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Nigeria is now free of Ebola virus transmission


The “index” case: how it all started

The Ebola virus entered Lagos on 20 July via an infected Liberian air traveller, who died 5 days later. At the departure airport, he was visibly very ill, lying on the floor of the waiting room while awaiting the flight.

He vomited during the flight, on arrival and, yet again, in the private car that drove him to a private hospital. The protocol officer who escorted him later died of Ebola.

At the hospital, he told staff that he had malaria and denied any contact with an Ebola patient. As was learned later, his sister was a confirmed case who had died from the disease in Liberia. The traveller visited his sister while in hospital and attended her traditional funeral and burial ceremony.

As malaria is not transmitted from person to person, no staff at the hospital took protective precautions. Over the coming days, 9 doctors and nurses became infected and 4 of them died.

The second outbreak site: Port Harcourt

The virus entered the country’s oil hub, Port Harcourt, on 1 August, when a close contact of the index case flew there seeking care from a private physician. That doctor developed symptoms on 10 August and died of Ebola on 23 August. Laboratory tests confirmed the city’s first case on 27 August.

An investigation undertaken by a team of epidemiologists from the Nigerian Centre for Disease Control (NCDC), the Nigeria Field Epidemiology and Laboratory Training Programme and the State Ministry of Health, assisted by WHO, revealed an alarming number of high-risk and very high-risk exposures for hundreds of people.

Again, all the ingredients for an explosion of new cases were in place. Dr Rui Vaz, the head of WHO’s country office in Nigeria, visited Rivers State (where Port Harcourt is located) to assess the situation there. He informed the State’s Governor of the potentially explosive situation and made his advice crystal clear: “All required resources must be immediately mobilized to stop this outbreak.”

Again, that explosion never happened. Fortunately, the State’s Governor heeded WHO’s advice.

Today, exactly 42 days (twice the maximum incubation period for Ebola virus disease) after the country’s last infectious contact with a confirmed or probable case occurred, the chains of transmission have been broken.

The virus is gone – for now. The outbreak in Nigeria has been defeated.

What accounts for this great news?

To a large extent, the answer is straightforward: the country’s strong leadership and effective coordination of the response. The Nigerian response to the outbreak was greatly aided by the rapid utilization of a national public institution (NCDC) and the prompt establishment of an Emergency Operations Centre, supported by the Disease Prevention and Control Cluster within the WHO country office.

Another key asset was the country’s first-rate virology laboratory affiliated with the Lagos University Teaching Hospital. That laboratory was staffed and equipped to quickly and reliably diagnose a case of Ebola virus disease, which ensured that containment measures could begin with the shortest possible delay.

In addition, high-quality contact tracing by experienced epidemiologists expedited the early detection of cases and their rapid movement to an isolation ward, thereby greatly diminishing opportunities for further transmission.

How a highly contagious virus was stopped dead in its tracks

Dr Rui Vaz and the WHO country team of epidemiologists, clinicians, logisticians and administrators have identified a number of specific lessons that may be useful for other countries facing their first imported Ebola case or preparing for one. They have also carefully documented a large number of “best practices” for containing an Ebola outbreak quickly.

The most critical factor is leadership and engagement from the head of state and the Minister of Health. Generous allocation of government funds and their quick disbursement helped as well. Partnership with the private sector was yet another asset that brought in substantial resources to help scale up control measures that would eventually stop the Ebola virus dead in its tracks.

Health and government officials fully appreciated the importance of communication with the general public. They rallied communities to support containment measures.

House-to-house information campaigns and messages on local radio stations, in local dialects, were used to explain the level of risk, effective personal preventive measures and the actions being taken for control. On his part, the President reassured the country’s vast and diversified population through appearances on nationally televised newscasts.

The full range of media opportunities was exploited – from social media to televised facts about the disease delivered by well-known “Nollywood” movie stars.

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