Return of Ebola: How Nigeria can prepare against an outbreak

Guinea was also one of the three most-affected countries in the 2014-2016 West Africa Ebola outbreak which was the largest since the virus was first discovered in 1976.

On February 14, health authorities in Guinea declared an Ebola outbreak in the country after three cases detected in Gouécké, a rural community in N’Zerekore prefecture, tested positive for the virus.

The cases were detected among seven people who attended the burial of a nurse on the 1st of February. It was the first Ebola outbreak in Guinea since 2016 when a large one was successfully brought under control.

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Guinea was also one of the three most-affected countries in the 2014-2016 West Africa Ebola outbreak which was the largest since the virus was first discovered in 1976.

Earlier on February 7, the Democratic Republic of Congo (DRC) health ministry had announced that a new case of Ebola had been detected in Butembo, a city in North Kivu Province, where a previous outbreak was declared over in June 2020.

Butembo was one of the epicentres of the previous Ebola outbreak in eastern DRC.

During the West Africa Ebola outbreak in 2014 to 2016, there were 28, 000 cases and 11, 000 deaths.  The outbreak started in Guinea and then spread across land borders to Sierra Leone and Liberia.

Nigeria was one of the countries hit by the disease in 2014 and lives were lost due to ignorance and other reasons. Between July and September 2014, Nigeria had 19 confirmed cases of Ebola out of which eight people died.

However, many more Nigerians died not from the Ebola virus itself but from rumour mongering and actions taken out of panic and ignorance to prevent the disease.

After some efforts at containing the disease, Nigeria was declared free of Ebola on October 20, 2014 by the World Health Organisation (WHO).

Ebola is an infectious and frequently fatal disease marked by fever and severe internal bleeding, and spread through contact with infected body fluids.

According to WHO, the severe viral illness is characterized by sudden onset of fever, intense weakness, muscle pain, headache, nausea and sore throat. This can be followed by vomiting, diarrhoea, impaired kidney and liver function, and in some cases, both internal and external bleeding.

According to the Nigeria Centre for Disease Control (NCDC), the Ebola Virus Disease (EVD) can be transmitted via direct contact with bodily fluids of a person who is sick with or has died from EVD.

Since 2014, Nigeria has not witnessed any outbreak even with cases recorded in DRC and other countries in 2017 and last year.

However, the return of the disease in Guinea and DRC, and the fact that the country and the rest of the world had already been battling the COVID-19 pandemic for over year which has already stretched a health system, makes it expedient for the country to put necessary measures in place to prevent an outbreak.

The NCDC in a statement on Friday said given the proximity of Guinea to Nigeria and other West African countries as well as other indicators, Nigeria has been placed at moderate risk of an EVD outbreak. The outputs from this risk assessment are being used to initiate preparedness activities in-country.

The Federal Government had earlier on Tuesday alerted Nigerians to the fresh outbreak in the two countries.

The Secretary to the Government of the Federation and Chairman, Presidential Task Force on COVID-19, Boss Mustapha, raised the alarm during a briefing in Abuja.

He said, “We shall keep a keen eye on it to avoid having to combat with the two deadly diseases at the same time.

“This is not a task for government alone but for all Nigerians and indeed all members of the public have a role to play,” he said.

How to prevent an outbreak in Nigeria – Experts

A renowned virologist, Prof. Oyewale Tomori, advised the country to be vigilant particularly with travellers from affected countries, and to also improve surveillance.

He said, “We monitor what is going on and be on the alert with emphasis on travellers coming in from the affected countries. We must do everything not to compound existing COVID-19 disaster.”

Coordinator of the Africa Health Budget Network, Dr Aminu Magashi Garba, said there is need for timely information sharing, and collaboration between Nigeria and all neighbouring countries in Africa.

He said there was need to strengthen efforts at all borders – land, sea and at the airports, to ensure surveillance and detection of cases among travellers.

“We also have to strengthen the workforce at the borders, especially at the airport and also ensure that frontline workers are protected and adequately kitted.”

