2. WHAT ARE VACCINE PREVENTABLE DISEASES?
Vaccine-preventable diseases are illnesses
that can be effectively prevented through
vaccination. Vaccines stimulate the immune
system to produce an immune response
without causing the disease itself. This
allows the immune system to "remember"
the disease-causing organism and respond
rapidly if the person is exposed to the
actual disease in the future.Examples of
vaccine preventable diseases
are;measles,poliovirus,diphtheria,tetanus,
anthrax,etc.
4. WHAT IS DIPHTHERIA?
Diphtheria is a serious infection caused by strains of bacteria called
Corynebacterium diphtheriae that makes toxin.
The earliest recorded descriptions of diphtheria-like illnesses date
back to the 5th century BC, when Hippocrates described a disease that
caused a "leathery" covering on the throat.
In the 18th century, diphtheria became a major public health problem
in Europe and North America. Epidemics occurred frequently, and the
disease was often fatal. In the early 19th century, Pierre-Fidèle
Bretonneau introduced the term "diphtheria" to describe the disease.
In 1883, Edwin Klebs and Friedrich Löffler discovered the bacterium
that causes diphtheria, Corynebacterium diphtheriae. In 1890, Emil
von Behring developed the first diphtheria antitoxin, which was a
major breakthrough in the treatment of the disease.
Diphtheria can lead to difficulty breathing, heart rhythm problems,
and even death.The bacteria can spread from person to person, usually
through respiratory droplets, like from coughing or sneezing.
People can also get sick from touching infected open sores or ulcers.
5. SYMPTOMS OF DIPHTHERIA
The symptoms of diphtheria depends on which part of the body is
affected, it affects the the respiratory tract (classical diphtheria)and
skin(cutaneous diphtheria). If a person has been exposed to
diphtheria, he or she will normally develop symptoms between 2
and 5 days after contracting the disease.
When bacteria enters and attach to the nasal lining, one may
witness symptoms like; weakness,sore throat,mild fever and
massive glands in the neck.
In the respiratory tract, bacteria make a toxin that is able to kill
normal tissue. Within two to three days, the dead tissue forms a
thick, gray coating that can build up in the throat or nose. The
medical community refers to this thick, grey coat as
“apseudomembrane”. It's likely to cover the tissues in the nose,
cheeks, tonsils, voice box and throat.
This will make breathing and swallowing very difficult. The toxin
can cause damage to heart, nerves and kidneys if it enters the blood
stream.
6. PREVENTION OF DIPHTHERIA?
1. Vaccination: The most effective way to prevent diphtheria is through vaccination. The
Pentavalent vaccine is often given as part the steps to prevent diphtheria,the vaccine also
protects against tetanus, pertussis (whooping cough), Hepatitis B and Haemophilus influenzae
type b .The vaccine is given to newborns in Nigeria at 6,10 and 14 weeks of birth .High
vaccination coverage not only protects individuals but also contributes to community
immunity(herd immunity), reducing the overall spread of the disease.
2. Good Hygiene: Practicing good hygiene, such as frequent handwashing and avoiding close
contact with infected individuals, can help prevent the spread of the bacteria.
3. Personal Protection:Avoiding close contact with those with those who are sick. If contact
is neccesary there should be use of PPE.
NB- If someone is suspected or diagnosed with diphtheria, immediate medical attention is crucial.Diphtheria is treatable when
detected early as it can cause severe complications if responded to late. The infected person should follow the guidance of
healthcare professionals in the treatment and preventing spread of the disease.
7. EMERGENCE OF DIPHTHERIA IN NIGERIA
The first case of diphtheria in Nigeria was reported in 1907.The disease caused a
major outbreak in the country in 1912, with over 100,000 cases and 20,000 deaths.
The disease caused widespread illness and death, and there were several major
outbreaks in the early 20th century. In the 1940s, Nigeria began to introduce
diphtheria vaccination into its routine immunization schedule. This led to a
significant decline in the number of cases and deaths from diphtheria.
