The lines
on the tabular situation reports, sent to WHO each day by its country office in
Nigeria, have now been full of zeros for 42 days.
WHO officially declares that Nigeria
is now free of Ebola virus transmission.
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.
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