Shortage of medicine exacerbating diphtheria outbreak in Karachi, Sindh

Dozens of children have died this year in Karachi, and rural areas of Sindh and Balochistan due to diphtheria, a vaccine-preventable bacterial disease, as routine immunisation continues to decline in the region, health experts and officials reported on Saturday.

In Karachi alone, approximately 100 children have so far died from diphtheria at various public and private health facilities in 2024. During last year, over 52 children died at a single public hospital in Karachi, according to an investigation by this scribe.

The Sindh health department, however, reports a much lower figure acknowledging 28 deaths from diphtheria in the province, including 10 in Karachi, out of a total of 166 cases reported this year.

The situation is particularly alarming due to the unavailability of diphtheria antitoxin (DAT), the only treatment for children infected with the deadly disease. The Sindh Institute of Child Health and Neonatology (SICHN) is the only facility that has a limited supply of DAT, which it distributes among public health facilities upon request.

“We are witnessing an unprecedented rise in diphtheria cases this year, which is both unique and alarming. I’ve never seen such a large number of cases in a single year. It’s possible that an invasive strain or variant of diphtheria is causing the surge, but we are unsure at this stage,” said Prof Jamal Raza, senior paediatrician and executive director at the SICHN.

He explained that diphtheria cases began rising in 2022 and worsened in 2023, and have now escalated further in 2024. He remarked that the surge reflected alarmingly low rates of routine immunisation across Sindh.

“Diphtheria is a vaccine-preventable disease. When its cases rise, alongside other vaccine-preventable diseases like measles and polio, it indicates that many children are not receiving routine immunisation under the Expanded Program on Immunisation (EPI),” he added.

The SICHN procured the diphtheria antitoxin earlier this year, anticipating a rise in cases based on the 2023 trends. “Now, everyone in Karachi is relying on the SICHN for DAT, but it’s a costly treatment. A child may require several vials of antitoxin, costing between 200,000 and 300,000 rupees per patient,” Prof Raza maintained.

He called on national health institutions, such as the National Institute of Health (NIH) Islamabad, to conduct a disease outbreak investigation and genome sequencing of the strain responsible for this surge. He also stressed the need for preventive measures based on these findings.

Officials at the NIH have also expressed concern over the rising diphtheria cases in Sindh, Balochistan and Khyber Pakhtunkhwa. An NIH official revealed that they had issued an advisory earlier this year, anticipating a rise in cases, and are now receiving reports of outbreaks across the country.

“Unfortunately, diphtheria antitoxin is not available anywhere in the country, except at a few centres like the SICHN. We are willing to launch a disease outbreak investigation in Karachi upon the Sindh health department’s request, and we will also initiate a probe based on media reports,” the official stated.

Dr Qalbe Abbass, senior health expert at the Aga Khan University, noted that diphtheria was entirely preventable with timely vaccination. He pointed out that most of the cases in Karachi originated from rural Sindh and Balochistan, where healthcare infrastructure was weaker, and immunisation coverage low.

“By the time these children reach hospitals in Karachi, they are often in critical condition, making treatment ineffective,” Dr Abbass explained.