Diphtheria – Guinea

18 October 2023

Situation at a Glance

On 5 September 2023, the Ministry of Health notified WHO of a diphtheria outbreak in Guinea. From 4 July to 13 October 2023, a total of 538 cases of diphtheria, were reported in the Kankan region, in the east-central part of Guinea. Of the total cases reported, 520 are suspected and 18 confirmed with 58 deaths including 13 among confirmed cases (case fatality rate (CFR) among all cases, 11%). The 1-4 years age group accounted for the largest proportion of reported cases. Diphtheria is a highly contagious vaccine-preventable disease caused mainly by the bacteria Corynebacterium diphtheriae which can be fatal in 5-10% of cases, with a higher mortality rate in young children. However, in settings with poor access to diphtheria antitoxin, the CFR can be as high as 40%. Diphtheria remains a significant health problem in countries with poor routine vaccination coverage. According to WHO/UNICEF estimates of national immunization coverage (WUENIC), the immunization coverage with the diphtheria tetanus toxoid and pertussis (DTP3) containing vaccine was reported to be 47% for 2022 in Guinea and has remained below 50% since 2014. This is insufficient for achieving the coverage of 80–85% required to maintain community protection. WHO assesses the risk of diphtheria to be high in Guinea, considering the chronically low vaccination coverage.

Description of the Situation

On 5 September 2023, the Ministry of Health notified WHO of the current diphtheria outbreak in Guinea. On 4 July 2023, two children aged 2 and 4 years, attended the otolaryngology department of the Siguiri prefectural hospital in the Kankan region of Guinea, for similar symptoms (dyspnea, dysphasia, fever, cough). They were hospitalized for tonsillitis and respiratory infection and received antibiotic treatment before being referred to the Kankan regional hospital for additional care.

Since 4 July and as of 13 October 2023, 538 cases have been reported, including 18 confirmed cases. In total, 58 deaths including 13 among confirmed cases were registered (case fatality rate (CFR) among all cases, 11%)., and 461 contacts are being followed up. Of the cases reported, 62% are female. The 1-4 years age group, with 445 cases, accounted for the largest proportion of reported cases, 82%, followed by the 5-9 years age group, with 5% and 5% for the 10 years and above age group. Children under the age of 12 months make up 7% of reported cases. None of the 538 cases were vaccinated.

Kankan Region is divided into five prefectures and only the Kérouané prefecture has not reported any cases to date.

The prefecture of Siguiri is the most affected, with 510 cases (95%). Of the 363 patients admitted to the treatment centers in Siguiri, 37 (10%) have died.

Other prefectures reporting cases are Mandiana (13 cases), Kankan (13 cases) and Kouroussa (two cases).  Of the 15 patients admitted in the treatment center in Kankan, 12 (80%) have died.

The treatment centers in the country do not have the capacity in terms of human resources and material for adequate case management. Suspected and confirmed cases were treated with Amoxicillin and Azithromycin as first line therapy. Antibiotic prophylaxis (Amoxicillin, Azithromycin) was administered to the direct contacts.

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