where the outbreak has presumably started and is currently the most affected areas, with more than 70 suspected cases along with 25 related deaths occurred during the last weeks. An RFI has been sent to EpiCore members to collect more details from official sources and be able to assess in real time the risk for the population in relation to this confirmed outbreak. The EpiCore network has been able to provide additional details. KAno was the first state reporting confirmed diphtheria cases with 25 deaths documented and first cases identified in late December 2022. On Jan 21 the Commissioner for Health of Kano has provided more details during an official press conference. The authorities have confirmed that the diphtheria outbreak is currently representing a serious threat to the local population and additional burden to the health system also considering the recent detection of Lassa fever cases. Following this information, the first diphtheria case in Kano was confirmed on Nov 30, 2022 and since then several suspected cases were reported from different health facilities. Following these events, the State Public Health Emergency Operation Center (PHEOC) officially declared the outbreak and implemented a coordinated response. NCDC and other key stakeholders were notified and a National rapid Response Team led by NCDC was deployed in support to the local authorities. A case definition was developed together with case investigation forms and treatment guidelines. Contact tracing and active case search were started immediately in the affected LGAs as well as sensitization of Health Workers and community members. With the increase in cases, the state authorities have decided to set up a Diphtheria treatment center with the support of MSF: since then cases are managed using DAT supplied by NCDC. Kano has recorded so far suspected cases from 13 LGAs and the plan is to conduct a Routine immunization intensification campaign Suspected cases were reported in the following weeks also from other states: as of Jan 24, the Nigeria CDC is reporting a total of 132 cases nationwide, with 41 deaths, from five states: Kano (100 confirmed cases and 32 deaths), Lagos (5 cases and 3 deaths), Yobe (17 cases and 3 deaths) , Osun (1 case) and Katsina ( 9 cases and 3 deaths). The latest NCDC press release includes also recommendations for the general population and more details on response and monitoring activities in place. To be noted that the last relevant diphtheria outbreak in the country before this one has occurred in 2011 (Borno, 98 cases/21 deaths) and was caused by low vaccination coverage, delayed clinical recognition/laboratory confirmation, and absence of antitoxin and antibiotics for treatment. The current situation, as any diphtheria outbreak, reflects an inadequate vaccination coverage in the affected areas. The NCDC director has reported to media that given the sub-optimal coverage for the 3rd dose of diphtheria containing pentavalent vaccine (54%, 2021 Nigeria Immunization Coverage Survey) more cases may be identified and are expected. This RFI has been supported with relevant updates extracted from official sources online, including risk assessment details. This summary may be updated in the coming weeks in case relevant details not available on online sources will be shared by the network.