Ebola Virus Disease Preparedness and Awareness in Nigeria

Introduction

In spite of increasingly aggressive efforts to identify a cure for the Ebola virus disease (Preston, 2014), outbreaks continue to occur, including an ongoing one in the Democratic Republic of the Congo — which has proven to be the most difficult to manage to date — each with the potential to escalate into a worldwide pandemic (Brown, 2015). Therefore, national and local emergency managers must develop a comprehensive understanding of the etiology of this disease, its course, and what steps should be taken in response to confirmed cases in order to contain outbreaks when they occur and to educate citizens so as to prevent the spread of rumors that can further exacerbate the virulence and lethality of the Ebola virus disease (Allam, 2014).

The overarching purpose of this study was to provide a systematic and critical review of the relevant peer-reviewed, scholarly, and governmental literature concerning Ebola in order to develop an awareness manual for educating Nigerian citizens on the Ebola virus disease. A secondary purpose of this study was to identify any gaps in the current body of scholarship concerning optimal strategies for responding to Ebola outbreaks in order to recommend further areas of study.

Unlike many other deadly diseases that continue to plague humankind, Ebola occupies a category almost by itself in terms of its lethality. Indeed, Ebola infections typically kill between 25% and 90% of their victims, and it is not surprising that the public generally reacts to even the mention of this disease with dread and terror (Ebola outbreak, 2019). The largest outbreak of Ebola occurred in West Africa during the period between 2014 and 2016, but the second-largest outbreak remained ongoing in the Democratic Republic of Congo despite efforts on the part of the international health care community to contain it (Ebola, 2019). Notably, the outbreak in the Democratic Republic of Congo was all the more significant because the country had a comprehensive preparedness plan already in place (Hancock, 2019).

While many countries of the world remain directly unaffected by Ebola, the potential for this deadly disease to spread beyond the borders of the African continent is pronounced, especially due to the ease with which people can travel long distances today (Hood, 2015). Moreover, the Ebola virus disease has been shown to cross national borders with relative ease, and its impact on the nations of Africa has been severe. According to the U.S. Centers for Disease Control and Prevention (CDC), "A total of 28,616 cases of EVD and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone. There were an additional 36 cases and 15 deaths that occurred when the outbreak spread outside of these three countries" (Ebola outbreak, 2019). The fear and dread associated with Ebola are due in large part to the fact that there is no cure for the disease and that misinformation and rumors abound concerning its effects (Ebola, 2019) — a troubling situation that directly motivates the rationale for this study.

Developing effective responses to the Ebola virus disease requires a series of multifaceted interventions, all of which are essential for containing outbreaks (Ebola, 2019). The elements of an effective response include isolating infected victims, providing them with the best palliative care possible, and identifying new victims so that these interventions can be repeated (Ebola, 2019). Other critical elements include preventing further infections by performing safe but respectful burials of deceased victims and ensuring that affected health care facilities, ambulances, and victims' homes are decontaminated (Ebola, 2019).

While these steps can help contain an outbreak, they do not stop outbreaks from occurring in the first place. Therefore, while the search for a cure for the Ebola virus disease continues, it is vitally important for national and local emergency management teams to formulate effective response interventions to minimize the transmission of the disease — including educating citizens about Ebola to prevent the spread of misinformation that could adversely affect the ability of emergency managers to achieve this objective.

Overview of the Ebola Virus Disease

The Ebola virus disease is caused by an infection from a group of viruses included in the genus Ebolavirus — specifically the Ebola virus and the species Zaire ebolavirus (What is Ebola virus disease?, 2019). One of the more challenging aspects of Ebola is its virulence, which facilitates transmission from person to person or from animal to person. According to the CDC (2019), "Ebola virus disease is a rare and deadly disease in people and nonhuman primates. The viruses that cause Ebola are located mainly in sub-Saharan Africa. People can get Ebola through direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with Ebola virus" (Ebola virus disease, 2019, para. 2).

Because many people in West Africa come into regular contact with animals — including the common practice of eating so-called "bush meat" such as fruit bats, which are the only known natural reservoir for the disease — the opportunities to contract the Ebola virus disease are especially pronounced in many African nations, including Nigeria. Holakouie-Naieni and Ahmadvand (2015) report that, "Although the current epidemic of Ebola virus is propagated by human-to-human transmission, it is hypothesized that transmission from reservoir to human has likely occurred by consuming 'bush meat' or handling an infected animal" (p. 1670). At present, there are five different strains of the Ebola virus, named for the locations where they were first identified: Ivory Coast, Bundibugyo, Reston, Zaire, and Sudan (Ebola, 2019). These factors have significant implications for emergency management professionals.

Because Ebola infections can be caused by contact with the bodily secretions of infected individuals, it is vitally important for first responders and health care practitioners — in fact, anyone who comes into contact with people infected by the Ebola virus disease — to wear appropriate protective clothing and gear to avoid becoming infected themselves (Ebola, 2019). It is also important to note that Ebola can be transmitted from pregnant women to their babies in utero, during delivery, or through contact with the mother's bodily fluids, including breast milk (Ebola, 2019). Emergency managers should additionally understand that the Ebola virus disease is not transmitted through water or air, nor by newly infected individuals who have not yet developed any symptoms (Ebola, 2019).

