Ebola Virus Case Study

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The World Health Organization (WHO) has declared Nigeria to be  free of Ebola virus transmission.

In the words of WHO, “This is a spectacular success story that shows that Ebola can be contained. The story of how Nigeria ended what many believed to be potentially the most explosive Ebola outbreak imaginable is worth telling in detail.   Such a story can help the many other developing countries that are deeply worried by the prospect of an imported Ebola case and eager to improve their preparedness plans. Many wealthy countries, with outstanding health systems, may have something to learn as well.”

On July 23, 2014, the first Ebola case in Nigeria occurred. Of concern at the time was that it occurred in Lagos – a city of 21 million people. The United States Consul General in Nigeria, Jeffrey Hawkins, said it best at the time, “The last thing anyone in the world wants to hear is the 2 words, ‘Ebola’ and ‘Lagos’ in the same sentenc.,” since it bought up the images of an “apocalyptic urban outbreak”.

Fortunately, that never happened and the case study provides a model to other countries (including the United States) on how to contain and eradicate the virus when it first presents itself.

The first Ebola outbreak

According to WHO, the Ebola virus entered Lagos on July 20th via an infected Liberian air traveller. Before, during, and after the flight he showed symptoms. He vomited during the flight, on arrival and in the private car that drove him to a private hospital. At the hospital, he told staff that he had malaria and denied any contact with an Ebola patient. Later, it was learned that he had visited his Ebola infected sister while she was in a hospital and he also attended her traditional funeral and burial ceremony.

Five days after arriving in Lagos, the man died. Over the coming days, 9 doctors and nurses became infected and 4 of them died. One peace officer who transported the man also died.

The second Ebola outbreak

On August 1st, 2014 , a close contact of the first Ebola case flew to Port Harcourt (Rivers State region) seeking care with a private physician. Subsequently, the doctor developed symptoms on August 10th and died of Ebola on August 23rd.

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 during this exposure.

Fortunately. Dr Rui Vaz, the head of WHO’s country office in Nigeria, visited the Port Harcourt area to assess the situation there and 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.”

42 Days Without Ebola

Since those two outbreaks, no new Ebola cases have been identified which is 42 days in length (i.e., twice the maximum incubation period for Ebola virus disease).

According to the WHO, the reason Ebola has been contained in Nigeria is due to a number of factors, including strong leadership, effective coordination of the response, first rate virology lab available at Lagos university, and experienced epidemiologists who expedited the early detection of cases and their rapid isolation.

Some key points noted by the WHO were:

  • Dr Rui Vaz and the WHO country team of epidemiologists, clinicians, logisticians and administrators 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 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 brought in substantial resources to help scale up control measures.
  • Health and government officials 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.

 

The success of the containment makes it clear that Ebola, along with the other diseases plaguing Nigeria, can be controlled, regardless of the country. Dr Margaret Chan, the WHO Director-General said:

“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.”

 

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