{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:00:33Z","timestamp":1790690433124,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Immunity Inflam &amp;amp; Disease"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The introduction of the diphtheria\u2212tetanus\u2212pertussis (DTP) vaccine into childhood immunization programs resulted in its widespread elimination in high\u2010income countries. However, Nigeria is currently experiencing an outbreak. The primary cause of diphtheria outbreaks and its high mortality rates in Nigeria was waning herd immunity due to low DTP coverage and a lack of diphtheria antitoxin (DAT), respectively. However, the underlying causes of Nigeria's low DTP coverage and DAT supply remain unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Relevant studies and reports included in our review were obtained by a search through Google Scholar, PubMed, and organization websites using the terms \u201cDiphtheria\u2212Pertussis\u2212Tetanus vaccine OR Diphtheria antitoxin and Nigeria OR Diphtheria Outbreak.\u201d All articles considering diphtheria outbreaks, DTP vaccine, and DAT supply in Nigeria were considered without time restriction due to the paucity of data. We used the narrative synthesis approach to critically appraise, analyze, and draw inferences from the selected articles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The main causes of low DTP coverage are insufficient supply, an inefficient cold chain system, and low uptake due to poor health literacy and negative sociocultural and religious beliefs, whereas the key barriers to DAT availability are insufficient production by pharmaceutical industries because of low demand and priority.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The underlying causes of Nigeria's low DTP coverage and DAT supply are multifactorial. Both short\u2010term and long\u2010term measures are needed to control this outbreak and prevent future occurrences.<\/jats:p><\/jats:sec>","DOI":"10.1002\/iid3.1096","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T16:10:18Z","timestamp":1701187818000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Recurrent diphtheria outbreaks in Nigeria: A review of the underlying factors and remedies"],"prefix":"10.1002","volume":"11","author":[{"given":"Nasir","family":"Abdulrasheed","sequence":"first","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-7449","authenticated-orcid":false,"given":"Lukman","family":"Lawal","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"},{"name":"Centre for Malaria and Other Tropical Diseases Ilorin Nigeria"},{"name":"Toufik's World Medical Association Sumy Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulazeez B.","family":"Mogaji","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed O.","family":"Abdulkareem","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman K.","family":"Shuaib","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"},{"name":"University of Ilorin Teaching Hospital Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sodiq G.","family":"Adeoti","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9483-6188","authenticated-orcid":false,"given":"Opeyemi P.","family":"Amosu","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmujeeb O.","family":"Muhammad\u2010Olodo","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulwahab O.","family":"Lawal","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"},{"name":"MCON Research Institute Ilorin Nigeria"},{"name":"University of Ilorin Teaching Hospital Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawakalitu A.","family":"Jaji","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences University of Ilorin Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0153-287X","authenticated-orcid":false,"given":"Toufik","family":"Abdul\u2010Rahman","sequence":"additional","affiliation":[{"name":"Toufik's World Medical Association Sumy Ukraine"},{"name":"Medical Institute Sumy State University Sumy Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,28]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0131-y"},{"key":"e_1_2_12_3_1","unstructured":"World Health Organization. Diphtheria: vaccine preventable diseases surveillance standards.\u00a02018.\u00a0Accessed February 7 2023.\u00a0https:\/\/www.who.int\/publications\/m\/item\/vaccine-preventable-diseases-surveillance-standards-diphtheria"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2510.190271"},{"key":"e_1_2_12_5_1","unstructured":"Nigeria Centre for Disease Control and Prevention. Diphtheria health advisory for health care workers amidst outbreak in Nigeria. 2023.\u00a0Accessed February 7 2023.