Epidemics of emerging and re-emerging infectious disease outbreaks have been on the increase in Nigeria lately. When emergency epidemic preparedness plans are in place, timely detection of outbreaks is followed by prompt and appropriate response. AJUMA EDWINA OGIRI analyses Nigeria’s emergency preparedness.
Ebola Experience
Millions of Nigerians were thrown into panic in 2014, when the first case of Ebola Virus Disease (EVD) was confirmed in Lagos. The EVD was imported into Nigeria by a Liberian diplomat, Mr. Patrick Sawyer, who arrived via Murtala Mohammed Airport Lagos on July 20, 2014.
The diplomat had cared for a sibling with EVD in Liberia, who eventually died from the disease. On that same day, the Federal Ministry of Health in collaboration with the Nigeria Centre for Disease Control (NCDC), declared an Ebola emergency in Nigeria.
Sawyer, who died in First Consultants Hospital, Obalende, Lagos, five days later, set off a chain of transmission that infected a total of 19 people, of whom seven died including Dr. Ameyo Stella Adadevoh, who diagnosed the index case.
The EVD cases were not limited to only Lagos state, as Rivers state recorded two confirmed cases of EVD with one dying.
Three months after, the Ebola outbreak in Nigeria was effectively controlled using the incident management approach with massive support provided by the private sector and international community, and Nigeria was on October 20, 2014, declared free of the ebola virus, by the World Health Organisation (WHO).
Monkey pox outbreak and others
Between December 2016 and June 2017, meningitis disease killed about 1,166 people in 27 states of the federation. Within the same period, more than 500 persons had contracted Lassa fever in about 17 states, and 104 died.
While Nigerians were still battling with the above familiar mentioned diseases, then came a new unfamiliar ‘visitor’; Monkeypox. Monkeypox outbreak, which was first reported in Bayelsa state, is described as a rare viral zoonotic disease; an infectious disease that spreads between animals and humans, with symptoms similar to smallpox, although in a milder form.
It is defined by the appearance of rash all over the body of the patient, often starting from the face and then spreading down to other parts of the body.
It affects mostly the face, palms of the hand and spreading to the feet. Like a typical viral infection, it has no known cure, neither has any vaccines been developed for it.
From Bayelsa, it spread to 15 states across the federation; Bayelsa, Rivers, Cross-river, Akwa-Ibom, Lagos, Ogun, Ekiti, Delta, Enugu, Abuja, Imo, Niger, Nasarawa, Kano, Benue and Edo, with a total number of 94 suspected cases.
Comparing ebola and monkey response
The ebola virus disease outbreak that hit Nigeria in 2014, caused a lot of panic both in the country and outside the country. However, the outbreak was effectively and swiftly contained with only eight deaths out of 20 cases.
Within a few weeks, it was curtailed through interdisciplinary collaboration, intensive case management, detailed contact tracing, active port health services, isolation, quarantine and supportive management for the infected.
Also, a combination of health workers and public education, coordinated field epidemiology and laboratory training programmes; with prior experience in disease outbreak control in other diseases, and effective set-up of emergency operations centres.
In addition, An EVD-isolation ward was constructed from an existing ward, a field incinerator was designed, hand sanitizers were produced locally and personal protective equipment were procured.
The manner the response was coordinated at the time saved several lives and prevented what could have been a national calamity. But the same cannot be said of the recent outbreak of emergent epidemics, especially the monkeypox.
When monkeypox hit Nigeria, for more than two weeks, authorities were treating it as a “suspicion”, owing to the fact that they awaiting laboratory results and confirmation from WHO laboratory in Senegal. It took three weeks for Nigeria to get the laboratory reports from Senegal and confirm monkeypox in some of the cases.
The samples had to be taken to Senegal, because Nigeria has no lab that can make a definitive finding on these samples taken from patients. Both the Health Minister and Nigeria Centre for Disease Control (NCDC), tried to justify this by saying monkey pox is new in Nigeria, and that is why there are no labs to test for it.
This does not really come as a surprise, owing to the fact that Lassa fever, a disease that has been in Nigeria for decades now, still has only one centre in the whole country, that can diagnose it. Therefore, it might take us decades to establish a monkey pox diagnostic centre.
Passing the NCDC bill
Presenting the 2018 Appropriation Bill recently to law makers, President Muhammadu Buhari, called on the National Assembly to expedite the passage of the bill for the Nigeria Centre for Disease Control, NCDC.
He recounted the alarming number of disease outbreaks in the country in 2017, such as Meningitis, Yellow Fever, Monkey
Pox and Lassa Fever.
“This collaboration was a key factor in the low mortality rates experienced. To further improve our response to such outbreaks, we are working to upgrade our Integrated Disease Surveillance and Response System.
This will further enhance the efficiency of our diagnostic and clinical management processes.
“A speedy passage of the NCDC bill will consolidate on the successes recorded in stemming the tide of outbreaks in the country,” he explained.
The NCDC was established in 2011 in response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics through prevention, detection, and control of communicable and non-communicable diseases.
Its core mandate is to detect, investigate, prevent and control diseases of national and international public health importance. However, a formal bill for an Act establishing the NCDC is yet to be passed to law.
Reactions from medical laboratory scientists on emerging epidemics
Concerned that Nigeria is still vulnerable to emerging epidemics such, the Association of Medical Laboratory Scientists of Nigeria (AMLSN), urged the federal government to invest in state, regional and national public health laboratories, to suit the WHO standard, for routine medical surveillance of infectious diseases before their outbreaks.
The association also added that “if government had invested in the nation’s laboratories and made it comparable with the WHO’s laboratory in Senegal, where the blood samples of the monkeypox victims were tested, getting results would have been faster, and national response against the virus would have been much easier.”
“It is the failure of the Nigerian health system that compelled Nigerian government to take blood samples of persons with Monkey pox to Dakar, Senegal, for testing.
“It breaks my heart to see how Nigeria has become a fertile ground for emerging and re-emerging infectious diseases, in the face of dwindling budgetary allocation to the health sector by government, and rabid inter-professional rivalry by key players in the health team.
“Why can’t government listen to our continuous calls for establishments of state, regional and national public health laboratories for routine medical surveillance of infectious diseases before their embarrassing outbreaks?
Government must be careful not to turn the health professionals in Nigeria to unarmed soldiers in a war zone.
“This development reverberates the sordid disgust on the lack of concrete action by government in curtailing the resurgence of haemorrhagic fevers, meningitis and other infectious diseases in the country in spite of several appeals by AMLSN and other stakeholders on the need to establish and equip public health laboratories, human vaccines laboratories as well as viable and integrated surveillance system.
“Why is it that most of our public health laboratories are no longer in existence, and where they exist, little or no attention is given to them for proper management and support with the needed resources?
“Why is it that despite abundant resources in Nigeria, the managers of our health sectors are not ashamed of sending blood and other samples collected from those suspected or infected victims of infectious diseases such as Monkey pox for testing to Senegal or less endowed countries and institutions to the consternation of our health system,” president of the association, Toyosi Raheem, queried.
Raheem further said, “The ministers never saw the need to convince government to create enabling environments and opportunities for medical laboratory scientists, pharmacists and others in the health sector to strengthen the health system in Nigeria to a level that our country will face her health challenges head on, and avoid the incessant embarrassment from infectious diseases.
