“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.

More than 100 children in Karachi have died from diphtheria this year due to the unavailability of Diphtheria Anti-Toxin (DAT), despite the disease being preventable through vaccination, disclosed a Sindh health department official.

The number of diphtheria cases and children’s deaths due to the disease have grown exponentially in the megalopolis.

All the diphtheria cases were being referred to the Sindh Infectious Diseases Hospital (SIDH).

According to the provincial health official, last year, 140 cases were received by the SIDH and 52 of them could not make it. Whereas, over 10 kids were under treatment at the hospital at the moment, they added.

However, following the publishing of this report, the Sindh Health Department later claimed that only 28 children, not 100, lost their lives in 2024.

“This year, 166 diphtheria cases have been reported in Sindh, out of which 28 deaths took place,” it said.

Meanwhile, experts of infectious diseases said the antitoxin medicine used against the disease was not available across Sindh, including Karachi. They said antitoxin worth Rs0.25 million was used for treating one child.

“The only cure for diphtheria is complete vaccination and treatment with antitoxin,” said experts.

Diphtheria is a serious infection caused by strains of bacteria called ‘Corynebacterium diphtheria that make toxins. It can lead to breathing, heart rhythm problems, and even death. Pakistani children are given a vaccine, a combination of five vaccines that protects from five major diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenza type b (DTP-hepB-Hib), the experts added.

Khyber Pakhtunkhwa Director Expanded Programme on Immunisation (EPI) Dr Muhammad Arif Khan had said last year that diphtheria was a life-threatening disease and timely vaccination was the sole way to prevent fatal ailment and its outbreaks in the community.

“It primarily affects the throat and upper respiratory tract but can also lead to systemic complications. Diphtheria is known for the formation of a greyish-white membrane in the throat, which can cause difficulty in breathing and swallowing.”

A disease that has been eradicated in most countries around the world has lingered on in Pakistan and it is not an enviable situation for the country and its health authorities. Keeping in view the fact that diphtheria is a lethal bacterial infection, there should not be any compromise in its vaccination to all children.