How Nigeria prevented an Ebola epidemic

Date: Oct-22-2014 Nigeria is the most populous country in Africa and a growing economic

powerhouse. The capital, Lagos, is home to some 21 million people - almost as many as

live in Guinea, Liberia and Sierra Leone combined. When news broke on July 23rd that a

case of Ebola had been confirmed in Lagos, the world held its breath. But Nigeria has

successfully prevented the feared "apocalyptic urban outbreak."

WHO suggest the most critical factor in Nigeria's successful response to the Ebola outbreak was "leadership and engagement from the head of state and the Minister of Health," followed by generous allocation of government funds.

In a situation assessment released on Monday, October 20th, the World Health

Organization (WHO) declare Nigeria "free of Ebola virus transmission." The chains of

transmission have been broken, it says, because it has been exactly 42 days - double the

maximum incubation period for Ebola virus disease - since the last infectious contact

with a confirmed or probable case occurred.

Such a "spectacular success story" of how Ebola can be contained is worth telling in detail, says the UN health agency.

Many other developing countries are very worried about the prospect of Ebola cases

crossing their borders and want to know how best to prepare themselves. Many wealthy

countries may also learn a few things from the Nigerian story, despite their more

advanced health systems.

The success follows another remarkable achievement in Nigeria, when earlier this year

WHO confirmed the country had eradicated Guinea worm disease. When the eradication

campaign started in 1986, Nigeria had 650,000 of the estimated 3.5 million Guinea worm

cases worldwide, more than any other country. In January 2014, the campaign estimated

there remained only 148 cases of Guinea worm disease

worldwide.

How Ebola started in Nigeria

A Liberian air traveler infected with Ebola entered Lagos on July 20th and died 5

days later. He had vomited in the flight and in the car that drove him to a private

hospital. There, he told staff he had malaria and denied having had any contact with

people infected with Ebola - later it was discovered he had.

As malaria does not transmit from person to person, the hospital staff attending the

index patient did not protect themselves. Nine became infected and four of them died, as

did the man who had escorted the patient to the hospital.

There was a second outbreak at Port Harcourt, Nigeria's oil hub, when on August 1st,

a close contact of the Lagos index patient arrived by plane and sought help from a

private doctor. The doctor developed symptoms 9 days later and died of Ebola on August 23rd.

When the Nigerian authorities, with help from WHO, studied the contacts involved,

they discovered an alarming number of high and very high-risk exposures for hundreds of

people.

It was clear that all required resources had to be mobilized immediately to stop the

outbreak.

Contact tracing

One of the challenges was to trace all the people who had come into contact with

infected Ebola patients.

Lagos is the largest city in Africa. It has a large population living in crowded,

unsanitary conditions, many in slums. Also, for work and to sell their goods, thousands

of people travel in and out of the city every day.

"How can contact tracing be done under such conditions?" was a main concern, voiced

right at the beginning, when the first case was confirmed. Jeffrey Hawkins, the United

States Consul General in Nigeria, said the prospect of Ebola in Lagos conjured up images

of an "apocalyptic urban outbreak."

But such an appalling prospect was averted. With help from WHO, the US Centers for

Disease Control and Prevention (CDC) and other organizations, the Nigerian authorities

reached 100% of known contacts in Lagos and 99.8% in Port Harcourt.

Prompt set-up of isolation, treatment and real-time reporting systems

Another important feature of Nigeria's success was that federal and state governments

very quickly provided financial and material resources, and well-trained and experienced

staff.

They immediately set about constructing isolation wards and then designated Ebola

treatment centers. Vehicles and specially adapted mobile communications systems were

made available and greatly assisted real-time reporting of the changing situation.

Unlike in Guinea, Liberia and Sierra Leone, in Nigeria, all identified contacts were

monitored on a daily basis for the maximum incubation period of Ebola - 21 days. A few

contacts did try to escape during the surveillance period, but they were tracked and

special intervention teams returned them to complete the required monitoring.

Strong leadership, funding and response coordination

WHO suggest the most critical factor in Nigeria's successful response to the Ebola

outbreak was "leadership and engagement from the head of state and the Minister of

Health," followed by generous allocation and quick disbursement of government funds.

Another big factor, say WHO, was strong partnership with the private sector, as was

rapid involvement of the Nigerian Centre for Disease Control (NCDC) and the prompt

establishment of an Emergency Operations Centre, supported by local WHO officials.

Nigeria also has a first-rate virology laboratory that is affiliated to the Lagos

University Teaching Hospital. The lab was quickly staffed and equipped to reliably

diagnose Ebola cases so containment could proceed promptly.

Coupled with high-quality contact tracing by experienced epidemiologists, these

factors ensured cases were detected early and quickly isolated, greatly reducing the

chance of further transmission.

Communication with the general public

The Nigerian authorities were quick to put out messages to the general public, the

idea being that this would get communities to support the containment measures.

Various initiatives put out messages and key facts about Ebola on different

media.

House-to-house and local radio campaigns - using local dialects - explained the

risks, how to take personal preventive measures and what was being done to control

virus spread.

President Goodluck Jonathan also appeared on television newscasts to reassure

Nigeria's vast and diverse population. Also, messages were put out on social media, and

well-known "Nollywood" movie stars were enlisted to give out Ebola facts on

television.

Drawing on the success of Nigeria's polio eradication program, traditional, religious

and community leaders were engaged early on and played a critical role in raising public

awareness.

Polio eradication strategies 're-purposed' for Ebola control

Nigeria is implementing one of the world's most innovative polio eradication programs.

Re-purposing the infrastructure of the program also helped the country avoid an Ebola

disaster.

Nigeria's polio eradication program makes use of cutting-edge GPS technology to

ensure no child misses out on polio vaccination. During the high transmission season,

only one case of polio was detected. WHO say the country is on track to interrupt wild

poliovirus transmission from its borders before the close of 2014.

When Nigeria's first Ebola case was confirmed in Lagos in July, the authorities

immediately re-purposed the polio eradication infrastructure and technology to trace

Ebola cases and contacts.

Using the latest GPS technology, the Nigerians, with help from WHO, were able to quickly trace contacts and map links between identified chains of transmission.

Eventually, every single one of the country's 19 confirmed cases was linked back to

direct or indirect contact with the air traveler who brought Ebola to Lagos from

Liberia on July 20th.

WHO Director-General, Dr. Margaret Chan, says Nigeria's achievements have a very

clear message:

"If a country like Nigeria, hampered by serious security problems, can do this - that

is, make significant progress towards interrupting polio transmission, eradicate

guinea-worm disease and contain Ebola, all at the same time - any country in the world

experiencing an imported case can hold onward transmission to just a handful of

cases."

Written by Catharine Paddock PhD

Not to be reproduced without permission.

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Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.