Ebola in Nigeria

Ebola virus disease in Nigeria

Nigerian states with Ebola cases (Lagos and Rivers)

Disease| Ebolavirus
First outbreak| Patrick Sawyer
Index case| 6 August 2014
Confirmed cases| 20

Deaths

| 8

Cases of the Ebola virus disease in Nigeria were reported in 2014 as a small part of the epidemic of Ebola virus disease (commonly known as "Ebola") which originated in Guinea that represented the first outbreak of the disease in a West African country. Previous outbreaks had been confined to countries in Central Africa.[1][2]

## Epidemiology[edit]

Articles related to the

Western African
Ebola virus epidemic
Overview

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* Timeline of the epidemic
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* Ebola virus disease treatment research
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### West African Outbreak[edit]

Main article: West African Ebola virus epidemic

On 25 March 2014, the World Health Organization (WHO) reported that Guinea's Ministry of Health had reported an outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths had been reported as of 24 March.[3]

Researchers generally believe that a one-year-old boy,[4] later identified as Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea, was the index case of the Ebola virus disease epidemic.[5][6] His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages.[7][8]

Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.[6][7]

### Index Case[edit]

The index case in Nigeria was a Liberian-American, Patrick Sawyer, who flew from Liberia to Nigeria's most populous city of Lagos on 20 July 2014.[9] Sawyer became violently ill upon arriving at the airport and died five days later.[10] In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country.[11][12][13]

Sawyer was believed to have suspected he was infected with Ebola because he cared for his sister who died of the disease on July 8, he was hospitalised in Monrovia for fever and Ebola symptoms on July 17 before discharging himself (against professional medical advice) to fly to Lagos, where he lied to the staff of First Consultants Medical Centre that he had not had any exposure to anyone that had contracted Ebola.[14][15]

### Subsequent Transmission[edit]

On 6 August 2014, the Nigerian health minister told reporters, "Yesterday the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward."[16] The nurse was Obi Justina Ejelonu.

The doctor who treated Sawyer, Ameyo Adadevoh, subsequently also died of Ebola.[17]

Others that died included Mrs Ukoh (a Ward Maid at First Consultants Medical Center), Jato Asihu Abdulqudir (an acquaintance of Sawyer, who was on the plane with him and carried his bag when he was ill), a private hospital doctor in Port Harcourt who was treating Jato and an elderly patient at the hospital that treated the private hospital doctor for Ebola.[18]

On 22 September 2014, the Nigeria health ministry announced, "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days." According to the WHO, 20 cases and 8 deaths had been confirmed, including the imported case, who also died.[19] Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance.[20]

### Outbreak successfully contained[edit]

Nigerian health care workers at a training event, August 2014

On 9 October 2014, the European Centre for Disease Prevention and Control (ECDC) acknowledged Nigeria's positive role in controlling the effort to contain the Ebola outbreak. "We wish to thank the Federal Ministry of Health, Abuja, Nigeria, and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria." Nigeria's quick responses, including intense and rapid contact tracing, surveillance of potential contacts, and isolation of all contacts were of particular importance in controlling and limiting the outbreak, according to the ECDC.[21] Complimenting Nigeria's successful efforts to control the outbreak, "the usually measured WHO declared the feat 'a piece of world-class epidemiological detective work'."[22]

The WHO's representative in Nigeria officially declared Nigeria to be Ebola free on 20 October after no new active cases were reported in the follow-up contacts, stating it was a "spectacular success story[23]".[24]

### Relief contributions to West Africa[edit]

On 14 August 2014 the Nigerian government said Aliko Dangote have donated $1 million to halt the spread of the Ebola virus outbreak.[25] On 5 November 2014 volunteer medical workers arrived in Liberia and Sierra Leone from Nigeria. The first arrivals included 100 volunteers in Freetown, Sierra Leone and a further 76 in Liberia. Nigeria announced it would send 600 volunteers to help stem the spread of the disease.[26]

## Background: Healthcare in Nigeria[edit]

Further information: Health in Nigeria

A hospital in Abuja, Nigeria's capital

Health care delivery in Nigeria is a concurrent responsibility of the three tiers of government in the country, and the private sector.[27] Nigeria has been reorganizing its health system since the Bamako Initiative of 1987, which formally promoted community-based methods of increasing accessibility of drugs and health care services to the population, in part by implementing user fees.[28] The new strategy dramatically increased accessibility through community-based healthcare reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to all areas of health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost.[29]

