Ebola in Nigeria: Challenges and Containment Strategies

Introduction: Ebola and Its Origins

There is no known origin of the Ebola virus that emerged with such severity in 2014 in West Africa. While there had been numerous other documented cases of Ebola in Africa, previous 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 and Symptoms of Ebola

The Ebola virus fruit bat has been shown to be a host carrier of the Ebola virus in Africa (Hassanin et al., 2016). Because the fruit bat is a food source in Africa and is considered a delicacy, it has been identified as the likeliest source of transmission to humans. 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's Arrival in Nigeria

Ebola first appeared in Nigeria during the 2014 outbreak in West Africa that originated in Guinea. After spreading from Guinea, the virus penetrated Liberia. A traveler from Liberia flew into Lagos, Nigeria on July 20, 2014, was identified as being gravely ill, and died five 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. Nineteen lab-confirmed cases followed the death of the index patient on July 25, 2014. Nearly 900 additional contacts were identified. Eight more patients died, while 11 patients were effectively treated and discharged. No new cases subsequently emerged (Shuaib et al., 2014).

Nigeria's 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), 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 health infrastructure was ready to respond effectively. As documented in the official report, "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).

References

Alexander, K. A., Sanderson, C. E., Marathe, M., Lewis, B. L., Rivers, C. M., Shaman, 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 West African Ebola epidemic. EMBO Molecular Medicine, 7, 17–23.

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.