The Ebola virus was introduced into Nigeria on 20th July, 2014 when an infected Liberian man arrived by aeroplane into Lagos, Africa’s most populous city. The man, who died in hospital 5 days later, set off a chain of transmission that infected a total of 19 people, of whom 7 died.
According to WHO recommendations, the end of an Ebola virus disease outbreak in a country can be declared once 42 days have passed and no new cases have been detected. The 42 days represents twice the maximum incubation period for Ebola (21 days). This 42-day period starts from the last day that any person in the country had contact with a confirmed or probable Ebola case.On 20th October, 2014, Nigeria reached that 42-day mark and is now considered free of Ebola transmission.
WHO commends the Nigerian Government’s strong leadership and effective coordination of the response that included the rapid establishment of an Emergency Operations Centre.When the first Ebola case was confirmed in July, health officials immediately repurposed technologies and infrastructures from WHO and other partners to help find cases and track potential chains of transmission of Ebola virus disease.WHO, United States Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), UNICEF and other partners supported the Nigerian Government with expertise for outbreak investigation, risk assessment, contact tracing and clinical care.Strong public awareness campaigns, teamed with early engagement of traditional, religious and community leaders, also played a key role in successful containment of this outbreak..
The first is the capacity of the state to act in a timely and aggressive manner. Behind this success story lies competent public leaders and institutions that pursued their mission with vigour. After the diagnosis was made, Nigeria implemented a co-ordinated approach that involved making 18,000 visits to about 898 people to check their temperatures. This was possible because Nigeria had the state capacity to undertake such a massive effort in a timely manner.The 898 people were linked to one initial infected patient. These included 351 primary and secondary contacts as well as 547 tertiary contacts. One nurse who had cared for the patient had traveled over 500km to Enugu where she potentially infected at least 21 people.Actually what Nigeria did is routine, regular—but vigorous and rigorous—public health practice. They identified cases early—fortunately they had a limited number—and they got a list of all of the contacts, and they put those people under rigorous surveillance so that if they were to become sick, they wouldn’t transmit the infection to others,” he says.
In addition to contact tracing and rapid isolation, teams of “social mobilizers” canvassed areas around the homes of Ebola contacts, reaching around an additional 26,000 households with health information. Communicating that information effectively to the broader public is another challenge. Ensuring that people have confidence in the government—and understanding of what it is trying to do—is absolutely key, Vanderbilt’s Schaffner notes. Part of that is controlling what he calls “the outbreak of anxiety.”
Commenting on the experience, Dr. Lamunu said: “There was a huge difference in response capacity in Nigeria and what was possible in Guinea, Sierra Leone and Liberia where you can almost count the numbers of doctors on one hand.“In Nigeria we had people with Masters degrees doing the tracing work and there was no shortage of qualified medical personnel and lab facilities. All the resources necessary were mobilised quickly. The national Government, the public, partners, and the global community were concerned about it getting out of control.“There was great detective work in tracking down hundreds of contacts and the Nigerian Federal Ministry of Health, CDC (US Centre for Disease Control and Prevention), Médecins Sans Frontières, the Nigerian Red Cross and many other partners deserve much credit for how they managed to contain the risk of a major health disaster.”
Dr. Chadia Wannous, UNISDR health focal point, noted: “The experience of Nigeria when contrasted with that of other affected countries underlines how important it is to enhance the capacity of low-income developing countries to manage not just emergencies and disasters but the underlying risks. This requires resilient health systems with trained personnel, risk information and risk communication systems, logistics and supply chain structures, financing mechanisms and solid health governance as we have seen in Nigeria.”She also highlighted the significant role played by the community, with teams of “social mobilizers” reaching thousands of households with health information and facilitating understanding so that fear and mistrust do not hinder mounting an effective response.
Art Reingold, head of epidemiology at the University of California, Berkeley, School of Public Health agrees. The steps are basic: “isolation, quarantine of contacts, etcetera,” but governments must “get in quickly and do it really well.” It was Nigeria’s vigorous and rapid public health response that really stopped the spread. Because when Ebola lands one August afternoon in a city of 21 million, things could go very, very differently. But, says Folorunso Oludayo Fasina, a senior lecturer at the University of Pretoria in South Africa, co-author of the Eurosurveillance paper and a native Nigerian, it was actually lucky that the index patient in Nigeria fell ill at the airport. “Had the index case gotten the opportunity to contact persons in Lagos or Calabar—[another Nigerian city] where he was to deliver a lecture—it may have been a complete disaster.
The Nigerian government are well aware that the country remains vulnerable to other imported cases of disease epidemic. The surveillance system remains at a level of high alert. Nigeria has revised its national preparedness and response plan to ensure that the country is well prepared for other imported cases of diseases.