Paediatricians demand scale-up of immunisation to combat diphtheria, others

The Paediatric Association of Nigeria has expressed concern over the resurgence of vaccine-preventable diseases, including diphtheria and cerebrospinal meningitis, within the nation.

The association highlighted that these outbreaks raise serious doubts about the immunisation status of children entering schools, emphasizing that this situation “indicates a failure in the immunisation programme and overall infection prevention and control measures.”

Prof. Ekanem Ekure, the president of PAN, called for a thorough evaluation of the country's immunisation initiatives and urged school administrators to verify the immunisation records and status of students upon their admission.

Recently, a suspected outbreak of cerebrospinal meningitis in Kebbi State resulted in the deaths of 26 individuals.

The Nigeria Centre for Disease Control (NCDC) has classified cerebrospinal meningitis (CSM) as an epidemic-prone illness, with cases reported throughout the year, particularly in the 19 Northern states and certain regions in the south.

CSM is characterized by acute inflammation of the membranes surrounding the brain and spinal cord.

Additionally, last week, there were reports of a diphtheria outbreak at Kings College in Lagos, which resulted in the death of one student and the hospitalization of 14 others at the Lagos University Teaching Hospital.

In response to this situation, the Lagos State Government initiated immunisation efforts for students and staff at the affected school last week.

On Sunday, the NCDC reported that the death toll from diphtheria has reached 1,319, with a total of 25,812 confirmed cases nationwide.

In light of these outbreaks of vaccine-preventable diseases, the PAN president stated, “While the Paediatric Association of Nigeria is still celebrating the success of the recent annual conference in Gombe, where the effective rollout of the Human Papillomavirus Vaccination across all 36 states and the FCT was acknowledged, we are disheartened by media reports regarding the outbreaks of certain vaccine-preventable diseases in the country.”

A diphtheria outbreak was reported in a school in Lagos, coinciding with an outbreak of cerebrospinal meningitis in certain regions of northwest Nigeria.

The Pediatric Association of Nigeria (PAN) recognizes that these incidents highlight the necessity for a thorough evaluation of the national immunization program.

Ekure emphasized that while cerebrospinal meningitis is endemic in the northern regions of the country, with outbreaks typically occurring during the peak of the dry season, Nigeria became the first nation to introduce a new five-in-one vaccine for this disease in April 2024.

She noted that this vaccine, endorsed by the World Health Organization, targets five strains of the bacteria responsible for cerebrospinal meningitis, known as Meningococcus.

The consultant pediatric cardiologist also raised concerns regarding the progress of the meningococcal vaccine distribution in light of the recent outbreak in northern Nigeria.

Additionally, the PAN president inquired about the immunization status of children following the diphtheria outbreak in Lagos.

"The diphtheria situation in Lagos similarly prompts concerns regarding the immunization status of children enrolled in schools.

Children who are either partially vaccinated or whose immune responses to initial vaccinations have diminished can act as reservoirs for potential outbreaks," she stated.

Ekure praised the swift actions taken by the relevant State Governments in response to the outbreaks, noting that both confirmed and suspected cases were hospitalized, close contacts were vaccinated, and public awareness campaigns were initiated.

She mentioned that health workers in Lagos were receiving vaccinations and that ongoing surveillance was in place, with major hospitals on alert for preparedness.

"PAN observes that the current national immunization program only includes primary diphtheria vaccinations within the first fourteen weeks of life, without any official provisions for booster doses at this time."

The World Health Organization (WHO) recommends administering three booster doses of the diphtheria vaccine at ages 12-23 months, four to seven years, and nine to 15 years; however, this protocol has not yet been implemented in the country.

The academic emphasized that sporadic outbreaks of diseases that can be prevented by vaccination indicate shortcomings in the immunization program and overall infection prevention and control measures.

She proposed that children should be educated on fundamental personal hygiene practices, including proper cough etiquette, to help mitigate the transmission of infectious droplets.

The president of PAN highlighted that overcrowding significantly contributes to the spread of diphtheria and cerebrospinal meningitis, urging that residential facilities, school hostels, and dormitories take this factor into account during their design and planning phases.

Furthermore, she stated, “It is essential to revitalize the school health program, particularly in terms of policy review, implementation, and the use of standardized pre-entry medical fitness documentation regarding students' immunization status and their connection to health services.

“This initiative will be crucial in preventing, detecting early, and controlling the spread of infections among school-aged children.

“Governments at all levels are encouraged to develop comprehensive plans for preparedness against disease outbreaks, extending beyond mere disaster and accident readiness.”

Ekure also advocated for the integration of disease outbreak preparedness into the annual budget, emphasizing that it should include targeted public education, clinical and laboratory surveillance for case confirmation, intersectoral collaboration, facilities for quarantine and isolation, contact tracing, post-exposure prophylaxis, and treatment for confirmed cases.

She remarked that such funding would enhance the efficiency and effectiveness of government responses to disease outbreaks.

The government must enhance its investment in vaccine procurement to facilitate the introduction of booster doses. It is scientifically established that the immunity gained by children from primary vaccinations during early infancy diminishes over time, leaving them vulnerable to natural infections in the absence of booster doses.

Implementing booster doses within schools is a compelling option, as schools provide convenient access to a large population of children.

The vaccination schedule should be revised to incorporate booster doses of diphtheria vaccines, in accordance with WHO recommendations. The school health program can serve as an effective mechanism for executing these enhancements, as noted by the pediatrician.

The cardiologist emphasized the importance of parents ensuring their children are fully vaccinated and that any missed doses are administered at the earliest opportunity.

She urged parents to share their children's vaccination history during pre-admission medical screenings to accurately assess infection risks and enable the school management to implement appropriate precautionary measures.

Community engagement is also crucial in combating vaccine hesitancy, which remains a significant barrier to achieving adequate vaccine coverage.

The Pediatric Association of Nigeria (PAN) has consistently led efforts to advocate for children's health in Nigeria through robust advocacy and networking initiatives.

We are currently focused on enhancing the national school health program and are prepared to offer the necessary technical support to mitigate the frequency and impact of outbreaks of vaccine-preventable diseases, stated the PAN president.