Ebola in Nigeria

Ebola Epidemics – Challenges & Containment In Nigeria
Ebola and Its Origins
There is no known origin of the Ebola virus that emerged with a vengeance in 2014 in West Africa. And while there had been numerous other documented cases of Ebola in Africa, the outbreaks had always been much smaller and confined to a particular locale. In 2014, however, tens of thousands of infections occurred, ranging across seven different African countries (Mari-Saez, Weiss & Nowak, 2015). What caused the outbreak is unclear, though some researchers have speculated that the fruit bat may be, if not the primary source of the virus, at least a transmitter of the virus to humans (Hassanin et al., 2016).
Transmission, Symptoms of Ebola
The fruit has been shown to be a host carrier of the Ebola virus in Africa (Hassanin et al., 2016). As the fruit bat is a source of food in Africa and considered a delicacy, it has been identified as the likeliest source of transmission. Other sources of transmission include the “ingestion of fruit contaminated with Ebola-infected bat saliva or feces” (Alexander et al., 2015). Symptoms of the virus include “headache, myalgias, arthralgias, abdominal pain, vomiting, diarrhea, new skin rash, and unexplained bruising or bleeding,” both internally and externally, which can lead to low blood pressure and death (Cardile et al., 2015).
Ebola in Nigeria
Ebola first appeared in Nigeria during the 2014 outbreak in West Africa that started in Guinea. After spreading from Guinea, Ebola penetrated Liberia. A traveler from Liberia flew into Lagos, Nigeria on 20 July 2014, was identified as being very sick and died 5 days later. This was the “index patient” in Nigeria and was believed to have “potentially exposed 72 persons at the airport and the hospital” (Shuaib et al., 2014, p. 867). The potential outbreak was contained, however, thanks to the swift action of the Federal Ministry of Health, which received oversight from the Nigeria Centre for Disease Control. An Ebola emergency was declared. 19 lab-confirmed cases followed the death of the index patient on 25 July 2014. Nearly 900 more contacts were identified. 8 more patients died. 11 patients were effectively treated and discharged. No new cases emerged (Shuaib et al., 2014).
Nigerian Containment Strategy
The containment strategy in Nigeria was to quickly identify the virus and enact an Ebola emergency by establishing an Ebola Incident Management Center, which would become the Emergency Operations Center (EOC). Using this base, cases could be confirmed, contacts evaluated and monitored, and patients treated. Using an Incident Management System (IMS), the Nigerian authorities were able to contain the Ebola outbreak and limit its severity. Because Nigeria had experience dealing with outbreaks in the past, its national public institution was ready to effectively respond to the Ebola outbreak: “six response teams were developed within the EOC specific to an Ebola response, including: 1) Epidemiology/Surveillance, 2) Case Management/Infection Control, 3) Social Mobilization, 4) Laboratory Services, 5) Point of Entry, and 6) Management/Coordination” (Shuaib et al., 2014, p. 868).
Challenges Faced in Dealing with Ebola Virus in Nigeria
Ethical Challenges
Ethical challenges faced during the outbreak included alerting possible contacts and monitoring them in order to ensure that anyone who came into contact with the index patient and subsequently infected persons was properly treated. Maintaining an alert system and overseeing the response was the prime ethical challenge.
Social Challenges
Establishing priorities during the outbreak were the biggest social challenges. Staffing had to be obtained, goals identified, partnerships struck and operations set in motion. At the same time, Nigerian authorities had to prevent panic and chaos from ensuing, which meant that proper education of the masses and assistance of the media was required.
Legal Challenges
Legal challenges included obtaining information about contact passengers on the flight of the index patient, isolating the contaminated ward of the airport, and alerting the World Health Organization (WHO) so as to put other countries on notice of the possible spread of the disease (Shuaib et al., 2014).
Political Challenges
Political challenges included responding effectively to contain the outbreak in the Lagos airport and preventing more Nigerians from becoming infected, as well as alerting other nations through WHO. It also included getting into contact with Liberian authorities so that potential contacts could be alerted there as well. Following this, there was the need to maintain a sense of order and responsible care for the public so that trust and calm could ensue.
Lessons Learnt & Conclusion
Lessons learnt included understanding that being prepared to deal with the outbreak ahead of time is the best approach. Collaborating with WHO to put other countries on alert was also a lesson learned—as was the need to have a close handle on contacts so that containment could be achieved. In conclusion, the Ebola outbreak in Nigeria was met with a prepared team of professionals who quickly met the threat and achieved containment within a matter of weeks.

References
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J., ... & Eubank, S. (2015). What factors might have led to the emergence of Ebola in West Africa?. PLoS Neglected Tropical Diseases, 9(6), e0003652.
Cardile, A. P., Murray, C. K., Littell, C. T., Shah, N. J., Fandre, M. N., Drinkwater, D.
C., ... & Vento, T. J. (2015). Monitoring exposure to Ebola and health of US military personnel deployed in support of Ebola control efforts—Liberia, October 25, 2014–February 27, 2015. MMWR. Morbidity and mortality weekly report, 64(25), 690.
Hassanin, A., Nesi, N., Marin, J., Kadjo, B., Pourrut, X., Leroy, É., ... & Ruedi, M.
(2016). Comparative phylogeography of African fruit bats (Chiroptera, Pteropodidae) provide new insights into the outbreak of Ebola virus disease in West Africa, 2014–2016. Comptes Rendus Biologies, 339(11-12), 517-528.
Marí Sáez, A., Weiss, S., & Nowak, K. (2015). Investigating the zoonotic origin of the
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Shuaib, F., Gunnala, R., Musa, E. O., Mahoney, F. J., Oguntimehin, O., Nguku, P. M., ...
& Nasidi, A. (2014). Ebola virus disease outbreak-Nigeria, July-September 2014. MMWR. Morbidity and Mortality Weekly Report, 63(39), 867-872.