NIH Issues Urgent Advisory as Diphtheria Cases Surge in Pakistan

Amid an alarming rise in diphtheria cases and fatalities, the National Institute of Health (NIH) has issued a second advisory urging immediate action. This year has seen an unprecedented increase in diphtheria cases across Pakistan, particularly affecting children who are unvaccinated or under-vaccinated. In Karachi alone, over 100 lives have reportedly been lost to the disease, prompting the NIH to push for an immediate scale-up in vaccination efforts, enhanced disease surveillance, and improved case management within healthcare facilities.

Rising Health Crisis and Transmission Concerns

The NIH advisory stresses that diphtheria, a highly contagious disease caused by Corynebacterium diphtheriae, thrives during cool, dry seasons, posing a severe public health risk if not swiftly contained. The disease spreads rapidly in crowded and unhygienic areas—urban slums, schools, and public gatherings—transmitting through respiratory droplets and contact with contaminated objects. Symptoms range from sore throats to life-threatening respiratory distress, including airway obstruction due to a thick membrane formation in the throat.

Health System Challenges: Vaccine Shortages and Public Awareness

Challenges to controlling the outbreak include vaccine shortages, limited public awareness, and vaccine hesitancy, leaving many children without essential immunity. Despite the three-dose diphtheria-tetanus-pertussis (DTP) vaccine being part of the national vaccination program, inconsistent healthcare access has resulted in suboptimal coverage. The advisory highlights the urgent need for public health campaigns to educate communities on diphtheria symptoms and the importance of timely vaccination.

Critical Response Measures

NIH has emphasized the following measures to combat the outbreak effectively:

1. Enhanced Vaccination Coverage: Expanding vaccination outreach and addressing vaccine hesitancy.
2. Early Diagnosis and Case Management: Healthcare providers are instructed to begin treatment upon clinical suspicion, as delays can result in fatal outcomes. DAT (diphtheria antitoxin) and antibiotics such as erythromycin and penicillin are essential for treatment.
3. Isolation and PPE Use: Health workers are advised to use personal protective equipment rigorously, while contacts of infected individuals should undergo prophylactic antibiotic treatment.
4. Strengthened Surveillance and Laboratory Testing: NIH is expanding lab support to facilitate testing of throat and nasopharyngeal swabs, ensuring prompt diagnosis and tailored treatment.

Urgent Call to Action

NIH’s advisory underscores the immediate need for healthcare providers to be well-trained in early diagnosis and patient isolation protocols. Intensive monitoring for cardiac and respiratory complications in patients is crucial, given the disease’s severe health impacts. As Pakistan faces this critical public health challenge, a unified national response is essential to prevent further outbreaks and ensure the health and safety of vulnerable populations across the country.