\u00a0https:\/\/ncdc.gov.ng\/news\/436\/diphtheria-health-advisory-for-health-care-workers-amidst-outbreak-in-nigeria"},{"key":"e_1_2_12_6_1","first-page":"2","volume-title":"Review of the Epidemiology of Diphtheria 2000\u20102016","author":"Clarke KE","year":"2017"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.18203\/issn.2454-5929.ijohns20195713"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268813001696"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/njbcs.njbcs_35_21"},{"key":"e_1_2_12_10_1","first-page":"83","article-title":"Risk factors associated to diphtheria outbreak in developing countries","volume":"9","author":"Rintani A","year":"2018","journal-title":"Jurnal Ilmu Kesehatan Masyarakat"},{"key":"e_1_2_12_11_1","unstructured":"Nigeria Centre for Disease Control and Prevention. January 2023 update on diphtheria.\u00a02023.\u00a0Accessed March 10 2023.\u00a0https:\/\/ncdc.gov.ng\/diseases\/sitreps"},{"key":"e_1_2_12_12_1","first-page":"97","volume-title":"The Epidemiology and Prevention of Vaccine\u2010Preventable Diseases","author":"Acosta AM","year":"2021"},{"key":"e_1_2_12_13_1","unstructured":"Nigeria Centre for Disease Control and Prevention. Diphtheria.\u00a02023. Accessed February 4 2023.\u00a0https:\/\/ncdc.gov.ng\/diseases\/info\/D"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2022.07.058"},{"key":"e_1_2_12_15_1","unstructured":"The Guardian Nigeria News. NCDC confirms 123 diphtheria cases 38 deaths in 4 states.\u00a02023.\u00a0Accessed February 4 2023.\u00a0https:\/\/guardian.ng\/news\/ncdc-confirms-123-diphtheria-cases-38-deaths-in-4-states\/"},{"key":"e_1_2_12_16_1","unstructured":"OsajiS.Lack of childhood immunization fuelling diphtheria\u2014NCDC 2023. 2023.\u00a0Accessed February 4 2023.\u00a0https:\/\/punchng.com\/lack-of-childhood-immunisation-fuelling-diphtheria-ncdc\/"},{"key":"e_1_2_12_17_1","unstructured":"AbujahR.Nigeria records 253 cases of suspected diphtheria in 2 months\u2014NCDC 2023.\u00a02023.\u00a0Accessed February 4 2023.\u00a0https:\/\/sciencenigeria.com\/nigeria-records-253-cases-of-suspected-diphtheria-in-2-months-ncdc\/"},{"key":"e_1_2_12_18_1","unstructured":"JoelM.FACTSHEET: what you should know about the diphtheria outbreak in Nigeria\u2010Africa check 2023. 2023.\u00a0Accessed February 4 2023.\u00a0https:\/\/africacheck.org\/fact-checks\/factsheets\/factsheet-what-you-should-know-about-diphtheria-outbreak-nigeria"},{"key":"e_1_2_12_19_1","doi-asserted-by":"crossref","unstructured":"LawalL AminuBM MurwiraT et al. Low coverage of COVID\u201019 vaccines in Africa: current evidence and the way forward. 2022;18.doi:10.1080\/21645515.2022.2034457","DOI":"10.1080\/21645515.2022.2034457"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2017.26.220.11453"},{"key":"e_1_2_12_21_1","unstructured":"SasuDD.Nigeria: poverty rate by state. Statista 2022.\u00a02022. Accessed February 4 2023.\u00a0https:\/\/www.statista.com\/statistics\/1121438\/poverty-headcount-rate-in-nigeria-by-state\/"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.4314\/ajcem.v12i2.64323"},{"key":"e_1_2_12_23_1","unstructured":"United Nations Children Fund. Diphtheria antitoxin: market update.\u00a02017.\u00a0Accessed March 4 2023.\u00a0https:\/\/www.unicef.org\/supply\/sites\/unicef.org.supply\/files\/2019-06\/diphtheria-antitoxin-market-update.pdf"},{"key":"e_1_2_12_24_1","unstructured":"World Health Organization. Diphtheria anti\u2010toxin (DAT) supply issues: brief review and proposition. 2017.\u00a0Accessed March 4 2023.\u00a0https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/sage\/2017\/sage-meeting-of-april-2017\/background-docs\/session-diphtheria\/3.-supply-of-diphtheria-antitoxin-pdf-204kb.pdf?sfvrsn=2bd062e3_3"},{"key":"e_1_2_12_25_1","first-page":"315","article-title":"Pandemics: risks, impacts, and mitigation","volume":"9","author":"Madhav N","year":"2017","journal-title":"Improving Health\u00a0Reducing Poverty"},{"key":"e_1_2_12_26_1","unstructured":"AdebiyiK. Role of traditional religious leaders in upscaling COVID\u201019 vaccination\u2014EnviroNews Nigeria 2021. 2021. Accessed February 9 2023.\u00a0https:\/\/www.environewsnigeria.com\/role-of-traditional-religious-leaders-in-upscaling-covid-19-vaccination\/"},{"key":"e_1_2_12_27_1","unstructured":"World Health Organization. Solar direct\u2010drive vaccine refrigerators and freezers.\u00a02017.\u00a0Accessed February 10 2023.\u00a0https:\/\/www.who.int\/publications\/i\/item\/WHO-IVB-17.01"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1124-9"}],"container-title":["Immunity, Inflammation and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/iid3.1096","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T11:37:53Z","timestamp":1703590673000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/iid3.1096"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":27,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/iid3.1096"],"URL":"https:\/\/doi.org\/10.1002\/iid3.1096","archive":["Portico"],"relation":{},"ISSN":["2050-4527","2050-4527"],"issn-type":[{"value":"2050-4527","type":"print"},{"value":"2050-4527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]},"assertion":[{"value":"2023-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e1096"}}