The Nigerian health care system is continuously faced with a shortage of doctors and nurses known as 'brain drain', because of emigration by skilled Nigerian doctors and nurses to North America and Europe. In 1995, it was estimated that 21,000 Nigerian doctors were practising in the United States alone, which was about the same as the number of doctors working in the Nigerian public service. Retaining these expensively trained professionals has been identified as one of the goals of the government.[30]

Despite this, in the 2014 Ebola outbreak, Nigeria was the first country to effectively contain and eliminate the Ebola threat that was ravaging three other countries in the West African region. The Nigerian unique method of contact tracing became an effective method later used by other countries, such as the United States, when Ebola threats were discovered.[31][32][33]

## In popular culture[edit]

The 2016 Nigerian drama thriller film 93 Days tells the story of the treatment of Patrick Sawyer by Adadevoh and other medical staff, and the successful containment of the outbreak.[34]

## See also[edit]

* Ebola virus epidemic in Sierra Leone
* Ebola virus epidemic in Guinea
* Ebola virus epidemic in Liberia
* Ebola virus disease in Mali
* 2014 Ebola Virus in West Africa timeline of reported cases and deaths
* Ebola virus epidemic in West Africa timeline

## References[edit]

1. ^ "Ebola virus disease Fact sheet No. 103". World Health Organization. September 2014.
2. ^ "History of Ebola Virus Disease | History | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 2021-05-27. Retrieved 2022-04-24.
3. ^ "Previous Updates: 2014 West Africa Outbreak". Centers for Disease Control and Prevention. Retrieved 11 April 2015.
4. ^ Kevin Sack, Sheri Fink, Pam Belluck and Adam Nossiter Photographs by Daniel Berehulak (December 29, 2014). "How Ebola Roared Back: For a fleeting moment last spring, the epidemic sweeping West Africa might have been stopped. But the opportunity to control the virus, which has now caused more than 7,800 deaths, was lost". The New York Times. Retrieved December 30, 2014. ""The messages about don't touch the dead, wash your hands, if somebody is sick, leave them — these were all strange things, completely contrary to our tradition and culture.""`{{cite news}}`: CS1 maint: multiple names: authors list (link) Anchor cite of important article, do not remove
5. ^ "Ebola: Patient zero was a toddler in Guinea - CNN.com". CNN. 28 October 2014. Retrieved 29 October 2014.
6. ^ a b Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni (16 April 2014). "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine. 371 (15): 1418–25. doi:10.1056/NEJMoa1404505. PMID 24738640.
7. ^ a b Grady, Denise; Fink, Sheri (9 August 2014). "Tracing Ebola's Breakout to an African 2-Year-Old". The New York Times. Retrieved 11 April 2015.
8. ^ Nassos Stylianou (27 November 2014). "How world's worst Ebola outbreak began with one boy's death". BBC News. Retrieved 11 April 2015.
9. ^ "Ebola: Why Patrick Sawyer travelled to Nigeria – Wife | Premium Times Nigeria". 2014-08-13. Retrieved 2022-04-22.
10. ^ "EXCLUSIVE: How Liberian Govt Cleared Patrick Sawyer to Travel to Nigeria while under observation for Ebola | Premium Times Nigeria". 2014-08-12. Retrieved 2022-04-22.
11. ^ "Nigeria 'on red alert' over Ebola death in Lagos". BBC News. 26 July 2014. Retrieved 27 July 2014.
12. ^ "Ebola Virus Disease Outbreak — Nigeria, July–September 2014". www.cdc.gov. Retrieved 2022-04-30.
13. ^ "One year after Patrick Sawyer introduced Ebola to Nigeria". Vanguard News. 2015-07-20. Retrieved 2022-04-22.
14. ^ "How Did Nigeria Quash Its Ebola Outbreak So Quickly?". Scientific American.
15. ^ Ambe, J. Radeino; Kombe, Francis K. (2019-03-20). "Context and Ethical Challenges During the Ebola Outbreak in West Africa". Socio-cultural Dimensions of Emerging Infectious Diseases in Africa. pp. 191–202. doi:10.1007/978-3-030-17474-3_14. ISBN 978-3-030-17473-6. PMC 7123815.
16. ^ Mark, Monica (6 August 2014). "Ebola Outbreak: Nurse who Treated First Victim in Nigeria Dies". The Guardian. Retrieved 7 August 2014.
17. ^ "Ebola strikes at the heart of Nigeria: Ameyo, daughter of Kwaku Adadevoh, grand daughter of Herbert Macaulay dies". Thisday. Archived from the original on 21 August 2014. Retrieved 22 August 2014.
18. ^ "FLASHBACK: 'Crazy man' Patrick Sawyer brought Ebola to Nigeria three years ago". 25 July 2017.
19. ^ "WHO | WHO declares end of Ebola outbreak in Nigeria". Archived from the original on October 21, 2014.
20. ^ "Nigeria in first step towards all-clear on Ebola". Yahoo News. 23 September 2014. Retrieved 26 September 2014.
21. ^ Fasina FO; Shittu A; et al. (9 October 2014). "Transmission Dynamics and Control of Ebola Virus Disease Outbreak in Nigeria, July to September 2014". Rapid Communications. Eurosurveillance. 19 (40): 20920. doi:10.2807/1560-7917.ES2014.19.40.20920. hdl:2263/42723. PMID 25323076.
22. ^ Courage, Katherine Harmon (October 2014). "How Did Nigeria Quash Its Ebola Outbreak So Quickly?". Scientific American.
23. ^ "Free at last: The Nigeria Ebola story". Vanguard News. 2014-10-25. Retrieved 2022-04-30.
24. ^ "Nigeria is now free of Ebola virus transmission". WHO. 20 October 2014. Archived from the original on October 21, 2014. Retrieved 20 May 2015.
25. ^ "Nigeria reports one more Ebola case, 11 in total | Top News | Reuters". Reuters. Af.reuters.com. 2014-08-14. Archived from the original on 2014-08-16. Retrieved 2014-08-20.
26. ^ "Nigerian Ebola volunteers fly into Liberia, Sierra Leone". Yahoo News. 6 December 2014. Retrieved 6 December 2014.
27. ^ Rais Akhtar; Health Care Patterns and Planning in Developing Countries, Greenwood Press, 1991. pp 264
28. ^ "User fees for health: a background". Archived from the original on 28 November 2006. Retrieved 28 December 2006.
29. ^ Uzochukwu, B. S. (2002). "Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria". Health Policy and Planning. 17 (4): 378–383. doi:10.1093/heapol/17.4.378. PMID 12424209.
30. ^ Anekwe, Mike Chinedu (April 2003). "BRAIN DRAIN: THE NIGERIAN EXPERIENCE (1)". Niger Delta Congress. Archived from the original on 27 May 2011. Retrieved 7 June 2011.
31. ^ Matt Schiavenza (14 October 2014). "Why Nigeria Was Able to Beat Ebola, but Not Boko Haram". The Atlantic. Retrieved 17 April 2015.
32. ^ "US sends experts to study Nigeria's anti-Ebola strategies". The Punch. 3 October 2014. Archived from the original on 5 December 2014. Retrieved 8 May 2015.
33. ^ "US sends medical experts to study how Nigeria tamed Ebola". Vanguard. 2 October 2014. Retrieved 8 May 2015.
34. ^ Adegoke, Yemisi (2016-09-15). "The woman who saved her country from Ebola". CNN. Retrieved 2018-08-18.

