With the recent outbreak of Ebola Virus Disease in Uganda, LARA ADEJORO writes on the need for the Federal Government to heighten awareness and surveillance systems at the borders to prevent the deadly virus
Just seven days before the 15th Ebola Virus Disease outbreak would be declared over in the Democratic Republic of Congo, health authorities announced an outbreak of the deadly Sudan strain of Ebola virus in Uganda.
The outbreak in DR Congo, which occurred on August 21, according to the World Health Organisation, was declared over on September 27.
Meanwhile, the outbreak in Uganda was confirmed in a village of Madudu sub-county in Mubende district, central Uganda – 1,201 km away from DRC.
The Uganda case was a 24-year-old male, who developed a wide range of symptoms on September 11, including high-grade fever, tonic convulsions, blood-stained vomit and diarrhoea, loss of appetite, pain while swallowing, chest pain, dry cough and bleeding in the eyes.
He was reported to have visited two private clinics, successively from September 11 to 15 without improvement. He was then referred to the Regional Referral Hospital on September 15 where he was isolated as a suspected case of viral haemorrhagic fever. A blood sample was collected on September 17 and sent to the Uganda Virus Research Institute in Kampala where RT- PCR tests conducted were positive for the Sudan virus of Ebola on September 19. On the same day, the patient died.
So far, 63 confirmed and probable cases have been reported, including 29 deaths as of October 2, 2022.
EVD, also known as Ebola hemorrhagic fever, is a severe disease of humans and other primates caused by an RNA virus of the family Filoviridae and genus Ebola virus, with a death rate ranging from 25 per cent to 90 per cent in past outbreaks.
The virus is transmitted to people from wild animals (such as fruit bats, porcupines, and non-human primates) and then spread in the human population through direct contact with the blood, secretions, organs, or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
The first symptoms of EVD are fever, fatigue, muscle, pain, headache, and sore throat, followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases internal and external bleeding (e.g. oozing from the gums, blood in the stools).
Nigeria at high risk
According to the Nigeria Centre for Disease Control, Nigeria is at a high risk of the virus due to the increased air travel between Nigeria and Uganda, especially through Kenya’s Nairobi airport, a regional transport hub, and other neighbouring countries that share a direct border with Uganda.
The centre said, “The likelihood of the spread in Nigeria following importation is high due to the gatherings and travel associated with politics, the coming yuletide as well as other religious gatherings and festivals during the last few months of the year.”
Recall that the largest Ebola outbreak in history was first reported in 2014 and declared over by the global health body on June 10, 2016.
The outbreak in 2014 primarily affected Guinea, Liberia, Sierra Leone, Senegal, and Nigeria. A total of 11,296 cases were recorded including suspected and probable cases, according to the NCDC.
Why readiness is important
Experts say weak surveillance systems and poor public health infrastructure contributed to the difficulty surrounding the containment of the 2014-2016 outbreaks.
For instance, in the index case of the 2014 outbreak in Nigeria, a Liberian diplomat, Patrick Sawyer, entered Nigeria unchecked; an act that caused the deaths of eight persons, including Dr Ameyo Adadevoh of First Consultant Hospital, who curbed a wider spread of the virus in Nigeria.
Although no current case of EVD has been reported in Nigeria, the need for readiness and immediate response cannot be overemphasised. Nigeria cannot afford to record another Ebola outbreak amid the rising cases of Lassa fever, monkeypox, cholera and COVID-19.
The rapid rise of the virus across five districts in Uganda has alarmed experts and raised fears that the outbreak may not be easy to contain; hence the call on the federal and state governments to heighten prevention and surveillance systems across all borders.
Speaking with our correspondent, a professor of Medical Virology at the College of Medicine, University of Lagos, Sunday Omilabu, said there was a need for increased surveillance and awareness because Ebola is deadlier than COVID-19.
Prof Omilabu said, “There should be health education to enlighten the public on the signs and symptoms and what people should look out for and where they should go to. All these things need to be made public as part of preparedness for it.
