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Diphtheria is a major public health problem in the WHO African Region despite substantial efforts on immunization activities over the past three decades.
Between 2000 and 2024, 75 789 suspected diphtheria cases were reported in the Region, with the majority reported from 2023 to 2024, when Algeria, Chad, Gabon, Guinea, Mali, Mauritania, Nigeria, Niger, and South Africa reported a resurgence of diphtheria outbreaks with approximately 57 000 suspected cases and 2 000 deaths (case fatality ratio (CFR) of 3.5%) recorded.
The countries most affected were Guinea, Nigeria and Niger.
Most cases reported were in children under fifteen years and female.
Over 50% of suspected cases were non-vaccinated or with unknown vaccination status.
In 2025, as of 19 October 2025, over 17 000 suspected diphtheria cases and about 900 deaths with an average CFR of 5.1% have been reported across eight Member States in the African Region; Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa.
Of these suspected cases, 7 886 were confirmed through laboratory testing, epidemiological linkage, or clinical compatibility.
Laboratory-confirmation has been conducted in 6.8% (n=1181) of the suspected cases.
Women, children aged between 5 and 18 years and young adults less than 30 are the most affected groups.
The situation seems to have worsened in Mali, Mauritania and Niger in recent weeks with increasing trends and geographic expansion of the outbreaks reported in these countries.
In addition, high CFRs (up to 24%) have been reported across all affected countries.
The overall public health risk posed by the diphtheria event in the African Region is classified as ‘’high’’ due to:
-- Significant risks of further widescale spread:
- The humanitarian profile of some of the affected countries (Chad, Mali, Niger, Nigeria): fragile, conflict-affected and vulnerable settings, with low vaccination coverage often recorded among displaced populations.
- Outbreak hotspots are sometimes located in hard-to-reach areas with security constraints.
- Crowded, unsanitary living conditions in displacement camps in humanitarian settings.
- Low routine immunization coverage in most affected countries and important heterogeneity in coverage at subnational level in a number of countries - with pockets of under-vaccination leading to outbreaks (e.g. Nigeria, Chad etc.).
- Disruptions caused by the COVID-19 pandemic, causing significant drop of vaccination coverage between the first and the third dose across all affected countries. Although in response to declining immunization coverage, global partners launched The Big Catch-up, a coordinated effort to restore and strengthen immunization services and close immunity gaps, especially for vaccine-preventable diseases such as diphtheria.
- Weak health system capacity in most affected countries (shortage of health professionals, low clinical management capacity, etc.).
- Shortage of laboratory supplies reported by most affected countries, leading to delays in case reporting and laboratory confirmation.
- Global shortage of diphtheria anti-toxin (DAT) necessary for the treatment of affected persons.
- High case fatality ratio observed in many of the affected countries.
- High internal and cross-border movements of susceptible individuals (unvaccinated or not fully vaccinated).
- Insufficient resources to control the outbreaks across most affected countries.
The overall public health risk posed by the diphtheria event at the global level is classified as ‘’low’’ due to:
-- The global risk of diphtheria outbreaks from the ongoing multi-country diphtheria outbreak in the African Region is assessed as low, given the existence of routine immunization programs in most countries.
- Nonetheless, the risk posed by international travel of susceptible populations from the African Region cannot be overlooked, highlighting the need to strengthen risk communication and surveillance globally.
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Source:
Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---diphtheria--african-region-v.1
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