Nigeria’s stable situation – with cases confirmed in Lagos, Africa’s most populous city, characterized by a vastly inadequate and fragile infrastructure, and in Port Harcourt, the country’s restive oil and energy hub – astonished experts at WHO and probably everywhere else in the world as well. No one expected an outcome as good as this one.
After the country’s first case, imported by an air traveller to Lagos on 20 July, was confirmed, the Ministry of Health responded urgently, dramatically, appropriately and effectively.
Contact tracing by highly-trained local health workers, aided by staff from WHO and the United States Centers for Disease Control and Prevention, would eventually reach nearly 100% of all exposed persons. Unlike the case in the three hardest-hit countries, Nigeria’s Ministry of Health created the facilities to isolate exposed persons during the requisite 21-day monitoring period. The government also built two new Ebola-specific treatment centres, one in Lagos and a second in Port Harcourt.
For its part, WHO supported the government’s response with several clinicians and with an epidemiological investigative team headed by one of its most experienced field epidemiologists, Dr William Perea Caro. Dr Perea Caro worked shoulder-to-shoulder with Nigerian health officials. The head of WHO’s country office, Dr Rui Vaz, another highly respected and experienced epidemiologist, likewise participated in the two investigations.
When a Lagos contact escaped the monitoring system and fled to Port Harcourt for treatment, the hundreds of high-risk exposures that followed were – once again – expected to lead to a rapid explosion of cases and spread of the virus to other Nigerian states.
But Nigeria has confined the outbreak to only 15 confirmed cases in Lagos and 4 in Port Harcourt. Altogether, seven deaths were reported. Sadly, five of these deaths occurred among doctors and nurses tending the ill. All of the country’s cases were linked back to the index case, the air traveller from Liberia.
Two key lessons
The fact that the worst-case scenario never happened supports two important lessons.
First, conventional control tools – like early detection, contact tracing, isolation and monitoring of those exposed, adequate supplies of personal protective equipment for medical and nursing staff, and strict procedures for infection prevention and control – are indeed highly effective when a country’s first imported case is detected early enough and managed as recommended by WHO.
Second, if Nigeria can control an outbreak caused by such a deadly and highly contagious virus, right from the start, any country in the world can do the same.
The Senegal case
These lessons were borne out when Senegal confirmed its first case in a Guinean national who entered Senegal by road on 29 August. To support the government, WHO immediately responded in emergency mode, with a risk assessment, airlifting of adequate quantities of medical supplies, and the deployment, within a day, of three of its most senior epidemiologists, Dr Guénaël Rodier, Dr Florimont Tshioko and Dr Amada Berthe.
Contact tracing was excellent. Numerous suspected cases were identified, tested, and then discarded as all test results came back negative. Dakar further benefitted from the presence of an Institut Pasteur laboratory with world-class diagnostic capacity. The first case has remained the country’s only one. He received excellent supportive care, completely recovered, and was released from the hospital with full confidence that he poses no risk to others.
The first 21-day period with no cases has passed and Senegal has entered the second 21-day period. If vigilance stays high and the country remains Ebola-free over the next three weeks, WHO will be able to announce that Senegal’s outbreak has ended.
However, as WHO Assistant Director-General Dr Bruce Aylward has noted, “This health crisis we’re facing is unparalleled in modern times.”
No one can predict with certainty how the outbreaks in these two countries will evolve.