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Taking steps to prevent a diphtheria outbreak in Yemen

May 18, 2018 —

In Yemen, a brutal civil war has caused a devastating humanitarian crisis. The conflict, which began in 2015, is crushing the country’s health care system and opening the door to infectious disease outbreaks. Yemen is already experiencing the world's largest cholera outbreak in recent history. Now, an anticipated diphtheria outbreak is posing an increasingly greater threat.

health officials discussionDiphtheria is a bacterial infection that produces a thick pseudo-membrane that covers the back of the throat and a toxin that affects other organs. The disease can lead to breathing difficulties, heart failure, paralysis and in the worst cases, death. Even with treatment, diphtheria can be deadly, and children are especially vulnerable.

Diphtheria can be treated with a strict regimen of diphtheria antitoxin and antibiotics. Vaccination has dramatically reduced the mortality and morbidity of the disease. Although the disease is generally rare, poor vaccination coverage, decreased hygiene, overcrowding and population displacement and migration due to conflict or natural disaster can lead to outbreaks in countries with a collapsed health system, such as Yemen. As of May 12, 2018, there were 1,742 probable cases of diphtheria and 93 associated deaths in Yemen, as reported through the Electronic Diseases Early Warning System.

FHI 360, in partnership with the World Health Organization (WHO), Aden Health Cluster and the Yemen Ministry of Public Health & Population, is working to slow the spread of diphtheria by strengthening the disease outbreak surveillance system and guiding prevention and control measures.

In April 2018, medical epidemiologists from FHI 360 and WHO conducted a trainer’s workshop in Aden-Hub in southern Yemen for 16 participants involved in surveillance and clinical case management. The workshop provided information about the latest science on diphtheria outbreak preparedness and response. Participants identified challenges and prioritized actions to strengthen diphtheria surveillance and clinical case management.

After the workshop, FHI 360 and WHO visited Al-Sadaqa Hospital and Aden Central Public Health Laboratory to monitor the status of their facilities and provide technical assistance on the clinical management and laboratory investigation of diphtheria. While the clinical management protocol at Al-Sadaqa Hospital meets minimum standards, its diphtheria treatment unit is struggling to maintain the required 24/7 availability of health workers who can provide intensive care. In addition, the proportion of suspected cases treated with diphtheria antitoxin at the hospital is low (estimated at less than 30 percent). There are stock outs of diphtheria laboratory supplies at Aden Central Public Health Laboratory.

To address these challenges, FHI 360, WHO, and Yemen’s Ministry of Public Health & Population are developing an improvement plan for diphtheria outbreak surveillance and response in southern Yemen. The plan will have these main components:

  • To establish a diphtheria subject-matter-experts task force that provides continuous technical assistance, including systematic analysis of diphtheria surveillance data, to identify challenges and lessons learned
  • To continue strengthening the capacity of health professionals at the district and governorate levels on the clinical management of diphtheria, for the purpose of increasing the use of diphtheria antitoxin
  • To strengthen diphtheria testing capacity at Aden Central Public Health Laboratory by providing sufficient laboratory supplies

    Photo credit: John Otshudiema/FHI 360