Ebola and the need for vigilance
The reports that there is a fresh outbreak of Ebola in the Democratic Republic of Congo should sound a note of warning to the government and people of Nigeria to be on guard. Since Ebola virus was first identified in 1976, sporadic outbreaks have been reported in Africa and the 2013–2016 West African Ebola outbreak resulted in more than 11 300 deaths. In 2014, more than 11,000 died of the disease in Liberia, Guinea and Sierra Leone.
The Ministry of Health (MOH) of the Democratic Republic of the Congo (DRC), the other day, declared an outbreak of Ebola Virus Disease (EVD) in Bikoro Health Zone, Equateur Province, the ninth outbreak of Ebola virus disease over the last four decades in that country. Available data reveal that from 4 April through 27 May 2018, a cumulative total of 54 Ebola virus disease (EVD) cases including 25 deaths had been reported from three health zones in Equateur Province. In response, the government has led the response in affected health zones with the support of the World Health Organisation, WHO, and partners. Since the launch of EVD vaccine on 21 May, a total of 462 people, especially those on the frontline of health care, have been vaccinated.
In 2014, there was EVD outbreak in Nigeria, an outbreak that was unprecedented both in the number of cases, deaths and scope. The first case was confirmed in Lagos on 23 July 2014 and then spread to involve 19 laboratory-confirmed EVD cases.
It was brought into Nigeria by one Patrick Sawyer, an American-Liberian who arrived Lagos on July 20, 2014 on official duty. Though the patient died within a few days of hospitalisation, the incident sent jitters into the spines of Nigerians. Ameyo Adadevoh, the medical doctor who gave her life to save Nigeria from what would have been an EVD epidemic remains an authentic Nigerian heroine.
According to the World Health Organisation (WHO), “EVD is a severe, often fatal illness in humans. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The average EVD case fatality rate is around 50 per cent. Case fatality rates have varied from 25 per cent to 90 per cent in past outbreaks.”
The symptoms of EVD include fever, severe headache, muscle pain, weakness, fatigue, diarrhoea, vomiting, abdominal pain and haemorrhage (bleeding or bruising). The symptoms may appear anywhere from 2 to 21 days after contact with the virus, with an average of 8 to 10 days. Many common illnesses can have these same symptoms, including influenza (flu) or malaria.
In a country where Ebola virus is widespread, people can protect themselves and prevent the spread of EVD by practising good hand hygiene through proper hand washing with soap and water or the use of an alcohol-based hand sanitizer. Furthermore, it is important to avoid contact with blood and body fluids such as urine, faeces, saliva, sweat, vomit, breast milk, semen, and vaginal fluids; items that may have come in contact with an infected person’s blood or body fluids; contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals or meat from an unknown source. Funeral or burial rituals that require handling the body of someone who died from EVD should also be avoided.
EVD is a severe and often deadly disease. So, during an Ebola outbreak, experts argue that recovery depends on good supportive clinical care and the patient’s immune response. Since, the virus can spread quickly within healthcare settings such as clinics or hospitals, clinicians and other healthcare personnel providing care should use dedicated medical equipment, preferably disposable ones.
Meanwhile, available evidence suggests that there is progress towards having EVD vaccines. During the 2014 outbreak in Nigeria, swift implementation of public health measures helped the nation forestall a country-wide spread of the dreaded disease. The principal strategy was an incident management approach that saw the identification and successful follow-up on 894 contacts, out of which there were a total of 20 confirmed cases. Eight of the confirmed cases of EVD in Nigeria eventually died and twelve were nursed back to good health. The cases brought out the best in Nigeria doctors.
However, this turned out to be episodic because immediately the disease was contained, and Nigeria was declared EVD free on October 20 2014 by the World Health Organization, individuals and government at various levels threw caution to the wind and hygiene consciousness dropped, while surveillance at the borders and ports by relevant agencies was relaxed.
Against the backdrop that the virulence of the Ebola virus is not in doubt, why did Federal Ministry of Health (FMoH) not sustain the interventions and surveillance that was introduced in 2014 to contain EVD? Why wait for the 2018 outbreak in DRC before the government directed the health ministry to step up surveillance at the nation’s borders? Mounting surveillance at the nation’s borders should be continuous! Ghana is a model country, where disease surveillance and inspection of evidence of vaccination against various diseases at the port is continuous.
As the EVD scare heightens with the news of another outbreak in DRC, all hands must be on deck because of its history of destruction. The Nigeria’s health ministry and international partners should scale-up surveillance and have emergency response preparedness plan, not discounting looking in the direction of vaccine.
Also, they should embark on and sustain public enlightenment on measures to prevent and contain EVD. Since there is currently no vaccine, containing EVD is only in prevention. Its prevention relies on scientific interventions, and societal and individual behavioural changes hinged on good hygiene. Therefore, Nigerians should embrace prevention with hygienic living.
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