The last most significant outbreak reported in Nigeria was between February and
November 2011 in the rural areas of Borno State, where 98 cases were reported.
8. Diphtheria cases in Nigeria reported to
the World Health Organization
4159
0
312
7253
2724
9479
11551
2144 2144
129
0
2000
4000
6000
8000
10000
12000
14000
2015-2019 2010-2014 2005-2009 2000-2004 1995-1999 1990-1994 1985-1989 1980-1984 1975-1979 1970-1974
Total of 39,895 cases was reported from 1970 to 2019
9. RESURGENCE OF DIPHTHERIA IN NIGERIA
The Nigeria Centre for Disease Control and Prevention (NCDC) was notified of suspected diphtheria
outbreaks in Kano and Lagos States on 1 December 2022. In January 2023, the number of confirmed cases
increased, peaking at over 150 cases in week 4 of 2023 (ending 28 January); since then, a weekly
decreasing trend has been observed.
As of July 2023, 3,850 suspected cases were reported with 1,387 confirmed as diphtheria. The disease has
tragically claimed 122 lives, with a case fatality rate (CFR) of 8.7%. The most recent outbreak began in
December 2022 and has affected 21 states and the Federal Capital Territory.
The Nigeria Centre for Disease Control (NCDC) has said that the outbreak is being driven by low
vaccination coverage. Only about 55% of children in Nigeria are fully vaccinated against diphtheria.
The outbreak has affected mainly Kano, Yobe, Katsina, Lagos, FCT, Sokoto, and Zamfara, which account
for 98.0% of the suspected cases. Most confirmed cases, approximately 71.5%, have occurred among
children aged 2 – 14 years.
10. Distribution of Diphtheria cases by state in Nigeria from Epi week 19,
2022 to Epi week 14, 2023
From 14 May 2022 to 9 April 2023,
1439, suspected diphtheria cases
were reported from 21 states in
Nigeria, with the majority (83%) of
cases reported from Kano (1188),
Yobe (97), Katsina (61), Lagos (25),
Sokoto (14) and Zamfara (13).
Of the 1439 suspected cases, 557
(39%) were confirmed (51
laboratory-confirmed, 504 clinically
compatible and two
epidemiologically linked), 483
(34%) were discarded, and 399
(28%) are pending classification.
Laboratory-confirmed cases were
reported from Kano (45), Lagos (3),
Kaduna (1), Katsina (1), and Osun
(1) states.
11. RESPONSE TO DIPTHERIA OUTBREAK IN NIGERIA
The NCDC being the coordinating agency for disease outbreaks and emergency
response in Nigeria has identified the challenges and gaps to the natiobnal
response of diphtheria.Some of the challenges and gaps includes:
• Difficulty in accessing some communities due to security concerns
• Poor latrines and toilets with good sanitary conditions
• Lack of potable drinking water in some rural areas and urban slums and sheltered
communities
• Inadequate vaccines to cover all LGAs, wards and settlements
• Inadequate health facility and diagnostics centres for management of patients
• Health professionals and front line workers not vaccinated or under vaccinated
• Lack of trained professionals for Diphtheria outbreak, detection, investigation,
and management
• Poor and inconsistent reporting from states.
12. RESPONSE TO DIPTHERIA OUTBREAK IN NIGERIA
The government of Nigeria has taken a number of steps to address the diphtheria outbreak in
the country. These include:
1. Providing free vaccines: The government has made free vaccines available to all
children in Nigeria. This includes the DTP vaccine, which protects against diphtheria,
tetanus, and pertussis.
2. Deploying rapid response teams: The government has deployed rapid response teams to
the affected states to help with surveillance, case management, and vaccination.
3. Raising awareness: The government has been raising awareness about diphtheria
through public education campaigns. These campaigns have focused on the importance of
vaccination and the symptoms of the disease.
4. Working with partners: The government is working with partners, such as the World
Health Organization (WHO) and UNICEF, to address the outbreak. These partners are
providing technical assistance and funding to help the government respond to the outbreak.
