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Nigeria is now free of Ebola virus transmission

Polio strategies “repurposed” for Ebola control

For some time now, with dedicated and enthusiastic support from President Goodluck Jonathan, Nigeria has been running one of the world’s most innovative polio eradication campaigns, using the very latest satellite-based cutting-edge GPS technologies to ensure that no child misses out on polio vaccination.

The country, which passed through the high-transmission season with only 1 single case of polio detected by a finely-tuned and sensitive surveillance system, is on track to interrupt wild poliovirus transmission from its borders before the end of this year.

When the first Ebola case was confirmed in July, health officials immediately repurposed polio technologies and infrastructures to conduct Ebola case-finding and contact-tracing.

The use of cutting-edge technologies, developed with guidance from the WHO polio programme, put GPS systems to work as support for real-time contact tracing and daily mapping of links between identified chains of transmission.

This is a good public health story with an unusual twist at the end. As part of preparedness for an imported case, several advanced countries with good health systems are now studying technologies “made in Nigeria”, with WHO support, to improve their own contact tracing capacities.

The story has another very clear message, as noted by Dr Margaret Chan, the WHO Director-General. “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.”

World-class epidemiological detective work would eventually link every single one of the country’s 19 confirmed cases back to direct or indirect contact with that 20 July air traveller from Liberia.

In another strategy, traditional, religious and community leaders were engaged early on and played a critical role in sensitizing the public. Like many others, the strategy drew on successful experiences in the polio programme.

The awareness campaigns that worked so well to create public acceptance of polio immunization were likewise repurposed to encourage early reporting of symptoms, backed by the message that early detection and supportive care greatly increase an Ebola patient’s prospects of survival.

All of these efforts were supported by social mobilization experts from UNICEF, CDC and Médecins sans Frontières, while the staff from the WHO Nigeria office, the Regional Office for Africa and headquarters boosted outbreak investigation, risk assessment, contact tracing and clinical care.

In the end, Nigeria confirmed a total of 19 cases, of whom 7 died and 12 survived, giving the country an enviable case fatality rate of 40% – much lower than the 70% and higher seen elsewhere.

Finally, to help maintain the confidence of citizens and foreign companies and investors alike, the government undertook the screening of all arriving and departing travellers by air and by sea in Lagos and Rivers State. The average number of travellers screened each day rose to more than 16 000.

Vigilance remains high

Nigerian government and health officials, including staff in the WHO country office, are well aware that the country will remain vulnerable to another imported case as long as intense transmission continues in other parts of West Africa.

The surveillance system remains on guard, at a level of high alert. Moreover, the country’s success, including its low fatality rate, has created another problem that calls for a high level of alert.

Many desperate people in heavily affected countries believe that Nigeria must have some especially good – maybe even “magical” – treatments to offer.

WHO’s Dr Vaz and others see a real risk that patients and their families from elsewhere will come to Nigeria in their quest for first-rate, live-saving care.

Based on the experience gained from the response in the 2 affected States, the national preparedness and response plan has also been revised and refined.

This strengthened response plan further boosts confidence that Nigeria’s well-oiled machinery has a good chance of working miracles again should another traveller – by land, air or sea – carry the Ebola virus across its borders again.