NIH raises alarm over diphtheria resurgence in country

• NIH issues second advisory for diphtheria spreading across country.
• The government calls for immediate prevention and control measures.
• The NIH advisory highlights the need for enhanced vaccination coverage.

Islamabad: The National Institute of Health (NIH) has sounded the alarm over the alarming rise in diphtheria cases across the country, The News reported on Tuesday.

“The current situation of diphtheria is alarming. There are deaths and cases all over Pakistan. Lab positivity is also being reported. But right now, we don’t have the actual number of deaths and cases,” an NIH official said in the report. the agency issued its second advisory on the spread of the disease a day earlier.

The development comes as the ongoing diphtheria outbreak in Pakistan, and particularly the tragic loss of more than 100 lives in Karachi, calls for decisive action.

Diphtheria, a toxin-induced disease caused by Corynebacterium diphtheriae, primarily affects the respiratory system and can lead to severe respiratory distress and death if left untreated.

Health authorities are under pressure to strengthen prevention and treatment protocols while stepping up awareness campaigns.

Without a coordinated national response to increase vaccination coverage and public health education, experts warn that Pakistan risks further outbreaks of this preventable disease, threatening the lives of countless children and vulnerable populations.

The NIH issued a second advisory, underscoring the urgent need for immediate prevention and control measures as cases increase in many areas, threatening to overwhelm already strained health care systems.

He also adds that with the increased transmissibility of diphtheria during the cool and dry season, rapid intervention is essential to curb its spread.

Authorities have categorized it as a priority reportable disease under Pakistan’s Integrated Disease Surveillance and Response System (IDSRS).

The current outbreak, which has resulted in an alarming 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 public and private health care facilities.

However, vaccine shortages and a lack of public awareness remain major obstacles. Many affected children have not received the standard three-dose diphtheria-tetanus-pertussis (DTP) vaccine, due to limited outreach, vaccination hesitancy, and inconsistent access to health care.

With Karachi particularly hard hit – where around 100 deaths have been reported this year – health experts are warning that urgent improvements in vaccination infrastructure and public health awareness are vital.

The advisory notes that diphtheria spreads rapidly in crowded, unsanitary conditions often found in urban slums, schools and public gatherings, with transmission occurring through respiratory droplets or contact with open wounds and contaminated objects.

Infected individuals are highly contagious, able to spread the bacteria for up to four weeks, with chronic carriers remaining infectious for several months.

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

Without timely administration of diphtheria antitoxin (DAT) and appropriate antibiotic therapy, patients are at significant risk of serious complications, including myocarditis, paralysis, and, in many cases, death.

The NIH advisory instructs health care providers to initiate treatment upon clinical suspicion to avoid fatal delays, with laboratory tests confirming the diagnosis and guiding further intervention.

To reduce deaths, the NIH urges health care facilities to stock adequate amounts of DAT and recommended antibiotics, such as erythromycin and penicillin, which are necessary for both treatment and containment. Antitoxin is especially critical, neutralizing circulating toxin before it can invade cells and cause irreversible damage.

Recognizing the importance of preparedness, the NIH has emphasized the need for health care providers to receive training on early diagnosis, patient isolation protocols, and management of respiratory complications.

Monitoring cardiac activity to detect cardiac complications caused by diphtheria is also critical. Prophylactic measures for contacts of confirmed cases include prompt administration of prophylactic antibiotics and regular follow-up.

Close contacts, such as household members and caregivers, are advised to be vigilant, and healthcare personnel interacting with suspected cases are encouraged to strictly use personal protective equipment.

In addition, the advisory supports public health campaigns to educate communities about the symptoms of diphtheria, emphasizing the importance of seeking medical attention promptly and adhering to recommended vaccination schedules.

Laboratory support for the diagnosis of diphtheria is being expanded through the NIH, enabling the testing of nasopharyngeal and throat swabs, which is critical for confirming cases and guiding treatment strategies.

However, vaccination history is a prerequisite for screening to ensure accurate diagnosis and management, underscoring the need to maintain accurate medical records and public health data.