Morocco has recorded 30 confirmed cases of diphtheria, mainly in the Casablanca-Settat and Rabat-Salé-Kénitra regions, and three deaths, Jaouad Hammou, head of the Health Ministry’s Communicable Diseases Division, told Le360.
Seeking to dispel misleading rumors surrounding the disease, Hammou stressed the importance of distinguishing suspected cases from those confirmed through laboratory testing.
Surveillance protocol designed to flag as many suspected cases as possible
Hammou acknowledged that there were “quite a few suspected cases,” but said this was “entirely normal” given the strict surveillance protocol introduced by the ministry. “The protocol is highly sensitive. Even the slightest suspicion allows us to identify and manage a suspected case promptly. That is how the ministry intends to keep the situation under control and prevent the disease from spreading,” he said.
That sensitivity stems from the case definitions set out in the national surveillance and response manual, presented during an October 7 webinar. Under the guidelines, any patient with an upper respiratory tract infection accompanied by an adherent pseudomembrane is considered a suspected case. An ear, nose or throat infection accompanied by a marked deterioration in the patient’s general condition or signs of complications is also sufficient to raise suspicion.
Hammou reiterated that a case is considered confirmed only after laboratory testing. A suspected case, therefore, is not necessarily an actual infection. The manual also sets strict criteria for recording fatalities: a death is counted only when the patient had a confirmed infection and died from a complication of diphtheria rather than another cause.
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“No outbreak clusters detected so far”
According to Hammou, no outbreak clusters have been identified. Instead, the country is dealing with “scattered cases.” He maintained that the situation remains under control, contrary to reports circulating elsewhere.
Hammou said the emergence of cases had been “expected” and that the ministry had prepared for it from the outset. “Nevertheless, three deaths have been recorded despite those preparations and the mobilization of all medical personnel,” he said. He pointed to a coordinated response involving the Health Ministry, private healthcare providers, military medical services and a dedicated scientific committee.
For people who have been in contact with infected patients, the ministry is using vaccination and antibiotics. The aim, Hammou said, is “to provide the greatest possible protection and minimize any risk.”
Doctors outlined the strategy in greater detail during the October 7 webinar. Mouad Merabet, coordinator of the National Public Health Emergency Operations Centre, divided contacts into three categories: high, moderate and low risk. Chemoprophylaxis—the use of medication to prevent infection from developing in someone who has been exposed or is considered at risk—is mandatory for high-risk contacts.
For moderate-risk contacts, preventive antibiotic treatment depends on the circumstances. It is not prescribed for low-risk contacts, to avoid unnecessary use of antibiotics that remain effective. Antibiotic resistance data show that the circulating strain is resistant to penicillin G. Vaccination, meanwhile, is strongly recommended for all contacts, including those considered low risk.
Mohamed Benazzouz, head of the National Immunisation Programme, also clarified the vaccination guidelines. During an outbreak, the period of protection considered valid after a vaccine dose is reduced from ten years to five. Previously administered valid doses still count, and vaccination schedules can be continued without restarting the series. Three vaccines contain a diphtheria component: the pentavalent vaccine, which protects against diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b; DTP, which covers diphtheria, tetanus and pertussis; and Td, which protects against tetanus and diphtheria. Children under seven receive DTP, a pentavalent vaccine or a hexavalent vaccine, which also protects against poliomyelitis. Children aged seven and over, as well as adults, receive Td.
How the surveillance system works
The manual also sets out the steps healthcare professionals must take when they encounter a suspected case. The attending clinician must isolate the patient, provide a surgical mask and immediately notify the provincial surveillance unit, including by telephone.
A rapid response team then assesses and validates the suspected case before reporting it to the national epidemiological surveillance service, which assigns a tracking code. Every suspected case validated at this stage must be admitted to hospital. Treatment begins without waiting for laboratory results.
Separately, the Ministry of National Education has announced a circular drawn up jointly with the Health Ministry. It calls for tighter surveillance in schools, checks on pupils’ vaccination status and, where directed by health authorities, the temporary exclusion of affected pupils from school.
