“The current diphtheria situation is alarming. There are deaths and cases all across Pakistan. Lab positivity is reported as well. But at the moment, we don’t have the actual number of deaths and cases,” an NIH official said as the body issued its second advisory on the disease spread a day earlier.

The development comes as the ongoing diphtheria outbreak in Pakistan, and particularly the tragic loss of over 100 lives in Karachi, demands decisive action.

Diphtheria, a toxin-driven disease caused by Corynebacterium diphtheriae, primarily affects the respiratory system and can lead to severe respiratory distress and death if untreated.

Health authorities are under pressure to strengthen preventive and treatment protocols while intensifying awareness campaigns.

Without a concerted national response to increase vaccination coverage and public health education, experts warn that the Pakistan risks facing further outbreaks of this entirely preventable disease, threatening the lives of countless children and vulnerable populations.

The NIH issued a second advisory, underscoring the urgency of immediate preventive and control measures as cases surge across multiple regions, threatening to overwhelm healthcare systems already under strain.

It also adds that with diphtheria’s heightened transmissibility during the cool and dry season, swift intervention is essential to curb its spread.

Authorities have categorised it as a priority reportable disease under Pakistan’s Integrated Disease Surveillance and Response System (IDSRS).

The current outbreak, resulting in a troubling mortality rate, particularly among un-vaccinated or partially vaccinated children, raises questions about the country’s preparedness and response capabilities.

The NIH advisory emphasises the need for enhanced vaccination coverage, improved surveillance for early detection and response, and proper case management in public and private healthcare facilities.

However, vaccine shortages and lack of public awareness remain significant hurdles. Many affected children have not received the standard three-dose diphtheria-tetanus-pertussis (DTP) vaccine, due to limited outreach, vaccine hesitancy, and inconsistent access to healthcare.

With Karachi particularly hard-hit-where around 100 deaths were reported this year, health experts warn that urgent improvements in vaccination infrastructure and public health awareness are crucial.

The advisory notes that diphtheria spreads quickly in crowded, unhygienic conditions often found in urban slums, schools, and public gatherings, with transmission occurring via respiratory droplets or contact with open sores and contaminated objects.

Infected individuals are highly contagious, capable of spreading the bacteria for up to four weeks, with chronic carriers remaining infectious for several months.

Symptoms range from mild sore throats to life-threatening complications, often involving the respiratory system. A thick, greyish membrane on the throat, a hallmark of the disease, can block airways and lead to fatal respiratory failure.

Without prompt administration of the diphtheria antitoxin (DAT) and appropriate antibiotic treatment, patients face a significant risk of severe complications, including myocarditis, paralysis, and, in many cases, death.

NIH’s advisory instructs healthcare providers to start treatment upon clinical suspicion to avoid fatal delays, with laboratory tests confirming the diagnosis and guiding further intervention.

To reduce fatalities, the NIH is urging healthcare facilities to stock sufficient quantities of DAT and recommended antibiotics, such as erythromycin and penicillin, which are essential for both treatment and containment. The antitoxin is particularly critical, neutralising the circulating toxin before it can invade cells and cause irreversible damage.

Recognising the importance of preparedness, the NIH has highlighted the need for healthcare providers to receive training on early diagnosis, patient isolation protocols, and the management of respiratory complications.

Monitoring cardiac activity to detect diphtheria-induced heart complications is also critical. Preventive measures for contacts of confirmed cases include immediate administration of prophylactic antibiotics and regular surveillance.

Close contacts, such as household members and caregivers, are advised to be vigilant, and healthcare personnel interacting with suspected cases are encouraged to use personal protective equipment rigorously.

Additionally, the advisory advocates for public health campaigns to educate communities about the symptoms of diphtheria, stressing the importance of seeking prompt medical attention and adhering to recommended vaccination schedules.

Laboratory support for diagnosing diphtheria is being expanded through NIH, enabling the testing of nasopharyngeal and throat swabs, which is crucial for confirming cases and guiding treatment strategies.

Vaccination history, however, is a prerequisite for testing to ensure precise diagnosis and management, underscoring the need for maintaining accurate medical records and public health data.