Health Alert: An Almost-Forgotten Disease Makes Resurgence In West Africa

In recent months, countries across West Africa have been battling the worst wave of diphtheria on record on the continent.

The first cases were diagnosed in August 2022 in Niger, before the disease spread to Algeria, Mauritania, Nigeria and Guinea.

The first patient in Guinea was diagnosed in July 2023 in Siguiri, a prefecture in the northeast of the country. Since then, cases of the life-threatening disease have continued to rise.

“My daughter was not feeling well – she had sores in her throat, she was struggling to eat and drink, and all she did was cry,” said Saran Keita, cradling her five-year-old daughter in her arms and handing her an orange to comfort her.

“It was then that someone took us to the Centre for the Treatment of Epidemics in Siguiri.” On their arrival at the treatment centre, which is supported by Médecins Sans Frontières/Doctors Without Borders (MSF), her daughter was examined before being given a diphtheria antitoxin.

With diphtheria cases on the rise, a major response is underway in Siguiri.

MSF mounted a major response in Siguiri in mid-August 2023. As of 4 January 2024, the treatment centre’s team – made up of 64 MSF staff and 184 Ministry of Health staff – have treated 2,122 people for diphtheria, most of them young children, but also teenagers and adults. 18% of patients were children under five; 43% were aged five to 15; 29% were aged 15 to 29; and 10% were over 30.

In the waiting room, patients and caregivers listen to MSF health promoters explain in Malinké, the local language, how to recognise the symptoms of diphtheria and how the disease spreads.

“Diphtheria is a bacterial infection that attacks the respiratory tract,” says MSF medical coordinator Dr Adélard Shyaka.

“It is transmitted by airborne droplets and can be fatal, especially for small children. It can also release a toxin that can affect the body’s organs, including the heart and kidneys. Among other things, the toxin kills the cells in the heart, nerves and airways. A pseudomembrane can also form due to the toxin.”

The pseudomembrane is a thick, gray coating, so-called because it is not naturally produced by the body. If an antitoxin is not administered quickly, the fast-growing pseudomembrane can soon block an infected person’s airways, leaving them struggling to breathe.

The incubation period for diphtheria is two to 10 days. “It often starts on the second day after exposure with a moderate fever, followed by inflammation of the pharynx or larynx, and difficulty eating and breathing,” says Dr Shyaka. “The pseudomembrane usually appears on the third or fourth day.”

Before the current outbreak, diphtheria had largely disappeared worldwide. Guinea had had no diphtheria cases in more than 30 years. As a result, most local health workers had never come across the disease until recently, while the antitoxin to treat it is not widely available.

“We lack health professionals who know how to recognise and treat this disease,” says MSF deputy medical coordinator Dr Charles Tolno. “The treatment is complex and requires a lot of resources, especially in terms of the antitoxin’s availability. Given its scarcity, we have no choice but to be selective in giving it to patients with the most severe symptoms.”

With only 50 beds at the treatment centre, patients with mild symptoms are sent home with antibiotics to treat the disease and reduce the risk of spreading it to others. They also receive strict instructions on how to reduce the risk of transmission. After three and seven days, patients return to the centre for a check-up.

Patients with more severe symptoms are admitted to the centre for treatment, where they stay for up to five days. If they need to receive the antitoxin, they must also undergo a battery of tests including blood oxygen, glucose, and temperature, beforehand. For instance, the antitoxin cannot be administered if the patient had a fever that would need to be lowered.