Diphtheria outbreak in Zhare Dasht IDP camp, southern Afghanistan

Diphtheria is transmitted through person-to-person contact and the cramped conditions of a camp, with many family members living under the same roof, are ideal for its transmission.
Information on the first cases in Zhare Dasht emerged on July 14, one death had already occurred, with a further two in the days that immediately followed. All the affected patients are under the age of 18, none of whom have been previously immunised. The most effective way to protect the population of Zhare Dasht camp is vaccination - and MSF has embarked on a mass vaccination campaign targeting the entire population of the camp, which stands at close to 40,000 people. Up to three vaccinations per person are required to ensure effective immunisation. The first round of the vaccination campaign will end this week, and it is expected that the entire process will be completed in the coming months. In addition, MSF has extended immunisation for children under five in four IDP camps (Internally Displaced Person) in Spin Boldak, further south on the Pakistani border, in order to prevent the spread of the disease. The mainstay of treatment for diphtheria is an anti-toxin alongside antibiotics, which eliminate the organism and prevent its spread. During the initial days of the outbreak, treatment in Afghanistan was impossible as the anti-toxin could not be found in country. Instead patients with diphtheria were transferred to Quetta, in Pakistan, where this treatment was available. Within days however, the World Health Organisation (WHO) managed to source and transport the anti-toxin to Kandahar and MSF began treatment for the diphtheria patients. Until now, cases of diphtheria have been clinically diagnosed. Patients are initially isolated in MSF's basic health care unit in Zhare Dasht. They are then transferred to the Infectious Diseases Ward in Kandahar city hospital, where MSF is working in support of the Ministry of Health. In the Infectious Diseases Ward, patients can be more effectively isolated and treated. Meanwhile in Zhare Dasht camp, MSF, along with other NGO partners working in the camp, are disseminating health education messages and administering prophylaxis to close contacts of diphtheria patients in an attempt to try and further prevent spread of the disease - which is transmitted through person-to-person contact. The cramped conditions of a camp, with many family members living under the same roof, are ideal for the transmission of an infectious disease such as diphtheria. Diphtheria is an acute bacterial disease affecting the tonsils, larynx, nose and throat causing death in up to 10% of cases. A massive outbreak of diphtheria began in the Russian Federation in 1990 and spread to all countries of the former Soviet Union. It was responsible for more than 150,000 reported cases and 5,000 deaths. The population of Zhare Dasht (literally meaning yellow desert) and the Spin Boldak camps is mainly made up of displaced Kutchi nomads from the south of Afghanistan and Pashtuns from the north of the country. The ongoing drought in the south of the country has forced the Kutchis to abandon their traditional nomadic way of life and has decimated their herds. The Pashtuns have fled from the north due to harassment and discrimination at the hands of other ethnic groups. MSF has been working in the IDP camps in Kandahar province since their inception in early 2002, providing basic health care, mother and child health, reproductive health, immunizations, nutrition activities and treatment for tuberculosis.