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| WHO/Andrew Esiebo |
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.
The
complete story also illustrates how Nigeria has come so close to the successful
interruption of wild poliovirus transmission from its vast and
densely-populated territory.
As
sometimes fortunately happens in public health, one success breeds others when
lessons and best practices are collected and applied.
Earlier
this year, WHO confirmed that Nigeria had eradicated guinea-worm disease –
another spectacular success story. When the eradication initiative was
launched, Nigeria was the epicentre of this disease, with more than 650 000
cases reported each year.
A shocked public health community – worldwide
When
laboratory confirmation of the country’s first Ebola case, in Lagos, was
announced on 23 July, the news rocked public health communities all around the
world.
Nigeria
is Africa’s most populous country and its newest economic powerhouse. For a
disease outbreak, it is also a powder keg. The number of people living in Lagos
– around 21 million – is almost as large as the populations of Guinea, Liberia
and Sierra Leone combined.
Lagos,
Africa’s largest city, is also characterized by a large population living in
crowded and unsanitary conditions in many slums.
Thousands
of people move in and out of Lagos every day, constantly looking for work or
markets for their products in a busy metropolis with frequent gridlocks of
vehicle traffic.
“How
can contact tracing be done under such conditions?” This was the main concern
raised at the beginning, shortly after the first confirmed case was announced.
As
the United States Consul General in Nigeria, Jeffrey Hawkins, said at the time,
“The last thing anyone in the world wants to hear is the 2 words, ‘Ebola’ and
‘Lagos’ in the same sentence. ” As he noted, that single juxtaposition conjured
up images of an “apocalyptic urban outbreak”.
That
never happened. With assistance from WHO, the US Centers for Disease Control
and Prevention (CDC), and others, government health officials reached 100% of
known contacts in Lagos and 99.8% at the second outbreak site, in Port
Harcourt, Nigeria’s oil hub.
Federal
and State governments in Nigeria provided ample financial and material
resources, as well as well-trained and experienced national staff.
Isolation
wards were immediately constructed, as were designated Ebola treatment
facilities, though more slowly. Vehicles and mobile phones, with specially
adapted programmes, were made available to aid real-time reporting as the
investigations moved forward.
Unlike
the situation in Guinea, Liberia and Sierra Leone, all identified contacts were
physically monitored on a daily basis for 21 days. The few contacts who
attempted to escape the monitoring system were all diligently tracked, using
special intervention teams, and returned to medical observation to complete the
requisite monitoring period of 21 days.
Source: http://www.who.int
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