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| Nigeria has today been declared Ebola free by the World Health Organisation. The country's swift reaction has saved many lives, but could not help the doctor who stemmed the outbreak. (Pic: channel4.com) |
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.
Source:
http://www.who.int
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