Between 1 January and 2 November 2025, 20 412 cases of suspected Diphtheria were recorded across the African continent, with 1252 people believed to have died from the disease (a case fatality ratio of 6%) according to a press release issued by the World Health Organization on 21 November 2025. Eight countries have recorded ongoing epidemics of Diphtheria, Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa. Epidemics in some places have been ongoing since 2023, with the disease continuing to spread to new areas.
In many areas, laboratory confirmation of cases remain the exception rather than the rule, due to a shortage of suitable testing facilities, as well as a shortage of diagnostic equipment. There is also currently a global shortage of Diphtheria Antitoxin, the most effective treatment for the disease, as well as a shortage of suitable facilities for administering the treatment in many areas. Many of the countries affected have extremely fragile healthcare systems, combined with large numbers of displaced persons and in many cases ongoing civil conflicts, leading to a strong possibility of the disease spreading further within the region. This has led the World Health Orgnization to categorise the crisis as a Grade 2 Emergency under the terms of the Emergency Response Framework.
Diphtheria is a highly contagious vaccine-preventable disease caused mainly by the Actinomycete Bacterium Corynebacterium diphtheria but also by the related Corynebacterium ulcerans. It spreads between people mainly by direct contact or through the air via respiratory droplets. The disease can affect all age groups; however, unimmunized children are most at risk.
Symptoms often come on gradually, beginning with a sore throat and fever. In severe cases, the Bacteria produce a poison (toxin) that causes a thick grey or white patch at the back of throat. This can block the airways, making it hard to breathe or swallow, and also creates a barking cough. The neck may swell in part due to enlarged lymph nodes.
Treatment involves administering Diphtheria antitoxin as well as antibiotics. Vaccination against Diphtheria has been effective in reducing the mortality and morbidity from Diphtheria dramatically. Diphtheria is fatal in 5-10% of cases, with a higher mortality rate in young children. However, in settings with poor access to Diphtheria antitoxin, the case fatality ratio can be as high as 40%.
Niger is suffering an ongoing Diphtheria epidemic which began in the Zinder Region in November 2022, and which has subsequently spread to the Adadez and Diffa regions, with 34 of the country's 72 districts reporting cases. In 2025, there have been 1926 suspected cases, with 122 deaths (a case fatality ratio of 6.3%), with 765 cases confirmed by laboratory testing. Attempts to combat the outbreak have been hampered by a severe humanitarian crisis, driven by civil conflict, climatic effects, economic breakdown, and a large number of displaced persons, with around 2.6 million people currently reliant upon humanitarian assistance. A vaccination program was initiated in September 2025, with uptake reported to be good, and a second round is being planned.
Nigeria has been suffering an ongoing Diphtheria epidemic since December 2022, and has the highest number of cases in Africa. In 2025 till November 2, a total of 12 150 cases were reported (8587 of which have been confirmed by laboratory testing), with 884 deaths (a case fatality ratio of 7.2%). Diphtheria has been reported this year from 240 local government areas in 30 of Nigeria's 36 states. This outbreak is disproportionately affecting children and adolescents, and is being exasperated by a low vaccine take-up rate, with around 71% of the population having received a first dose of vaccine and about 67% having received all three recommended doses. Nigeria is suffering from a shortage of vaccines, a limited ability to carry out laboratory testing, a poor public understanding of Diphtheria, and weak infection control practices.
A Diphtheria outbreak has been ongoing in Chad since mid 2024, with 4462 cases and 47 deaths reported in 2025 to 2 November, a case fatality ratio of 1.1%. Most of the cases have been among children aged 3-13 years. Chad is currently at the centre of a humanitarian crisis triggered by conflicts in multiple neighbouring countries, as well as political instability within its own borders. It is currently home to 1.4 million refugees, including 870 000 from Sudan, as well as about 300 000 internally displaced people. This makes it hard to assess the vaccination status of much of the population in areas where the outbreak is ongoing.
Mali is suffering an ongoing Diphtheria epidemic, which began in the northern part of the country in September 2024, with 430 suspected cases and 29 deaths (a case fatality ratio of 6.7%) in 2025 till 2 November. The epidemic spread significantly during 2025, reaching seven of the country's eleven regions and 30 of 75 districts, including the capital city, Bamako. Mali is currently suffering a complex humanitarian crisis, driven by civil conflict and climate-related disruptions, with 6.4 million people currently reliant on humanitarian assistance. Vaccine uptake is low, with 91% of the population having received a first dose, and only 82% all three recommended doses. The country also has a shortage of Diphtheria Antitoxin, as well as a healthcare system which has been severely overstretched by the multiple crises in the country.
Mauritania is suffering a Diphtheria outbreak which began in September 2024, and has spread to 11 of the country's 53 departments, with 849 suspected cases and 33 deaths (a case fatality ratio of 4%). Mauritania has a fairly high vaccination rate for Diphtheria, with 95% of the population having received a first dose of the vaccine, and 86% having received all three doses, but it is also currently home to a population of 118 000 Malian refugees, with vaccine records only available for about 10% of this population. The epidemic also coincides with an outbreak of Rift Valley Fever in the same areas. Efforts to combat these outbreaks has been hampered by poor funding, logistical problems, and a shortage of skilled healthcare workers.
A Diphtheria outbreak began in Guinea in June 2025, with 476 suspected cases and 123 deaths (a case fatality ratio of 25.8%, currently the highest of any affected country). Four of the country's 38 prefectures have been affected, although the outbreak is centred on the gold mining areas of Kankan, particularly in Siguiri District. Only 70 cases have been laboratory confirmed, largely due to a lack of facilities. Guinea also has a low vaccine uptake, with only 77% of the country having had a first vaccine dose, and 63% having received all three recommended doses. The country also has a chronic shortage of Diphtheria Antitoxin, as well as few facilities for treating patients.
Algeria is generally considered to be Diphtheria-free, with a high vaccination rate (98% of the population having received at least one vaccine dose, and 92% having received the recommended three doses). However, in recent years the southern part of the country has become host to a large number of displaced people, fleeing conflict zones in the Sahel Region. In 2024 this area suffered a Diphtheria outbreak in which over 900 people were infected and 119 people died (a case fatality ratio of 13%). A new outbreak was reported in southern Algeria in October 2025, with 13 people infected and two deaths.
Uniquely among affected countries, the Diphtheria epidemic in South Africa is unrelated to the ongoing crisis in the Sahel Region. The country has a long history of sporadic outbreaks, although these are usually small and quickly contained. The current outbreak, however, first appeared in Western Cape in October 2023, and quickly spread to KwaZulu-Natal, since when it has proven hard to contain. In 2025 till November 2, a total of 106 cases of Diphtheria have been reported in South Africa, all of them laboratory confirmed - a total which includes 37 asymptomatic carriers. The epidemic is still centred on Western Cape, but cases have also been reported in Limpopo, Gauteng, KwaZulu-Natal, and Mpumalanga. Vaccination cover remains low in South Africa, with 76% of the population having received a first dose and 74% all three doses, and this is believed to be worsening. South Africa is also affected by the global shortage of Diphtheria Antitoxin, as well as a health service stretched by multiple other issues.
Diphtheria is a recurrent problem in many areas of Africa, with 18 789 cases reported between 2020 and 2022. However, this has become much worse since 2023, with 57 000 cases and about 2000 fatalities reported in 2023 and 2024, across Algeria, Chad, Gabon, Guinea, Mali, Mauritania, Niger, Nigeria and South Africa, with Guinea, Niger, and Nigeria being the worst affected. The disease particularly infects children under 15, and females more than males. About 50% of those infected in 2020-24 are thought to have been unvaccinated.
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