13. RESPONSE TO DIPTHERIA OUTBREAK IN NIGERIA
The government's response to the diphtheria outbreak has been praised by international health
organizations. However, there is still more that needs to be done to ensure that all children in
Nigeria are vaccinated against diphtheria.
Some additional things that the government can do to address the diphtheria outbreak in Nigeria
are:
1. Increase funding for vaccination: The government needs to increase funding for vaccination
programs in order to reach all children in Nigeria.According to a recent study by the National
Immunization Coverage Survey 2021, at least 64% of Nigerian children between the ages of 12
and 23 months did not obtain all the required vaccinations in the previous five years. Forty-six
(46) percent of children were reported to have only received a partial immunization between
2016 and 2021, according to the study from the 2021 Multiple Indicator Cluster Survey (MICS)
and National Immunization Coverage Survey (NICS).
Routine immunization services have not reached many communities especially in hard-to-reach
areas. Immunization rate for diphtheria was reported to be lowest in the northeast region of
Nigeria, with only 41.7% of children receiving the vaccine. In the northwest region, the rate was
slightly higher at 42.9%, while the north-central region had the highest rate at 57.2%
16. RESPONSE TO DIPTHERIA OUTBREAK IN NIGERIA
2. Strengthen surveillance: The government needs to strengthen
surveillance systems to better track the spread of diphtheria and identify
outbreaks early. The case definition for diphtheria needs to be improved
to ensure that all cases are being detected. This includes ensuring that
health workers are aware of the symptoms of diphtheria and that they are
able to correctly diagnose the disease.
The government needs to strengthen laboratory capacity to test for
diphtheria and electronic surveillance to track the spread of diphtheria.
17. RESPONSE TO DIPTHERIA OUTBREAK IN NIGERIA
3. Improve access to healthcare: The government needs to improve access to
healthcare in rural areas and hard-to-reach communities. This will make it easier
for people to get vaccinated and receive treatment if they become sick.Establish
specialized treatment centers in areas with high diphtheria prevalence to provide
swift medical attention to affected individuals.
Ensure an adequate supply of diphtheria-specific medications, such as diphtheria
antitoxin, antibiotics, and other necessary medical equipment.
Organize workshops and seminars in communities to raise awareness about
diphtheria, its transmission, prevention, and the importance of seeking medical
help early.
19. WHAT IS ANTHRAX?
Anthrax is a serious infectious disease caused by gram-positive, rod-
shaped bacteria known as Bacillus anthracis. It primarily affects
animals, especially herbivores like cattle, sheep, and goats, but it can
also infect humans. Anthrax is a serious disease that can be life
threatening, particularly if not treated promptly.
The first clinical descriptions of cutaneous anthrax were given by Maret
and Fournier in the 18th Century. The German scientist Robert Koch
was the first to identify Bacillus anthracis as the bacterium that causes
anthrax.
The bacterium produces spores that can survive in the environment for
extended periods of time, making anthrax a concern in both natural
settings and as a potential biological weapon. Most commonly in South
and Central America, sub-Saharan Africa, central and southwestern
Asia, southern and eastern Europe, and the Caribbean. People who get
anthrax usually become infected from contact with infected animals or
with meat or products (such as hides or wool) from infected animals
while traveling in the countries where the disease is more common or
from products imported from those countries. Anthrax is commonly
found in livestock and wild animals, but it can also be found in soil.
20. TYPES AND SYMPTOMS OF ANTHRAX
All types of anthrax are caused by Bacillus anthracis but it can manifest in several different
forms, depending on the route of exposure and the site of infection. The primary types of anthrax
include:
1. Cutaneous Anthrax:This is the most common form of anthrax in humans. It occurs when
spores come into contact with broken skin or mucous membranes. Initial symptoms include a
small, painless sore that turns into a blister and then develops into an ulcer with a black center,
surrounded by significant swelling. There is often fever, headache, and muscle aches.