## Further reading[edit]

* Folarin, Onikepe A.; Ehichioya, Deborah; Schaffner, Stephen F.; Winnicki, Sarah M.; Wohl, Shirlee; Eromon, Philomena; West, Kendra L.; Gladden-Young, Adrianne; Oyejide, Nicholas E.; Matranga, Christian B.; Deme, Awa Bineta; James, Ayorinde; Tomkins-Tinch, Christopher; Onyewurunwa, Kenneth; Ladner, Jason T.; Palacios, Gustavo; Nosamiefan, Iguosadolo; Andersen, Kristian G.; Omilabu, Sunday; Park, Daniel J.; Yozwiak, Nathan L.; Nasidi, Abdusallam; Garry, Robert F.; Tomori, Oyewale; Sabeti, Pardis C.; Happi, Christian T. (4 July 2016). "Ebola Virus Epidemiology and Evolution in Nigeria". Journal of Infectious Diseases. 214 (suppl 3): S102–S109. doi:10.1093/infdis/jiw190. ISSN 0022-1899. PMC 5050462. PMID 27377746.
* Olowookere, Samuel A.; Abioye-Kuteyi, Emmanuel A.; Adekanle, O. (October 2016). "Willingness to participate in Ebola viral disease vaccine trials and receive vaccination by health workers in a tertiary hospital in Ile-Ife, Southwest Nigeria". Vaccine. 34 (47): 5758–5761. doi:10.1016/j.vaccine.2016.10.004. ISSN 1873-2518. PMID 27751640.

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