Ebola Containment in Nigeria
The outbreak was largely contained in Nigeria by careful disinfection, port-of-entry screening and quick isolation of suspected cases. This was also aided by accurate laboratory diagnosis at Lagos University Teaching Hospital.
While these efforts sound dramatic, they are really routine public health practice, says one expert. “Isolation and quarantine of contacts is world-class epidemiological detective work.” – Art Reingold, University of California, Berkeley, School of Public Health.
Public Health Response
When a man with Ebola flew into Lagos, Nigeria’s largest city and a major transit hub with air, land, and water links to many other countries, many public health professionals feared a “city-wide apocalypse.” Effective contact tracing would be impossible in this chaotic and densely populated country that swells and ebbs with daily migrants and refugees.
But the Nigerian government quickly mobilized resources and organized its response using proven structures honed by years of work on polio eradication, according to the authors of the MMWR paper. It established an Incident Management Center (which later morphed into an Emergency Operations Center) and deployed an incident management system to coordinate responses. The approach is credited with keeping the outbreak contained so early. Nigerian officials also devoted time to educating the public. House-to-house information campaigns and radio messages in local dialects helped ease widespread fears. And isolation facilities were quickly constructed, along with designated Ebola treatment centers. The same approaches can help countries prepare for future outbreaks of infectious diseases.
With a population of more than 180 million people, Nigeria’s high rate of travel promotes the rapid spread of infectious diseases. In response, the government has stepped up screening at airport gates and other points of entry to detect travelers potentially exposed to Ebola.
The country has also stepped up contact tracing and isolation of people who may have had exposure to the virus. At Lagos’ Murtala Muhammed International Airport, screening of passengers on nonstop flights to Guinea, Liberia, and Sierra Leone is ongoing.
The city of Port Harcourt, where the index case in Nigeria’s second-largest city first appeared, has been a testbed for Ebola prevention measures. Residents broadcast information on the virus via radio and leaflets, sold protective clothing, and set up four isolation wards. Unlike Cote d’Ivoire and Senegal, where frightened citizens attacked health workers, Nigerians largely accepted the risks and supported the response. In addition, unlike in the other countries, there was no denial of the existence of Ebola or claims that it was a conspiracy.
A vigilance and reassurance campaign that included robust disinfection, port-of-entry screening and rapid isolation enabled Nigeria to limit its Ebola outbreak to 19 laboratory-confirmed cases and one probable case in two states. As of September 24, 894 contacts had been identified and followed during the response; eleven patients with laboratory-confirmed Ebola were discharged, eight patients died (seven confirmed and one probable) and all but three patients who remained in the isolation wards had been cleared of disease by the end of their 21-day follow-up period.
This case illustrates how the ability to conduct laboratory diagnosis in-country is crucial to a successful public health response to an imported epidemic. It also underscores the need for African nations to plan and implement EOC/IMS structures to guide responses to importations of public health threats. This includes developing strategies for identifying health care workers who are trained to provide quality Ebola patient care and can respond quickly when the need arises.
When a person has tested positive for Ebola, their close contacts need to be tracked down and warned that they may also be infected. This process is known as contact tracing. Tracers call, text or email people who have had recent contact with the infected individual and ask about their symptoms. If they are showing signs of fever, they will be sent to an isolation ward.
As soon as Sawyer’s results were confirmed, the teams in Nigeria started a massive tracing effort, using “boot leather and lots of in-person follow up visits.” This included 18,500 face-to-face contact tracers checking for signs of fever, which requires some cajoling, Fasina notes.
Such extensive contact tracing can help limit the spread of an infectious disease by identifying potential cases early, and asking them to self-quarantine. It also helps to reduce the isolation recommendations that would otherwise be required. This is a common public health technique, and it can be highly effective when done quickly and thoroughly.