Cutaneous anthrax is rarely fatal if treated with appropriate antibiotics, such as ciprofloxacin or
doxycycline.
2. Pulmonary Anthrax (Inhalation Anthrax): This is the most serious form of anthrax. It
occurs when spores are inhaled, leading to infection of the respiratory system. Initial symptoms
resemble a common cold, including fever, cough, and muscle aches. As the disease progresses,
severe respiratory distress, shock, and meningitis-like symptoms can occur.
Pulmonary anthrax is often fatal if not treated promptly with aggressive antibiotic therapy, such
as ciprofloxacin and other antibiotics.
21. TYPES AND SYMPTOMS OF ANTHRAX
3. Gastrointestinal Anthrax:This form is acquired by consuming contaminated, undercooked
meat from infected animals. It affects the gastrointestinal tract and can cause symptoms like
nausea, vomiting, abdominal pain, diarrhea, and fever.
Gastrointestinal anthrax can be severe, but the prognosis improves with early diagnosis and
antibiotic treatment.
4. Injection Anthrax: A more recently recognized form, this occurs when drug users inject
heroin contaminated with anthrax spores. Injection anthrax can cause severe soft tissue infection
at the injection site, as well as systemic symptoms such as fever and body aches.
This form of anthrax can be fatal if not treated promptly with appropriate antibiotics.
5. Meningeal Anthrax:This is the rarest form of Anthrax,it occurs when the anthrax bacterium
infects the membranes surrounding the brain and spinal cord. Symptoms include severe headache,
fever, confusion, and neurological symptoms. Meningeal anthrax is usually fatal even with
treatment, as it is difficult to effectively treat infections within the central nervous system.
22. HOW ANTHRAX IS SPREAD
Anthrax is not contagious, which means an infected person can’t pass it on to
others like a cold or flu. However, people can get sick with anthrax if they come
into contact with infected animals or contaminated animal products, and spores get
cuts or scrapes on the person’s skin.
The disease often infects veterinarians, agricultural workers, livestock producers,
or butchers. Eating raw or undercooked meat from an infected animal or drinking
contaminated water can cause the disease. Anthrax can spread through the air,
where the spores are inhaled, which can happen in places like slaughterhouses and
tanneries.
The standard treatment for anthrax is an antibiotic such as ciprofloxacin or
doxycycline. Since some spores can take up to two months to be activated, people
need to take antibiotics for that long to be sure they are protected.
Anthrax bacteria can be killed by cooking meat to an internal temperature of 160
degrees Fahrenheit(71.1 degreeCelsius).
23. PREVENTION OF ANTHRAX
Preventing anthrax involves a combination of strategies to reduce the risk of exposure to the
Bacillus anthracis bacteria. The specific preventive measures can vary depending on the setting
and potential sources of exposure. Here are some key steps for preventing anthrax:
1.Vaccination: Anthrax vaccine adsorbed (AVA) are available for individuals at high risk of
exposure, such as military personnel, laboratory workers, and certain animal handlers. The anthrax
vaccine is typically administered as a series of doses followed by booster shots to maintain
immunity. However, this vaccine is not typically available for the general public. It is only
recommended for people who are at an increased risk of coming into contact with or have already
been exposed to B. anthracis.
2.Animal Handling and Agriculture: Farmers, veterinarians, and others who work with animals
should follow appropriate safety practices to minimize exposure to anthrax spores. Carcasses of
animals that have died suddenly and unexpectedly should be handled with caution and reported to
authorities for further investigation.
3.Avoiding Contaminated Products:A void contact with potentially contaminated animal
products, such as hides, hair, and wool from animals that may have died from unknown causes.
When consuming animal products, ensure they are properly cooked and come from reliable
sources.
24. PREVENTION OF ANTHRAX
4. Occupational Safety: Individuals who work in industries where exposure to anthrax spores is
possible should use personal protective equipment (PPE) such as gloves, masks, and appropriate
clothing. It is also necessary to implement proper hygiene practices, such as handwashing, to
prevent the transfer of spores to the mouth, nose, or eyes.
