Nigeria draws on polio mistakes to contain Ebola

MASSIVE JOB: Health workers at an isolation camp in Liberia.

MASSIVE JOB: Health workers at an isolation camp in Liberia.

A day after the death of Patrick Sawyer, the Liberian-American who brought Ebola to Lagos, Nigeria's government took over the empty floor of a building off a busy highway in Africa's largest city.

Drawing on the country's battle to eradicate polio, which is endemic in the West African nation, a command centre was set up in the densely packed Yaba district to co-ordinate efforts between state, federal and international health officials. The mission: Contain Ebola's spread after Sawyer died in the coastal city of more than 20 million people.

With the resources of Africa's largest economy and the benefit of tracking down the first case soon after it arrived, Nigeria has managed to limit the number of deaths from the virus to five. The worst-ever outbreak has killed at least 1350 people with Guinea, Liberia and Sierra Leone struggling to put a lid on the disease.

"What was pretty incredible was that the government, based on its polio experience, formed an emergency operation centre that could identify each of those assets and put them to use for the response," said John Vertefeuille, an epidemiologist with the US Centers for Disease Control and Prevention who advises the Nigerian government. "It allows the government to direct the key strategies that will be used to improve the response and it also set up a standard for accountability."

The CDC, which set up camp in the two-story building, has eight people in Nigeria, and is working with the government to screen people at borders and airports, help trace people exposed to the illness and keep health workers safe.

Sawyer was visibly sick when he landed at Murtala Muhammed International Airport in Lagos, the nation's commercial hub, on July 20. Nigerian government doctors had been on strike for about two weeks when he landed.

That may have proved fortunate for Nigerian authorities trying to limit the spread of the disease. Sawyer was taken to a private hospital in the city's Obalende district, which has better hygiene and control standards than a public facility, Oyewale Tomori, president of the Nigerian Academy of Science and a former World Health Organisation official, said by phone from Abuja, the capital. Sawyer died on July 25.

All the confirmed cases in Nigeria had contact with people Sawyer infected or Sawyer himself. Five patients have been discharged after recovering and four are being treated in Lagos, Health Minister Onyebuchi Chukwu told reporters in Abuja on August 22. The government is monitoring 213 people.

"The battle is not over, the country has done well in containing it," Chukwu said. "If by another two weeks we don't get any more cases from secondary contacts we will be happy."

South Africa last week blocked citizens of Guinea, Sierra Leone and Liberia from entering Africa's second-largest economy. The ban didn't include Nigeria because the risk is low given the relative containment of the disease, the Department of Health said in an emailed statement last week.

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The Democratic Republic of Congo said yesterday as many as 13 people have died of Ebola in a separate outbreak from the one in the West African nations.

Nigeria missed opportunities to eradicate polio in the past decade because some people refused to be vaccinated in the mainly Muslim north, where preachers said the campaign was a US ploy to sterilise followers. The Islamist-militant group Boko Haram, which means "western education is a sin," makes vaccination difficult in the northeast, where it operates.

Donors including the Bill and Melinda Gates Foundation are spending US$1 billion (NZ$1.20bn) annually to eliminate polio in Nigeria, Pakistan and Afghanistan. Health officials have enlisted top Muslim leaders to promote the campaign and are working more closely with health agencies, non-governmental organizations and others to target areas where there are coverage gaps.

The efforts seem to be paying off in Nigeria, the most populous country in Africa with about 170 million people. There have been five confirmed cases of polio this year, down from 53 cases in 2013, according to WHO.

In Lagos, people go about daily life amid state government, private industry and media education campaigns about Ebola.

Lagos state Governor Babatunde Fashola has asked residents to avoid urinating and defecating in public places, while reassuring Nigerians that the state and federal government has enough resources to control the spread of the disease.

"We should perhaps never have been in this situation, but we are now in it," Fashola said last week. "Our response is a lot better than when the news first broke; and our capacity is increasing daily."

Workers at supermarkets, highway tolls and compounds in the city have taken to wearing plastic gloves. At music venues such as the New Afrika Shrine run by the family of the late Afrobeat creator Fela Kuti, hands are sprayed with sanitizer before patrons can enter to enjoy bottles of palm wine in the warehouse club heavy with marijuana smoke.

"What is important is vigilance and surveillance," said Health Minister Chukwu. "It is not a death sentence."

 - The Washington Post

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