Nigeria’s worsening diphtheria outbreak is exposing a dangerous chain of failures in prevention, diagnosis and treatment, while health experts warn that missed vaccinations, delayed hospital visits and inadequate access to diphtheria antitoxin are turning a preventable disease into a deadly emergency.
The warning comes as the outbreak spreads across northern communities, with Katsina recording about 1,000 suspected cases since January and 30 of the state’s 34 local government areas affected.
Eight states, Kano, Kaduna, Katsina, Borno, Bauchi, Plateau, Sokoto and Zamfara, account for 98 per cent of Nigeria’s confirmed diphtheria cases, according to data cited by the Nigeria Centre for Disease Control and Prevention (NCDC).
Medical Laboratory Scientist and Early Career Researcher with the Royal Society of Tropical Medicine and Hygiene, Abdulrahman Abdulbasit Opeyemi, described the rising fatality rate in Katsina as “very serious”, saying a rate approaching 5.6 per cent points to a sustained regional emergency rather than isolated outbreaks.
“Diphtheria is preventable and treatable, so any rise in deaths points to system-level failure, not an unavoidable disease trajectory,” Opeyemi said in an interview with New Daily Prime.
His assessment exposes the central contradiction in Nigeria’s outbreak: the disease can be prevented through vaccination and treated when detected promptly, yet patients are still reaching health facilities after dangerous complications have developed.
When a sore throat becomes deadly
The early stage of diphtheria can be deceptively ordinary.
Kwara State Diphtheria Laboratory Diagnosis Lead and Chief Medical Laboratory Scientist with the University of Ilorin Teaching Hospital, Hamzat Ademola Ibraheem, told New Daily Prime that sore throat and difficulty swallowing should receive careful medical assessment rather than being dismissed as routine childhood illnesses.
He specifically identified a greyish pseudomembrane in the throat as a classical warning sign.
“Also, all sore throat should be carefully checked for greyish pseudomembrane which is a classical symptom of Diphtheria,” Hamzat said.
The danger intensifies when treatment is postponed.
According to Hamzat, as the infection progresses, the pseudomembrane can obstruct the airway and cause breathing difficulties. At the same time, the bacterial toxin can spread beyond the initial site of infection.
“The toxin production would have been in large scale and diffuses to both local and distant organs causing multiple organ damage and subsequently death,” he said.
Opeyemi similarly linked advanced cases to delayed recognition. He noted that families can mistake sore throat, mild fever and neck swelling for more familiar ailments.
By the time breathing difficulty or the characteristic membrane develops, he said, antitoxin treatment can become far less effective.
The distinction is critical because diphtheria antitoxin neutralises circulating toxin, but it cannot reverse toxin that has already attached to tissues. This makes early recognition and treatment central to survival.
Vaccination gap at the centre
Both experts placed immunisation at the heart of the crisis.
NCDC data cited in late August outbreak reporting show that about 68 per cent of confirmed cases were among unvaccinated people. The concentration of cases among children also makes routine childhood immunisation particularly important.
Opeyemi described the vaccination gap as the “central driver” of the outbreak.
His own research in Ilorin metropolis found that only 31.8 per cent of children assessed were vaccinated, while just 32.5 per cent of caregivers demonstrated correct knowledge of diphtheria vaccination before a targeted health education intervention.
The results changed sharply after the intervention. Reported vaccination uptake rose to 89.5 per cent, while correct knowledge reached 100 per cent.
In Opeyemi’s viewpoint, the finding demonstrates that the problem is not necessarily an unwillingness to vaccinate but a failure to consistently place accurate information and services within communities.
Hamzat also stressed that partial immunisation should not be treated as equivalent to full protection.
He said the diphtheria vaccine requires five childhood doses, followed by booster doses during adolescence and adulthood.
“Most important risk factor has always been lack of vaccination or incomplete vaccination routine,” he said, adding that protection can decline over time and boosters are therefore important.
Where the response is falling short
The experts identified several weaknesses that are allowing preventable infections to become fatal.
Opeyemi pointed to weak community-level risk communication, reactive vaccination campaigns, strained health facilities, inconsistent surveillance and gaps in routine immunisation.
He said outbreak campaigns launched after infections have surged cannot replace consistent, year-round vaccination services in underserved communities.
Hamzat identified four immediate clinical gaps: incorrect or delayed diagnosis, incomplete vaccination, late presentation, inadequate availability of antitoxin and insufficient isolation capacity.
The Federal Government has begun addressing some of these problems. On August 28, it activated an emergency task force involving federal agencies, affected states, WHO and UNICEF. The government also announced the deployment of 500,000 vaccine doses to Katsina and Kano, plans for treatment annexes across Katsina’s three senatorial districts and emergency support, including diphtheria antitoxin, antibiotics and additional clinical personnel.
But the experts’ warnings suggest that emergency interventions alone will not close the gaps that allowed the outbreak to spread.
Taking the response into communities
Opeyemi recommended sustained health education in markets, motor parks, schools and religious centres, where large numbers of people interact daily.
He also called for greater involvement of local media and community leaders in countering misinformation and encouraging vaccination.
Reactive immunisation campaigns should prioritise children aged one to 14, whom he identified as the most affected group, while DPT awareness should become part of routine school health programmes.
Hamzat called for a strong referral network so that suspected patients can reach appropriate facilities without lengthy delays.
To parents, he advised vigilance around symptoms and prompt reporting of children who become unwell. He also recommended that schools refer pupils with symptoms such as coughing and sneezing for medical assessment and that families avoid crowded environments during periods of heightened transmission.
Healthcare workers, he said, must conduct careful clinical evaluations and use laboratory testing where appropriate to avoid missed cases.
The Federal Government’s response already recognises the importance of bringing treatment closer to affected communities. Its August intervention included plans for treatment annexes in Katsina and emergency supplies of diphtheria antitoxin at the state’s principal referral centre.
The central lesson from the outbreak is stark: vaccination can prevent the disease from taking hold, early diagnosis can stop progression, and timely antitoxin can limit the damage caused by the bacterial toxin.
But when those three safeguards fail at the same time, a child who begins with what appears to be an ordinary sore throat can quickly become critically ill.
For Opeyemi, that is why the current situation demands more than a response whenever case numbers rise. Nigeria needs sustained immunisation, accurate community information, reliable surveillance and treatment capacity that reaches patients before the disease crosses the point where intervention becomes increasingly difficult.
The outbreak may be spreading through communities, but the experts’ message is that many of the conditions enabling its deadliest outcomes are preventable.
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