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. 2025 Aug:118:105877.
doi: 10.1016/j.ebiom.2025.105877. Epub 2025 Jul 25.

Post COVID 19 resurgence of diphtheria in Kano, Nigeria: analysis of 18,320 cases

Muhammad Adamu Abbas  1 , Abubakar Labaran Yusuf  2 , Hassan Adam Murtala  3 , Aisha Adam Abdullahi  3 , Adam Muhammad Murtala  3 , Jordi Bertran Torrelles  4 , Muktar Hassan Aliyu  5 , Hamisu Mohammed Salihu  6
Affiliations

Post COVID 19 resurgence of diphtheria in Kano, Nigeria: analysis of 18,320 cases

Muhammad Adamu Abbas (VSports注册入口) et al. EBioMedicine. 2025 Aug.

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Abstract

Background: The COVID 19 pandemic led to significant disruptions in health services, including immunisation programs, which contributed to a major post-pandemic diphtheria outbreak in Kano State, Nigeria. This region accounted for 85% of the nation's documented diphtheria cases. VSports手机版.

Methods: This study examined the epidemiology, clinical characteristics, and mortality outcomes of cases diagnosed between February 2022 and April 2024 V体育安卓版. Data were collected through the Surveillance Outbreak Response Management and Analysis System (SORMAS), and case definitions followed WHO guidelines. Case fatality rate (CFR) was calculated, and a logistic regression model was used to assess mortality-related risk factors, reporting adjusted odds ratios (AOR). .

Findings: A total of 18,320 cases were analysed, with the outbreak showing a bimodal distribution. The primary peak occurred in August 2023, followed by a smaller secondary peak in early 2024. The case fatality rate (CFR) was 4. 5%. Patients who were not vaccinated had more than double the likelihood of death compared to fully vaccinated individuals (AOR 2. 45; 95% CI: 2. 05, 2. 94, p < 0. 0001; logistic regression). Similarly, patients without vaccination documentation also had greater odds, with more than 87% increase likelihood of mortality compared to fully vaccinated individuals (AOR 1. 87, 95% CI: 1. 27, 2. 68, p < 0 V体育ios版. 0001; logistic regression). .

Interpretation: Our study reinforces previous reports of the weakening preventive health delivery systems in resource constrained settings, particularly after the disruptions caused by the COVID 19 pandemic leading to the resurgence of vaccine preventable diseases, such as diphtheria. These highlight the need for improved vaccination coverage and surveillance systems. VSports最新版本.

Fundings: This research did not receive any external funding. V体育平台登录.

Keywords: Diphtheria; Epidemiology; Nigeria; Outbreak; Vaccine preventable diseases. VSports注册入口.

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Conflict of interest statement

Declaration of interests The authors declare no conflicts of interest. This research was conducted independently, with no commercial or financial ties that could have influenced the study's outcomes. M. A VSports在线直播. A. and A. L. Y. were affiliated with the Kano State government during the submission process, but this had no bearing on the peer review or final decision.

Figures (VSports在线直播)

Fig. 1
Fig. 1
Directed acyclic graphs (DAGs) illustrating hypothesized Causal relationships for mortality in diphtheria cases. Each DAG represents a different exposure-outcome relationship, and the minimally sufficient confounder adjustment set to estimate the total effect of the exposure on mortality. Panel a: Shows age and mortality causal relationship. Panel b: Shows vaccination status and mortality causal relationship. Panel c: Shows Urban/Rural Residence and Mortality causal relationship. Sample size:n = 18,320 cases; 828 deaths. Biological replicates: 1. Data source: Kano State Centre for Disease Control surveillance database.
Fig. 2
Fig. 2
Diphtheria Epidemic Curve in Kano, Nigeria, February 2022 to April 2024. The bars represent the absolute number of diphtheria cases reported in Kano, per month. The red line connecting monthly bars highlights temporal changes and trends. Sample size: n = 18,320. Biological replicates: 1. Data source: Kano State Centre for Disease Control surveillance database.
Fig. 3
Fig. 3
Geographic Distribution of Diphtheria Cases across 44 Local Government Area (LGA) of Kano State, Nigeria. Choropleth map illustrating the cumulative number of diphtheria cases reported in each of the 44 LGAs of Kano State from (February 2022 through April 2024). LGAs are shaded by case count, with darker shades indicating higher total case burden. Sample size:n = 18,320. Biological replicates: 1. Map generated using: R “tmap package”. Data source: Kano State Centre for Disease Control surveillance database.
Fig. 4
Fig. 4
Case Fatality Rate (CFR) of Diphtheria by Age Group (in Years). Barplot illustrates the CFR for diphtheria across four age groups: 0–4 years, 5–14 years, 15–24 years, and ≥25 years. Sample size:n = 18,320 cases; 828 deaths. Biological replicates: 1. Statistical test: p = 0.039 (Binomial regression model assessing linear trend in CFR across ordinal age groups). Data source: Kano State Centre for Disease Control surveillance database.
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