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Diphtheria in Sudan

Federal Ministry of Health (FMOH) Sudan reported an outbreak of diphtheria, starting from epidemiologic week 33. Till the reporting date (week 49), a total of 63 suspected diphtheria cases with 11 associated deaths (CFR 17.46%) are reported from six states (See graph). Out of these, 57 cases with 9 deaths are reported from Al-Sunta locality of South Darfur state alone. 83% of the total (52) were not vaccinated against Diphtheria. One out of six samples collected was laboratory confirmed through PCR on November 28, 2019 .

Editorial note

Diphtheria is a highly contagious bacterial disease that primarily infects the throat and upper airways, and produces a toxin affecting other organs. The disease has an acute onset and can result in low grade fever, difficulty in breathing, swollen glands in the neck and the toxin, in severe cases, may cause heart failure, paralysis, and even death. Transmission occurs from person to person through close respiratory and physical fluid contact. Diphtheria is fatal in 5-10% of the cases, with a high mortality rate in young children. Vaccinations are available and recommended for its prevention.

Sudan has a very high immunization coverage for DPT3 93% - 2018 (See table ) and it has never reported such number of diphtheria cases in the past. But the reporting of cluster cases from Al-Sunta locality South Darfur (56 cases with 09 associated deaths) is an alarming sign as most of the cases from the locality were un-vaccinated, whereas the national average for DPT3 coverage is significantly high from last five years (>92%).

Majority of the cases (97%) aged from <1 to 44 years of age and 77% cases were less than 15 years old and all deaths occurred in this age group. Most of the cases presented with low grade fever, difficulty in swallowing, neck swelling, lymph node enlargement and typical greyish membrane.