NIH for enhanced vaccine coverage, antitoxin availability to combat diphtheria

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M. Waqar Bhatti

Islamabad: Following an unprecedented rise in diphtheria cases and deaths, the National Institute of Health (NIH) on Monday issued a second advisory addressing the alarming resurgence of diphtheria that has claimed dozens of lives across the country so far this year.

“Diphtheria situation is not very good. There are deaths and cases all across Pakistan. Lab positivity is reported as well. But at the moment, we don’t have the actual number of deaths and cases,” an NIH official told The News while commenting on the issuance of the advisory.

The NIH advisory underscores the urgency of immediate preventive and control measures as cases surge across multiple regions, threatening to overwhelm healthcare systems already under strain. With diphtheria’s heightened transmissibility during the cool and dry season, swift intervention is essential to curb its spread, the advisory adds.

Diphtheria, a toxin-driven disease caused by Corynebacterium diphtheriae, primarily affects the respiratory system and can lead to severe respiratory distress and death if untreated. Health authorities have categorized it as a priority reportable disease under Pakistan’s Integrated Disease Surveillance and Response System (IDSRS).

The current outbreak, resulting in a troubling mortality rate particularly among unvaccinated or partially vaccinated children, raises questions about the country’s preparedness and response capabilities. The NIH advisory emphasizes the need for enhanced vaccination coverage, improved surveillance for early detection and response, and proper case management in both public and private healthcare facilities.

Health authorities are focusing on ensuring widespread vaccination, especially in under-immunized and at-risk communities. The advisory outlines targeted interventions, including vaccination campaigns, better surveillance, and rigorous case management, to mitigate transmission.

However, vaccine shortages and lack of public awareness remain significant hurdles. Many affected children have not received the standard three-dose diphtheria-tetanus-pertussis (DTP) vaccine, due to limited outreach, vaccine hesitancy, and inconsistent access to healthcare.

With Karachi particularly hard-hit—where around 100 deaths were reported this year due to diphtheria—health experts warn that urgent improvements in vaccination infrastructure and public health awareness are crucial.

The advisory notes that diphtheria spreads quickly in crowded, unhygienic conditions often found in urban slums, schools, and public gatherings, with transmission occurring via respiratory droplets or contact with open sores and contaminated objects.

The advisory emphasizes that the most effective measure to prevent infection is a robust vaccination program, paired with thorough contact tracing and timely isolation of confirmed cases. Infected individuals are highly contagious, capable of spreading the bacteria for up to four weeks, with chronic carriers remaining infectious for several months.

Symptoms of diphtheria range from mild sore throats to life-threatening complications, often involving the respiratory system. A thick, grayish membrane on the throat, a hallmark of the disease, can block airways and lead to fatal respiratory failure.

Without prompt administration of the diphtheria antitoxin (DAT) and appropriate antibiotic treatment, patients face a significant risk of severe complications, including myocarditis, paralysis, and, in many cases, death. NIH’s advisory instructs healthcare providers to start treatment upon clinical suspicion to avoid fatal delays, with laboratory tests confirming diagnosis and guiding further intervention.

To reduce fatalities, the NIH is urging healthcare facilities to stock sufficient quantities of DAT and recommended antibiotics, such as erythromycin and penicillin, which are essential for both treatment and containment. The antitoxin is particularly critical, neutralizing the circulating toxin before it can invade cells and cause irreversible damage.

Recognizing the importance of preparedness, NIH has highlighted the need for healthcare providers to receive training on early diagnosis, patient isolation protocols, and the management of respiratory complications. Monitoring cardiac activity to detect diphtheria-induced heart complications is also critical.

Preventive measures for contacts of confirmed cases include immediate administration of prophylactic antibiotics and regular surveillance. Close contacts, such as household members and caregivers, are advised to be vigilant, and healthcare personnel interacting with suspected cases are encouraged to use personal protective equipment (PPE) rigorously.

Additionally, the advisory advocates for public health campaigns to educate communities about the symptoms of diphtheria, stressing the importance of seeking prompt medical attention and adhering to recommended vaccination schedules.

Laboratory support for diagnosing diphtheria is being expanded through NIH, enabling the testing of nasopharyngeal and throat swabs, which is crucial for confirming cases and guiding treatment strategies. Vaccination history, however, is a prerequisite for testing to ensure precise diagnosis and management, underscoring the need for maintaining accurate medical records and public health data.

The ongoing diphtheria outbreak in Pakistan, and particularly the tragic loss of over 100 lives in Karachi, demands decisive action. Health authorities are under pressure to strengthen preventive and treatment protocols while intensifying awareness campaigns. Without a concerted national response to increase vaccination coverage and public health education, experts warn that Pakistan risks facing further outbreaks of this entirely preventable disease, threatening the lives of countless children and vulnerable populations.

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