Although the majority of Ebola infection cases have occurred in remote regions of African countries, it is also important to take preventive steps when infected victims reach health care facilities. Doctors Without Borders (2019) counsels that, "During an outbreak, Ebola virus can spread quickly within health care facilities. Proper infection control in health centers is therefore vital to reduce risks for other patients, caregivers, and health workers" (para. 5). In sum, anyone coming into contact with or providing health care services to infected victims must take precautions, most particularly the use of protective clothing and gear.

Symptoms, Diagnosis, and Treatment

One of the more challenging aspects of diagnosing Ebola is the variable time that may elapse from first exposure to the development of any discernible symptoms. This period can range from just 2 days to 3 weeks, with an average of 14 days prior to the onset of discernible symptoms (Allam & Vonka, 2015). Although the disease tends to manifest itself in various ways in different patients, most victims share many of the same symptoms. Clinicians at Doctors Without Borders report that, "Ebola usually begins with a sudden onset of fever, weakness, muscle pain, headache, and sore throat. This is often followed by vomiting, diarrhea, and abdominal pain, which may progress to severe disease with altered mental status, shock, multi-organ failure, and sometimes abnormal bleeding" (Ebola, 2019, para. 6).

Additional symptoms associated with Ebola infections include difficulty swallowing and breathing, hiccups, red eyes, and chest pains (Ebola, 2019). Further complicating early diagnosis is the fact that these symptoms are also common to a number of other serious diseases, such as typhoid fever, leptospirosis, influenza, yellow fever, dengue, and malaria (Ebola, 2019). It is therefore essential that individuals suspected of having contracted Ebola have appropriate screening samples tested in laboratories to confirm the diagnosis before treatment of symptoms can proceed (Ebola, 2019). Laboratory tests use methods capable of detecting the genetic material of Ebola. In the past, these tests required specialized medical technicians and modern laboratory facilities, which were frequently located great distances from outbreak zones — meaning that health care practitioners, patients, and family members often waited an inordinate amount of time to receive results (Ebola, 2019).

Following the West African epidemic, an innovative test was developed using a small GeneXpert machine that facilitates testing for Ebola infections closer to outbreak zones (Ebola, 2019). As a direct result of this innovation, the waiting time for receiving results has been reduced from several days to just a few hours — an improvement of particular significance for responding to the ongoing outbreak in the Democratic Republic of the Congo (Ebola, 2019). It is important to note, however, that this simplified testing regimen lacks the full rigor of laboratory testing, and any results indicating Ebola infection should be repeated after 72 hours for confirmation (Ebola, 2019).

Following the confirmation of an Ebola virus disease infection, first responders must react quickly to contain any potential outbreak. Notwithstanding this urgency, it is also important to account for the needs of patients and their communities when formulating an effective response (Ebola, 2019). Common features of an effective response to newly confirmed Ebola cases include the following:

Even after an outbreak has been successfully contained, the work of the emergency management team is not complete, since effective surveillance protocols must remain in place to identify any additional potential cases of Ebola infection (Ebola, 2019). The World Health Organization (WHO) classifies an Ebola outbreak as over only after 42 full days — or two incubation periods — have elapsed without any new confirmed cases (Outbreak preparedness, 2019). Since many developing nations in Africa may lack the resources needed to achieve all of these interventions, assistance from the international community in helping them prepare for Ebola outbreaks represents a timely and valuable investment in public health resources (Sirleaf, 2018).

Because there is no cure currently available for the Ebola virus disease, treatment has largely focused on palliation of symptoms such as controlling pain, reducing fevers, and decreasing the frequency of vomiting and diarrhea. Other common palliative care treatments include a rigorous hydration regimen to prevent dehydration and shock caused by uncontrolled vomiting and diarrhea (Ebola, 2019). In cases where patients remain alert, are not vomiting, and are able to actively participate in their own care, the hydration regimen may simply consist of rehydration drinks; in other cases, however, intravenous fluid replenishment may be necessary (Ebola, 2019). Therapeutic foods, vitamins, and anti-anxiety medications can also help infected patients (Ebola, 2019).

There are studies currently underway that promise to expand this limited set of interventions to include more effective medications for treating the symptoms of Ebola and perhaps even an outright cure, but at present the foregoing steps are regarded as best evidence-based practices in the health care community (Ebola, 2019). Equally essential to an effective response is the timely dissemination of accurate information about the disease to populations at risk.

Conclusion

Nigeria's 2014 Ebola response demonstrated that a coordinated combination of clinical intervention, community health worker mobilization, and accurate public information can contain an outbreak even in a densely populated urban environment. The reviewed literature consistently shows that no single intervention is sufficient; rather, effective preparedness requires integrating surveillance, protective protocols, palliative care, and — critically — community-level education and outreach. As long as there is no definitive cure for the Ebola virus disease, public awareness remains one of the most powerful tools available to emergency managers. Future research should focus on identifying scalable models for community health worker programs and on developing standardized information-dissemination strategies tailored to the linguistic and cultural diversity of nations like Nigeria, where the risk of future outbreaks remains real and the stakes could not be higher.

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