Peer-reviewed article
Diphtheria Outbreak in Somalia: An Alarming Public Health Crisis, Challenges, and Solutions.
Abdimajid Said Siad, Abdirizak Mohamud Yusuf, Mohamed Omar Warsame, Mohamed Ahmed Nor, Said Nuriye Abshir et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Diphtheria re-emerged in Somalia in 2023, causing an outbreak that spread across multiple regions with 1,811 suspected cases and 89 deaths by August 2025. More than 80% of cases occurred in children under 15 years old, most of whom had no history of diphtheria vaccination. Although immunization campaigns have improved coverage, vaccination rates remain below the level needed to stop transmission. The outbreak reveals weaknesses in the country's health system, including limited laboratory capacity, poor disease surveillance, and under-reporting of cases.
Key points
- By August 2025, Somalia reported 1,811 suspected diphtheria cases and 89 deaths with a case fatality rate of 5%
- More than 80% of cases occurred in children under 15 years of age
- The majority of patients had no history of diphtheria vaccination
- PENTA 3 vaccination coverage remained below the herd immunity threshold required to halt transmission despite immunization campaigns
- Weaknesses identified include limited laboratory confirmation capacity, under-reporting in IDP camps, inadequate surveillance systems, and delayed case detection
Limitations
The document does not provide specific vaccination coverage percentages, details on the timeline of outbreak spread, or comparative analysis with other diphtheria outbreaks. It does not specify which regions or populations were most vulnerable beyond age group.
Abstract
Diphtheria, known in Somalia as Gawracato, has re-emerged in 2023, highlighting growing vulnerabilities in the country's health system. The first case reported in the Mahaday District of Hirshabelle state. Then, immediately, the outbreak spread south to Banadir and north to Puntland, resulting in widespread transmission. In August 2025, Somalia had reported 1811 suspected cases and 89 deaths, with a case fatality rate (CFR) of 5%. More than 80% of cases occurred in children under fifteen years of age, and the majority of patients had no history of diphtheria vaccination. Although immunization campaigns such as the Big Catch-Up improved national coverage, PENTA 3 coverage remained below the herd immunity threshold required to halt transmission. However, contributing factors include limited laboratory confirmation capacity, under-reporting in IDP camps, inadequate surveillance system, and delayed case detection and response to emerging outbreaks. Therefore, the ongoing outbreak underscores the urgent need for strengthened vaccination systems, sustainable financing, laboratory expansion, and community engagement to prevent future resurgences of vaccine-preventable diseases.