title: Diphtheria outbreak with high mortality in northeastern Nigeria.
abstract: SUMMARY A diphtheria outbreak occurred from February to November 2011 in the village of Kimba and its surrounding settlements, in Borno State, northeastern Nigeria. We conducted a retrospective outbreak investigation in Kimba village and the surrounding settlements to better describe the extent and clinical characteristics of this outbreak. Ninety-eight cases met the criteria of the case definition of diphtheria, 63 (64.3%) of whom were children aged <10 years; 98% of cases had never been immunized against diphtheria. None of the 98 cases received diphtheria antitoxin, penicillin, or erythromycin during their illness. The overall case-fatality ratio was 21.4%, and was highest in children aged 0-4 years (42.9%). Low rates of immunization, delayed clinical recognition of diphtheria and absence of treatment with antitoxin and appropriate antibiotics contributed to this epidemic and its severity.
authors.affiliation: Epicentre, Paris, France.
authors.forename: N C
authors.initials: NC
authors.lastname: Besa
authors.affiliation: Epicentre, Paris, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Coldiron
authors.affiliation: Médecins Sans Frontières, Abuja, Nigeria.
authors.forename: A
authors.initials: A
authors.lastname: Bakri
authors.affiliation: Médecins Sans Frontières, Abuja, Nigeria.
authors.forename: A
authors.initials: A
authors.lastname: Raji
authors.affiliation: School of Medicine, Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nsuami
authors.affiliation: Médecins Sans Frontières, New York City, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Hurtado
authors.affiliation: Epicentre, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Porten
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004165:Diphtheria / Q000453:epidemiology* / Q000401:mortality*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires