A disease that once resulted in countless deaths is making a resurgence across the globe. Diphtheria, historically known as the “strangling angel” for the way it destroys airway linings, has returned with alarming frequency in Europe, Africa, and the Middle East.

Health officials warn that a “perfect storm” of conflict, climate change, and gaps in routine immunisation exacerbated by the Covid-19 pandemic has left millions vulnerable to this preventable bacterial infection.

A global resurgence

Last year saw Europe enduring its largest diphtheria outbreak in 70 years. According to the European Centre for Disease Prevention & Control (ECDC), multiple countries, including Austria, Germany, the United Kingdom, and Switzerland, have reported a spike in cases since 2022. The outbreak has resulted in over 500 cases and at least 10 deaths since it began, primarily affecting vulnerable groups such as migrants and those experiencing homelessness.

Closer to home, the situation is equally critical. In South Africa, the National Institute for Communicable Diseases (NICD) reported in a statement that 91 confirmed cases of respiratory diphtheria occurred between January 2024 and January 2026, with the majority located in the Western Cape. Meanwhile, Nigeria has battled a significant outbreak since early 2023, with cases concentrated in Kano and Yobe states. In regions plagued by instability, such as Somalia, Sudan, and Yemen, the disease has returned “with a bang” due to damaged health systems and mass displacement caused by war and climate change.

Signs and symptoms

Diphtheria is caused by the Corynebacterium diphtheriae bacterium, which produces a toxin that can damage the heart and nerves. The infection is highly contagious, spreading through coughs, sneezes, or close contact with infected individuals.

Symptoms typically appear 2 to 5 days after exposure and initially resemble a common cold, including a sore throat, fever, weakness, and swollen neck glands often referred to as a “bull neck”. However, the hallmark of the disease is the formation of a thick, grey coating (pseudomembrane) of dead tissue over the throat and tonsils. This membrane can obstruct the airways, making it difficult to breathe or swallow, leading to suffocation.

If the toxin enters the bloodstream, it can cause severe complications, including inflammation of the heart (myocarditis), kidney damage, and nerve damage. Without proper treatment, diphtheria is fatal in approximately 30% of cases, with young children being at the highest risk.

Treatment and prevention

The World Health Organization (WHO) emphasises that vaccination is the most effective way to prevent diphtheria. The vaccine is often administered in combination with tetanus and pertussis (DTP) or as part of a pentavalent vaccine. WHO recommends a primary series of three doses in infancy, followed by booster doses during childhood and adolescence to sustain immunity.

For those infected, time is of the essence. Treatment involves the administration of diphtheria antitoxin (DAT) to neutralise the toxin and antibiotics to kill the bacteria. Health authorities stress that treatment should begin immediately upon suspicion of the disease, without waiting for laboratory confirmation.

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