As diphtheria cases resurfaced in Nigeria, claiming three lives in just two months, the country is once again faced with the daunting task of containing a potentially deadly outbreak.
In 2023, the country witnessed a significant surge in cases, with 8,353 suspected cases reported in 27 states, notably in Kano, Yobe, and Katsina.
According to the World Health Organization (WHO), between January and August 2023, a total of 4717 cases were confirmed, including 169 laboratory-confirmed, 117 epidemiologically linked, and 4431 clinically compatible cases.
The case fatality ratio (CFR) was 6.1 percent, with the highest burden of the outbreak among children aged 1-14 years.
In September 2023, the outbreak resulted in over 11,500 suspected cases with more than 7000 confirmed cases and 453 deaths, which prompted UNICEF to raise alarm for urgent need for widespread vaccines.
This year, there have been reports of pockets of outbreak in the country. In March 2025, several students at Kings College Lagos were hospitalized with suspected diphtheria symptoms which tragically resulted in the death of one junior student.
The Lagos State Commissioner for health, Prof. Abayomi, in late March revealed that the outbreak has been reported in multiple Local Government Areas (LGAs), with Eti-Osa being the most affected, recording 44 suspected cases. According to him, other impacted LGAs include Alimosho, Badagry, Ikorodu, Kosofe, Ojo, Mushin, and Lagos Island, where various numbers of suspected and confirmed cases were identified.
The state within the space of two to three months has recorded ten confirmed cases of diphtheria between January 1 and March 27, 2025.
Similarly, a community leader and director in the Northern Elders Forum, Abdul-Azeez Suleiman, on May 4, raised alarm over the resurgence of diphtheria in Tukur-Tukur Community of Zaria, Kaduna State, citing a recent tragic loss of two children within 48 hours.
According to Suleiman, the affected children exhibited symptoms such as sore throat, fever, swollen lymph nodes, and debilitating weakness.
WHO described Diphtheria as a highly contagious vaccine-preventable disease caused by the bacteria Corynebacterium diphtheriae. It spreads through direct contact or respiratory droplets, affecting all age groups, but unimmunized children are particularly vulnerable.
The symptoms include sore throat, fever, and a thick grey or white patch at the back of the throat, which can block airways and lead to breathing difficulties, and weakness.
Prevention and Control
According to WHO, UNICEF, and NCDC, the best preventive measure for diphtheria is immunization with the Pentavalent or TD vaccine. The Federal Government of Nigeria provides free, safe, and effective vaccines at all Primary Healthcare Centres nationwide.
They further advised that parents should ensure that their children are fully vaccinated against diphtheria with a 3-dose primary vaccination series with diphtheria containing vaccine, followed by the 3 booster doses.
Healthcare workers should maintain a high index of suspicion for diphtheria and practice standard infection prevention and control precautions while handling all patients in their care.
All healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with a high level of exposure to cases of diphtheria should be vaccinated against diphtheria.
Individuals with signs and symptoms suggestive of diphtheria should promptly present to a healthcare facility or designated diphtheria treatment centres.
Close contact with a confirmed case of diphtheria should be closely monitored and managed according to guidelines. Good hygiene practices and promotion of environmental sanitation should be encouraged.
Challenges
The diphtheria outbreak in Nigeria is attributed to low vaccination coverage, with only 57 percent of children receiving the third dose of the pentavalent vaccine. Insecurity in certain regions has also hindered vaccine accessibility, exacerbating the outbreak.
Government and Health Authority Response
According to Ayobami, the Lagos state health authorities, NCDC, WHO, and UNICEF have intensified great efforts to control the outbreak, urging the public to cooperate with the health authorities by maintaining good personal hygiene and availing themselves for vaccines.
The commissioner also emphasised the importance of prompt reporting of symptoms to enable saving of lives and help prevent further transmission of disease. The government has also made the treatment available free of charge at government health facilities.
The WHO has provided technical guidance and support to Nigeria in responding to the outbreak, which include conducting risk assessments to determine the severity of the outbreak and guide response efforts. It has also procured diphtheria antitoxin and other essential supplies to support case management.
Diphtheria antitoxin and antibiotics were also distributed to affected states to treat cases promptly, likewise the launch of community awareness campaigns to educate the public about diphtheria prevention and treatment.
UNICEF has been providing support to the Nigerian government in its efforts to combat the outbreak. A crucial part of this support was the procurement of vaccines to support the government’s response.
In September 2023, the foundation deployed 9.3 million doses of diphtheria vaccines to affected states including Kano, Bauchi, Borno, Yobe, Katsina, Kaduna and Jigawa.
NCDC on their part, provides national diphtheria surveillance and outbreak response guidelines.