5.Public Health Education: Public health authorities should provide information about anthrax,
its transmission, and preventive measures to communities at risk of exposure.
6.Active Surveillance: Governments and health organizations should monitor and report
outbreaks of anthrax to facilitate timely responses. Surveillance systems can help detect and
manage cases of anthrax in both humans and animals.
7. Emergency Preparedness: Establish emergency response plans in case of an outbreak,
especially in areas where anthrax is endemic. These plans should include strategies for early
detection, isolation, treatment, and communication.
25. EMERGENCE OF ANTHRAX IN NIGERIA
In Nigeria, anthrax is not a common disease. However, there have been a few
outbreaks of anthrax in recent years. In 2018, there was an outbreak of anthrax in
the state of Zamfara. The outbreak was caused by the consumption of contaminated
meat. In 2019, there was one case of inhalation anthrax in Borno State. In 2020,
there was another outbreak of anthrax in the state of Katsina. The outbreak was
caused by contact with infected animals. In 2022, there have been several cases of
cutaneous anthrax reported in Plateau State.
26. The Federal Ministry of Agriculture and Rural Development (FMARD) has
confirmed one case of Anthrax disease in a mixed livestock farm in Niger State.
This is the first animal case to be reported in Nigeria since the beginning of the
West Africa outbreak in Ghana in June 2023. On 13th July 2023, the sudden deaths
of livestock in this farm with eight (8) mortality was reported. In addition, the
animals who died were observed to have been bleeding from external orifices
without blood clotting.
Following this report, samples were collected on 14th July 2023 from multiple
species in this livestock farm and transported to the National Veterinary Research
Institute (NVRI), VOM, Plateau State for testing and the results were positive for
anthrax.
RESURGENCE OF DIPHTHERIA IN NIGERIA
27. RESPONSE TO ANTHRAX OUTBREAK IN NIGERIA
The Nigerian government has taken a number of steps to address the emergence of anthrax in the
country, including:
1. Surveillance and Detection: Nigerian government agencies, such as the Nigerian Centre
for Disease Control (NCDC), Ministry of Agriculture, and Ministry of Health, conduct
surveillance to detect and monitor anthrax outbreaks in both animals and humans.
Surveillance includes tracking cases, collecting samples, and analyzing data to identify the
extent and location of outbreaks.
2. Vaccinating livestock against anthrax: The government has been vaccinating livestock
against anthrax since 2019. This has helped to reduce the number of animals that are infected
with anthrax, and it has also helped to reduce the risk of human exposure to the disease.
3.Educating farmers about anthrax prevention and control: The government has been
educating farmers about anthrax prevention and control. This includes teaching farmers about the
symptoms of anthrax, how to prevent the disease from spreading, and how to treat animals that
are infected with anthrax.
28. 4. Monitoring for anthrax cases: The government is monitoring for anthrax cases
in order to identify and respond to outbreaks quickly. This includes conducting
surveillance of livestock and humans, and it also includes setting up early warning
systems.
5. Improving animal husbandry practices: The government is working to
improve animal husbandry practices in order to reduce the risk of anthrax
transmission. This includes teaching farmers about proper grazing practices, and it
also includes providing farmers with access to clean water and good sanitation
facilities.
RESPONSE TO ANTHRAX OUTBREAK IN NIGERIA
29. In conclusion, the resurgence of vaccine-preventable diseases like diphtheria and
anthrax in Nigeria serves as a reminder of the importance of comprehensive
immunization programs, robust surveillance systems, and effective communication
strategies. Sustained efforts are needed to ensure that vaccination coverage remains
high, that health professionals are well-equipped to diagnose and manage cases,
and that communities are informed about preventive measures. By addressing the
challenges contributing to the resurgence and implementing multifaceted
interventions, Nigeria can work towards reducing the burden of these preventable
diseases and protecting the health of its population.
CONCLUSION
