It had been over 30 years since the last case of diphtheria was seen in Guinea. So when patients began showing up six months ago with what looked like flu symptoms — fever, cough and sore throat – doctors weren’t alarmed. Until the children started dying.
That’s when they realized that this longtime scourge, long quashed by vaccination, was back.
As of December 2023, there have been around 25,000 cases of diphtheria in West Africa and 800 deaths. In Guinea, the cases were clustered in Siguiri, a rural prefecture in the country’s northeast, and early data showed that 90% occurred in children under the age of 5.
What diphtheria does — and why it’s showing up
Diphtheria is a highly contagious bacterial infection spread through direct contact with infected sores or ulcers but primarily through breathing in respiratory droplets. The bacteria then releases toxins, causing inflammation that blocks the airways; a thick mucus-like substance (called a “pseudomembrane”) can form at the back of the throat.
“This can kill by suffocating the patient,” says Adélard Shyaka, medical coordinator for Doctors Without Borders in Guinea. “But also the toxin moves through the body and can damage the heart, the kidneys, the nervous system.” Such damage — via suffocation, myocarditis, kidney failure and nerve malfunctioning — means diphtheria is fatal in up to 50% of cases without treatment.
The disease, which was a global scourge for much of the 20th century, is also almost entirely preventable through vaccination. After the diphtheria inoculation was included on the World Health Organization’s essential vaccine list in the 1970s, cases decreased dramatically worldwide. “Now, it’s an almost forgotten disease,” says Shyaka.
But that doesn’t mean this outbreak is surprising, according to Ankur Mutreja, a global health specialist with the Cambridge Institute of Therapeutic Immunology and Infectious Disease. “Diphtheria is and has always been a disease of poverty,” he emphasizes, with social unrest and poor vaccination coverage explaining most outbreaks nowadays. “It’s not just the West Africa outbreak but numerous other [recent] outbreaks — after the earthquake in Haiti, after war in Syria, in Bangladesh when the Rohingyas were displaced in 2017,” Mutreja says.