“The fatality rate of COVID-19 is about two per cent while the fatality rate for Ebola is almost 50-80 per cent. If there are 10 people with Ebola, at least five or eight of them will die. But if it’s COVID-19, the fatality rate is between 1.8 per cent and two per cent.
“That is why we need to be very careful and start to be on the lookout for it from all suspected cases and there are laboratories handling viral haemorrhagic fever which are located in the geopolitical zones of the country. All they need to do is to support the staff and supply all they need to detect Ebola on time.”
Also, another medical virologist at the Adeleke University, Ede, Dr Oladipo Kolawole, said, “The government should set up a good surveillance system at our borders.
“Flight from areas where the virus has been reported should be well monitored. Travel advice should be made available to Nigerians.”
Corroborating Kolawole is a virologist at the Department of Virology, College of Medicine, University College Hospital, Ibadan, Dr. Moses Adewumi, who said, “We don’t have to wait for alert. We are already in a belt. Uganda is a neighbouring country and we all know that infectious diseases can’t be stopped by boundaries. So we must take proactive measures to ensure that the surveillance rate is heightened. Our government should not relax on surveillance. It’s almost certain that it’s with us, so we should do everything humanly possible to improve surveillance to nip it in the bud.
“There is not enough awareness. There is no boundary when it comes to infectious diseases. Somebody could sleep in Nigeria and in the next six hours, he is already in Europe, and within 12 to 13 hours, he is already in the United States. We can strengthen our surveillance as people are coming in by ensuring that they are well screened.”
An epidemiologist at the Viable Knowledge Masters, Dr Olusesan Makinde, stressed the importance of the government to tighten the surveillance system in the country.
“People coming from those areas should be properly screened and quarantined or monitored in a specific location if need be.
How serious is the Sudan virus?
The fact that the Sudan strain of the disease is lethal and has no vaccine for treatment is a serious cause for concern. According to virologists, plans to mitigate such threats need to be robust and ‘ready-to-go.’
“We should be concerned about the Sudan strain. The original Sudan strain was not as deadly as this but what we are hearing now is that it seems to be causing more fatality, which is not impossible; maybe the virus has changed and mutated from a milder to a more severe one,” Omilabu added.
Relying on COVID-19 success
Using the incident management approach to COVID-19, experts say Nigeria can prevent the virus in the country.
“At least, we are yet to relax from our preparation for COVID-19, so I will say we are ready because we are going to use the preparations being used for COVID-19 to tackle Ebola if it should spread to the country.
“NCDC has been procuring diagnostic kits because Ebola is the viral haemorrhagic fever, and already we have Lassa which is common here and we have kits to screen with if we have any suspected case.
“We can rely on the successes of COVID-19 in tackling it because we use a public health approach to tackle COVID outbreak and we still need health education, public health approach, surveillance. We need the government to support, and of course, we have the community and private company responsibilities. Those are the ones we will refer to should we have a case.
In addition, the Ondo State Epidemiologist, Dr Stephen Fagbemi, stated that people must look out for international travellers, especially from Uganda.
Fagbemi said, “Nigeria has been on high alert and experts are already doing the risk assessment and having done that, they have increased our level of alertness. The surveillance is tightened at the airports because that is the easiest route for people coming from Uganda. Also, they are working on strategies for the screening of travellers.
“Beyond that, if anybody is detected, we already have treatment centres and isolation facilities in all the states we have international airports.
“For the rest of us, we need to create awareness and people need to be conscious. If you know anybody who is an international traveller, especially through Uganda, you have to be on the lookout for such a person.
“With our experiences with COVID-19, then we will be able to deal with it.”
Dr Chris Isokpunwu, who is the Director/Senior Technical Assistant to the Minister of Health, Dr. Osagie Ehanire, said, “The port health services are at high alert at our land borders and airports and vigilance has been increased. Details of passengers coming in from Uganda are being collected and sent to the NCDC in case there is a need for contact tracing.”
