The lines on the tabular situation reports, sent to WHO each day by its country office in Nigeria, have now been full of zeros for 42 days. WHO officially declares that Nigeria is now free of Ebola virus transmission.
This is a spectacular success story that shows that Ebola can be contained. The story of how Nigeria ended what many believed to be potentially the most explosive Ebola outbreak imaginable is worth telling in detail.
Such a story can help the many other developing countries that are deeply worried by the prospect of an imported Ebola case and eager to improve their preparedness plans. Many wealthy countries, with outstanding health systems, may have something to learn as well.
The complete story also illustrates how Nigeria has come so close to the successful interruption of wild poliovirus transmission from its vast and densely-populated territory.
As sometimes fortunately happens in public health, one success breeds others when lessons and best practices are collected and applied.
Earlier this year, WHO confirmed that Nigeria had eradicated guinea-worm disease – another spectacular success story. When the eradication initiative was launched, Nigeria was the epicentre of this disease, with more than 650 000 cases reported each year.
A shocked public health community – worldwide
When laboratory confirmation of the country’s first Ebola case, in Lagos, was announced on 23 July, the news rocked public health communities all around the world.
Nigeria is Africa’s most populous country and its newest economic powerhouse. For a disease outbreak, it is also a powder keg. The number of people living in Lagos – around 21 million – is almost as large as the populations of Guinea, Liberia and Sierra Leone combined.
Lagos, Africa’s largest city, is also characterized by a large population living in crowded and unsanitary conditions in many slums.
Thousands of people move in and out of Lagos every day, constantly looking for work or markets for their products in a busy metropolis with frequent gridlocks of vehicle traffic.
“How can contact tracing be done under such conditions?” This was the main concern raised at the beginning, shortly after the first confirmed case was announced.
As the United States Consul General in Nigeria, Jeffrey Hawkins, said at the time, “The last thing anyone in the world wants to hear is the 2 words, ‘Ebola’ and ‘Lagos’ in the same sentence. ” As he noted, that single juxtaposition conjured up images of an “apocalyptic urban outbreak”.
That never happened. With assistance from WHO, the US Centers for Disease Control and Prevention (CDC), and others, government health officials reached 100% of known contacts in Lagos and 99.8% at the second outbreak site, in Port Harcourt, Nigeria’s oil hub.
Federal and State governments in Nigeria provided ample financial and material resources, as well as well-trained and experienced national staff.
Isolation wards were immediately constructed, as were designated Ebola treatment facilities, though more slowly. Vehicles and mobile phones, with specially adapted programmes, were made available to aid real-time reporting as the investigations moved forward.
Unlike the situation in Guinea, Liberia and Sierra Leone, all identified contacts were physically monitored on a daily basis for 21 days. The few contacts who attempted to escape the monitoring system were all diligently tracked, using special intervention teams, and returned to medical observation to complete the requisite monitoring period of 21 days.
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