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Five cases of diphtheria have been confirmed in the wilaya of Skikda, including two deaths. While health authorities claim that the situation is under control, this reappearance of a disease that was thought to have disappeared raises many questions. Contacted this Saturday by the Young IndependentDr Youcef Boudjelal, microbiologist and president of the Autonomous Union of Public Health Biologists (SABSP), returned to the situation, the risks and the vital importance of vaccination.
The Young Independent: First of all, what can we say today about the epidemiological situation in Skikda?
Dr Youcef Boudjelal: According to data communicated by the Ministry of Health, five cases of diphtheria have been confirmed in the wilaya of Skikda, including two deaths, a 25-year-old man of foreign nationality and an unvaccinated 12-year-old girl. As soon as these recordings were made, a crisis unit was set up at the level of the health and population directorate (DSP) in order to monitor the evolution of the situation and coordinate response measures.
Epidemiological investigations were immediately initiated to identify people who had been in contact with the confirmed cases. These contact subjects were placed on prophylactic treatment and vaccinated. More than 500 people were immunized in the space of 48 hours, as part of a preventive vaccination campaign.
The situation is stable and monitoring on the ground continues in a rigorous and daily manner, through the strengthening of epidemiological surveillance activities in all health structures in the wilaya and the management of cases recorded in accordance with the therapeutic protocols in force. The situation is currently under control, but vigilance remains essential, as diphtheria is a rapidly spreading disease when not detected and contained in time.
To better understand, can you recall what exactly diphtheria is?
Diphtheria is an acute infectious disease caused by a bacteria called Corynebacterium diphtheriae. What makes it particularly dangerous is its ability to produce a powerful toxin, capable of seriously damaging several vital organs. This toxin first attacks the tissues of the upper respiratory tract, causing local lesions which form whitish false membranes in the throat.
But in the most severe cases, it can enter the bloodstream and reach the heart, diaphragm or central nervous system, causing potentially fatal cardiac or neurological complications. In the past, diphtheria was one of the leading causes of infant mortality. Thanks to vaccination, it has practically disappeared in many countries, but it has not been eradicated. As soon as vaccination coverage drops, it resurfaces, as we see today in Skikda.
Exactly, how can we explain the reappearance of this disease that we thought had been eradicated?
This disease has never completely disappeared. Vaccination has made it possible to control it, but as soon as a relaxation occurs, either due to neglect of boosters, or a lack of collective immunization, the disease can reappear.
It only takes one imported case to trigger an epidemic outbreak, especially if certain people have not been vaccinated. The bacteria circulates through respiratory droplets emitted when coughing or sneezing. But contact with soiled surfaces can also spread the bacteria through contact with contaminated objects or fabrics, including clothing and sheets. Hence the importance of complete and up-to-date vaccination coverage.
What are the symptoms that should alert you and prompt you to consult without delay?
The incubation period is short, usually between two and five days. The illness often begins with fever, sore throat and headache. Then appear the whitish false membranes which cover the tonsils and the pharynx. These membranes can hinder breathing and cause a risk of asphyxiation, especially in children.
Effectiveness depends on speed of diagnosis
Patients often present with severe fatigue, swelling of the neck, and sometimes later cardiac or neurological signs. These symptoms should never be taken lightly. Self-medication should be avoided. Taking antibiotics or paracetamol without a prescription can mask signs, interfere with diagnosis and delay appropriate treatment.
How do laboratories confirm illness?
The diagnosis is based on a clinical examination supplemented by bacteriological analyses. A throat swab is taken to identify the bacteria. We now have molecular techniques to directly identify the diphtheria toxin gene. This allows the presence of the toxigenic strain to be quickly confirmed and treatment to begin immediately. This combines the administration of diphtheria anti-toxins to neutralize the toxin, and antibiotic therapy or macrolides adapted to eliminate the bacteria. Effectiveness depends on the speed of diagnosis and treatment.
What preventive measures do you recommend to avoid the spread?
Hygiene, prevention and vaccination are an inseparable triptych. Hygiene remains the first line of defense, washing your hands regularly, wearing a mask in case of cough or respiratory symptoms, avoiding sharing personal objects and disinfecting surfaces. Then, any suspicious case must be reported in order to allow health teams to intervene quickly.
As soon as a case is confirmed, preventive vaccination can be carried out at the nearest dispensaries or medical centers. This is a quick and effective measure to prevent the spread. Vaccination campaigns around infectious foci are an essential weapon to contain the infection. It must be understood that a rapid reaction avoids community spread.
You place a lot of emphasis on vaccination. Why is this so important?
Because it is the only way to effectively prevent the disease. The diphtheria vaccine is administered from early childhood, often combined with that for tetanus and whooping cough. It requires boosters at 11 months, 6 years, 13 years. Then every ten years as adults, unfortunately, many adults neglect these reminders, thinking they will be protected for life. However, immunity decreases over time. In several countries, boosters are recommended at ages 25, 45 and 65.
Vaccination protects not only the individual but also the community. If vaccination coverage drops, the chain of immunity breaks and the disease resurfaces. This is what we must avoid at all costs.
What is your opinion on the reaction of the Ministry of Health to this episode?
The ministry acted quickly: activation of a crisis unit, close monitoring of cases, vaccination of those around them and a prevention campaign in the areas concerned. Health authorities reminded citizens that vaccines are available in all public health structures, whether at dispensaries or any other local health establishment.
He calls on citizens to scrupulously respect the vaccination schedule, recalling that vaccination remains the safest and most appropriate way to prevent this disease and other serious infections. This is a beneficial measure to strengthen citizens’ confidence in vaccination and prevent possible resurgences.
What do you remember from this health alert?
Above all, I remember that certain illnesses never really disappear. As soon as we relax our vigilance, they resurface. Diphtheria is a wake-up call. Citizens must realize that prevention, hygiene and vaccination are at the heart of our public health policy. Getting vaccinated is an act of responsibility and solidarity. It’s about protecting your family, your community and your country. We must preserve this collective health memory so as to never relive the tragedies of the past.