Diphtheria: Academy links low immunity to rising cases

The Academy of Medical Sciences has raised concern over the spread of diphtheria in the country, saying eight states account for 98 per cent of more than 10,000 confirmed cases recorded in 2026.

The Academy attributed the outbreak risk to pockets of low immunity, overcrowded settings, limited ventilation and other factors, warning that the disease could spread nationally without coordinated prevention measures.

According to the Academy, the vast majority of patients are unvaccinated, with children aged one to 14 years bearing the heaviest burden of the disease.

The Academy stated this in an advisory alert dated September 17 and issued to the Federal and state governments, ministries of health, health institutions and the general public.

The advisory, obtained by Sunday PUNCH, was signed by the Academy’s President, Prof. Osato Giwa-Osagie, and Chairman of its Rapid Response Committee, Prof. Obinna Onwujekwe.

The statement read partly, “Geographically, the outbreak is highly concentrated, with just eight states: Kano, Kaduna, Katsina, Borno, Bauchi, Plateau, Sokoto, and Zamfara, accounting for 98 per cent of all confirmed cases.

“Burden on healthcare systems may increase: Late presentation and outbreaks can raise demand for isolation spaces, oxygen/critical care, and antitoxin.

“Secondary outbreaks may emerge in immunization gaps: States with lower DPT/DT/TT coverage or recent disruption to routine services face elevated risk.

“Clinical severity can rise when care is delayed: Severe disease can progress rapidly, particularly where antitoxin and appropriate antibiotics are not started early.”

The Academy warned that the outbreak could result in public confidence and misinformation risks, saying rumours about cures or vaccine safety could lead to delayed care and reduced vaccine uptake.

It also warned that household and community transmission was likely, with crowded settings, limited ventilation and close contact facilitating the spread.

The Academy noted that a national spread was plausible due to human mobility without coordinated prevention measures.

It warned that the burden on healthcare systems could increase due to late presentation and outbreaks, which could raise demand for isolation spaces, oxygen and critical care, as well as diphtheria antitoxin.

Among the measures recommended by the Academy to control the spread of the disease are supporting infection prevention and control resources, providing transport for referrals and conducting community-based contact tracing.

It also called for the availability of personal protective equipment for health workers in outbreak areas and urged authorities to ensure that public advisories were adapted to local languages and literacy levels.

The experts warned authorities and Nigerians against complacency in unaffected states, urging them to maintain readiness for early detection and referral even where cases had not yet been reported.

They also called for coordinated interstate and national communication, with clear channels established for reporting suspected cases and sharing guidance with state ministries of health and partners.

The Academy urged the government and ministries of health to accelerate the immunisation response by conducting targeted outbreak response immunisation in affected states and high-risk neighbouring areas.

It advised authorities to prioritise children and under-immunised groups, address missed opportunities in routine DPT-containing vaccination schedules, and use community engagement to improve vaccine uptake and counter misinformation.

The Academy further advised affected states to conduct rapid community mapping of vaccination status and barriers to access.

It urged authorities to mobilise community influencers to support vaccine uptake and promote appropriate health-seeking behaviour, while monitoring trends among under-immunised populations to guide vaccination targeting.

The medical experts also advised states to target high-risk settings, including schools, boarding facilities, faith communities, camps and densely populated communities where contact rates are high.