Guinea: An almost forgotten disease makes a resurgence in West Africa

by MMC
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In recent months, West African countries have faced the worst wave of diphtheria ever recorded on the continent. The first cases were diagnosed in August 2022 in Niger, before the disease spread to Algeria, Mauritania, Nigeria and Guinea. The first patient in Guinea was diagnosed in July 2023 in Siguiri, a prefecture in the northeast of the country. Since then, cases of this potentially fatal disease have continued to increase.

“My daughter wasn’t feeling well – she had sores in her throat, she was having trouble eating and drinking, and she was just crying,” said Saran Keita, cradling his five-year-old daughter in his arms and him holding out an orange to comfort her. “That’s when someone took us to the Siguiri Epidemic Treatment Center. » Upon their arrival at the treatment center supported by Médecins Sans Frontières (MSF), her daughter was examined before receiving a diphtheria antitoxin.

Faced with the increase in cases of diphtheria, a major response is underway in Siguiri.

MSF launched a major intervention in Siguiri in mid-August 2023. As of January 4, 2024, the treatment center team – made up of 64 MSF staff and 184 members of the Ministry of Health – had treated 2,122 people with diphtheria, mostly young children. , but also adolescents and adults. Eighteen percent of patients were children under five; 43 percent were aged five to 15; 29 percent were aged 15 to 29; and 10 percent were over 30 years old.

In the waiting room, patients and caregivers listen to MSF health promoters explain in Malinké, the local language, how to recognize the symptoms of diphtheria and how the disease spreads.

“Diphtheria is a bacterial infection that attacks the respiratory tract,” explains Dr Adélard Shyaka, MSF medical coordinator. “It is transmitted by airborne droplets and can be fatal, especially for young children. It can also release a toxin that can affect organs in the body, including the heart and kidneys. Among other things, the toxin kills cells in the heart, nerves and respiratory tract. A pseudomembrane can also form because of the toxin.

The pseudomembrane is a thick, gray covering, so called because it is not produced naturally by the body. If an antitoxin is not administered quickly, the rapidly growing pseudomembrane can quickly block an infected person’s airway, leaving them struggling to breathe.

The incubation period for diphtheria is two to ten days. “It often begins on the second day after exposure with a moderate fever, followed by inflammation of the pharynx or larynx and difficulty eating and breathing,” says Dr. Shyaka. “The pseudomembrane usually appears on the third or fourth day.”

Before the current outbreak, diphtheria had largely disappeared worldwide. Guinea has not recorded any cases of diphtheria for more than 30 years. As a result, most local health workers had never encountered the disease until recently, and the antitoxin to treat it is not widely available.

“We lack health professionals who know how to recognize and treat this disease,” says Dr Charles Tolno, MSF deputy medical coordinator. “The treatment is complex and requires a lot of resources, particularly in terms of availability of the antitoxin. Given its rarity, we have no choice but to be selective in administering it to patients with the most severe symptoms.

With only 50 beds at the treatment center, patients with mild symptoms are sent home with antibiotics to treat the illness and reduce the risk of transmission to others. They also receive strict instructions on how to reduce the risk of transmission. After three and seven days, patients return to the center for a check-up.

Patients with more severe symptoms are admitted to the center for treatment, where they stay for up to five days. If they are to receive the antitoxin, they must also first undergo a battery of tests including blood oxygen, glucose and temperature. For example, the antitoxin cannot be administered if the patient has a fever that needs to be brought down.

This strategy was successful in reducing the number of deaths from diphtheria. “Thanks to MSF’s intervention, the mortality rate has decreased significantly,” explains Dr. Tolno. “When we arrived, the mortality rate was around 38 percent. Today, it’s less than 5 percent.

“I only had 10,000 Guinean francs (around €1) on me”

Most patients and caregivers have heard about the Siguiri treatment center on the radio, at school or by word of mouth. Due to the general lack of awareness about the disease and its symptoms, many had no idea what was wrong until they were diagnosed.

“Before coming here, I didn’t know that I had diphtheria,” says Fanta Fofana, 40 years old. “When I arrived three days ago by motorbike, I had already lost my voice. Since taking my treatment, I feel better. I ate well and slept well; I take my medication twice a day and have been able to regain my health. I hope to be released soon.

Djigui Berete’s 11-year-old son is also being treated for diphtheria. “As soon as I noticed that my child had a fever, a sore throat and a headache, I went to the clinic,” he says. “They told me it was diphtheria. I asked for an ambulance at the clinic. I only had 10,000 Guinean francs (around €1) with me. What can you do with this? I couldn’t get my child treated. Since I arrived at the treatment center, we can eat, drink and receive treatment without paying anything. Everything MSF offers is free. Today my son is taking his medication and feels so much better.

Patients and those living under the same roof can also be vaccinated at the center to protect themselves against various diseases: diphtheria and tetanus for adults; and diphtheria, tetanus, polio, hepatitis B and hib (Haemophilus influenzae type B) for children.

Vaccination against diphtheria protects against severe forms of the disease and prevents passing it on to others. At least two doses of vaccine are needed to achieve a significant level of protection. Unfortunately, long production lead times and backorders are currently causing a worldwide shortage of diphtheria vaccines. Given the situation in West Africa, MSF calls for accelerating the production of vaccines to control the disease.

“Ideally, we should have vaccinated the entire Siguiri region – all ages, but especially children – as soon as the first cases appeared,” explains Dr. Tolno. “However, due to the shortage of available vaccines, we have had to focus on vaccinating patients and their close contacts. What we need now are the means to obtain and conduct a large-scale vaccination campaign in Siguiri to stem the disease.

Distributed by APO Group for Doctors Without Borders (MSF).

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