He noted that this will enhance their knowledge to pick any suspected cases and also carry out investigations to confirm cases.

Dr Magashi said there should be adequate information on passengers entering Nigeria to ensure isolation, contact tracing and monitoring of the cases if they need arose.

He called for information on Ebola for travellers such as display messages and videos on Ebola at airports and travel notices at the Federal Ministry of Health and Nigeria Centre for Disease Control (NCDC) websites.

He also called for promotion of personal hygiene and sanitation among the populace.

“Ensure adequate use of clean water and reduce close contact at the airports. Now that we have COVID-19 in Nigeria and West Africa, having Ebola is going to be a big problem because we will need to manage two diseases. We need to prevent Ebola virus disease coming back to the country because we have a lot of challenges of human resources, and others in the health sector,” he said.

While commending the PTF on COVID-19 for raising an alert on the disease, he enjoined them to be vigilant and ensure prompt monitoring mechanism, especially at the borders.

He said the public, media and civil society organisations should not relent in alerting health ministries and port health authorities in the country and to also seek information from the NCDC to prevent the disease.

Meanwhile WHO said it is increasing efforts to curb Ebola outbreaks in Guinea and the Democratic Republic of the Congo and avert widespread infections.

“We are hard at work, shifting quickly through the gears to get ahead of the virus. With experts and emergency supplies already getting on the ground, the response is off to a strong start,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

“Our collective, quick action is crucial to averting an uncontrolled spread of Ebola amid the COVID-19 pandemic which has already pushed health workers and health facilities to the edge.”

The organisation said it has released $1.25m to support the response in Guinea and to reinforce Ebola readiness in neighbouring Cote d’Ivoire, Guinea-Bissau, Liberia, Mali, Senegal and Sierra Leone.

“With the epicentre of the Ebola outbreak in Guinea being a border area, countries in the sub-region are on high alert and increasing public health measures and surveillance in border towns and communities to quickly detect and respond to possible cross-border infections, WHO said in a statement.

How NCDC is preparing

The Nigeria Centre for Disease Control (NCDC) said it has an existing multisectoral National Emerging Viral Haemorrhagic Diseases Working Group (EVHDWG). This group coordinates preparedness efforts for EVD and other emerging viral haemorrhagic diseases.

The NCDC, in a statement signed by its director general, Dr. Chikwe Ihekweazu, on Friday, said the EVHDWG has carried out a risk assessment on the possibility of transmission of the virus to Nigeria.

The centre said several measures have been put in place to prevent and mitigate the impact of a potential EVD outbreak in Nigeria.

“A National Emergency Operations Centre (EOC) operating from NCDC’s Incident Coordination Centre (ICC) is on alert mode. We have a team of first responders on standby, ready to be deployed within 24 hours in the event of an EVD outbreak in Nigeria.

“We have also established testing capacity for EVD at the NCDC National Reference Laboratory. The NCDC will continue working with states to strengthen preparedness activities across the country.

“The Port Health Services of the Federal Ministry of Health has scaled up screening at points of entry. The NCDC will also scale up risk communications and other activities,” the centre said.

According to the centre, in January, the ICC announced the establishment of a vaccine stockpile for EVD. This stockpile is accessible to countries, in the event of outbreaks.

The centre said it will work with the National Primary Health Care Development Agency to develop a clear plan for accessing the EVD vaccine stockpile, as needed.

Ways to prevent the spread of Ebola

To prevent the spread of Ebola, NCDC advises members of the public to adhere to the following precautions:

-Wash your hands frequently using soap and water – use hand sanitisers when soap and water is not readily available.

– Avoid direct handling of dead wild animals.

-Avoid physical contact with anyone who has possible symptoms of an infection with an unknown diagnosis.

-Make sure fruits and vegetables are properly washed and peeled before you eat them.

-Health care workers are advised to ensure universal precautions at all times. This includes the use of personal protective equipment always when handling patients.