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Ebola: Nigeria is not out of the woods yet — Prof. Tomori

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Since the confirmation and subsequent death of a Liberian man who was the first to be diagnosed with the Ebola Virus Disease on Nigerian soil, anxiety, shock and fear have been expressed by a wide section of the populace.  Although several assurances have been given by officials of the Federal and state governments, the generality of Nigerians remain worried and doubtful about their safety.

Foremost virologist and Vice-Chancellor of Redeemer’s University, President of the Nigeria Academy of Science, Prof. Oyewale Tomori, is of the view that Nigeria’s effort in containing the first reported Ebola case was commendable. However, Tomori, who is currently the regional virologist with the World Health Organisation Africa Region and a Fellow of the Nigeria Academy of Science, the College of Veterinary Surgeons of Nigeria and the Royal College of Pathologists of the United Kingdom, warns that as far as Ebola is concerned, Nigeria is not yet out of the woods. He speaks to Sola Ogundipe. Excerpts .

WHAT should be the best step for monitoring passengers entering Nigeria by air, land and sea from Ebola affected countries? Do they need to be quarantined?
Not necessarily. The Port Health staff needs to screen passengers coming into Nigeria from Ebola affected countries, by checking for anyone ill with fever plus signs and symptoms of Ebola fever. The screening can be done using a prepared investigation form for taking details of the passenger – name, age, contact address, travel history (which countries visited, for how long and which part of the country, etc), plus any history of illness or sickness over the last 2-3 weeks.

Prof Oyewale Tomori
Prof Oyewale Tomori

Those who are sick, like the Liberian case, must be taken for observation to hospital with isolation facilities. Others must be let off, but monitored and contacted DAILY by phone to check if they fall sick over the next 3 weeks covering the incubation period of Ebola infection. They should be carefully monitored by competent health staff

From what we have witnessed in the handling of the first Ebola victim, is Nigeria in any way up to  the task of containing a possible outbreak of Ebola?
I will say that the health staff – federal, state and the hospital where the case was admitted and the laboratory staff have performed creditably well. However, the detection of the case was purely fortuitous and not because we had our preparedness machinery in place. We should count ourselves lucky that the Liberian case came into Nigeria already sick and landed in Lagos too sick to continue his journey to Calabar.

He arrived at a time when our government hospitals were operating at “half mast” because the doctors were on strike. We might have had a bigger problem in our hands, assuming this case was well enough to get to Calabar – (in which case he would have mingled with more passengers at the local airport and in Calabar) or that government hospitals were in full operation, (in which case he would not have been admitted into a private hospital, where there are fewer contacts). So, I am saying we were able to detect the case through fortuitous circumstances and not because of our preparedness.

We were simply lucky. In spite of our national penchant for declaring ourselves always on top of the situation, we were plain lucky on this occasion, not because we were prepared. Next time, we may not be so lucky. We must, however, commend staff of the Federal and State Ministries of Health and of the private hospital where the case was admitted for being alert and   taking prompt action as soon as suspicion was raised. Another point about this issue which made me proud was the laboratory support within the country.

The lab in LUTH under Prof Omilabu received samples on July 22nd and the next day provided results of a pan-FILOVIRUS family diagnosis, that is evidence of presence of a virus belonging to the family of Ebola virus (including Marburg, Ebola-Zaire, Ebola-Sudan Bundibugyo virus, Reston virus, and Taï Forest virus).

Samples were also sent to Prof. Happi’s lab at the Redeemer’s University (RUN), late on July 23. The Happi team worked and tested and confirmed that the virus was the specific Ebola-Zaire type virus early on July 25, 2014. All these happened before confirmation came in from Dakar. I understand the RUN lab will commence sequencing studies pretty soon. My congratulations to our colleagues in LUTH and RUN for a great job.

What should we be doing currently that we are not in terms of (a) preparedness (b) response?
We are certainly not out of the woods yet, until we ensure that we monitor and ascertain that every of his contact is free from infection. We must trace all  the passengers in the plane that brought him to Nigeria, to those in contact with him at the Lagos airport, and  all those who attended to him,  in the hospital where he was treated.

Every such person must be monitored for the duration of the incubation period of Ebola virus infection that is up to 21 days from point of contact. We must get in touch with them on a daily basis to find out if they fall sick, with fever and showing the signs and exhibiting the symptoms of viral hemorrhagic fever. This must be carried out thoroughly, efficiently and rapidly. I repeat, we are not out of the woods yet.

One other issue we should take note of is to find out the itinerary of the ASKY flight that brought the case to Nigeria. Did the flight come direct from Liberia or were there stops on the way say, Lome, etc., and who had contact with the case.

We need to contact other countries where ASKY might  have landed and is still landing. I hear also that other airlines – Arik does direct Abuja-Monrovia-Freetown flights. If that is so, then we must also mount our surveillance not only on Lagos, but also on Abuja, Not forgetting Idi-Iroko, Seme borders.

In the event of detection of subsequent confirmed cases of Ebola, what would be the implication and how should we respond to such?
Any suspected case arising from new comers into Nigeria or should any of the contact of the Liberian case become ill, the case should be admitted immediately into a hospital with isolation facilities and barrier nursing instituted.

Isolation facilities
This is why the monitoring at the border must not be scaled down. So long as we are still having people coming in from the affected West African countries, we must be on top alert with our border monitoring.

Are there any issues regarding the hospital where the victim was admitted and eventually died?
I am very pleased to say that the staff of the private hospital acted professionally in every aspect of the treatment and eventual containment of the case. I understand that the hospital has been decontaminate and closed for a period of time.

What is your last word on this?
As I mentioned earlier, the detection of the case was purely fortuitous and not because we had our preparedness machinery in place. We should have had our border monitoring in place soon after we learnt of the first case in Guinea.

Again, so long as ASKY or any other airlines are bringing in passengers from Liberia, Sierra Leone or Guinea, our border monitoring must remain in place until the countries are declared free and for another 2-3 weeks after the declaration

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