The Nigerian Minister of Health, Prof. Onyebuchi Chukwu, disclosed at a press conference after the second emergency meeting of the National Council on Health (NCH) Monday in Abuja that the new case brought the total number of confirmed EVD cases to 17, with six deaths and 271 persons under surveillance - 72 in Lagos and 199 in Port Harcourt respectively.
He said: “As of 31st August, 2014, the total number of cases of EVD in Nigeria stands at 17. The total number of cases treated at the isolation ward in Lagos State stands at 13. The total number of those discharged is seven. The total number of deaths among those treated in Lagos is five, and the total number currently under treatment in Lagos is two and both patients are stable.”
The minister said the three confirmed cases not treated in Lagos were: a surviving primary contact of the index case, Mr. Patrick Sawyer, an Economic Community of West African States (ECOWAS) Commission official who became symptomatic, evaded surveillance in Lagos, travelled to Port Harcourt and infected his attending physician.
“Presently, he does not have viraemia but other laboratory tests for antibodies confirm that he had suffered from EVD. He is under quarantine in Lagos at the moment undergoing further tests to ensure he is totally free from the virus,” he said.
Chukwu said the second confirmed case not treated in Lagos was a private medical practitioner who was infected while treating the ECOWAS Commission official.
“He died from EVD. It was his death that led to the investigation that revealed the introduction of EVD to Port Harcourt and the beginning of contact tracing of secondary and third degree contacts in Port Harcourt. Arrangements are being made to decontaminate the body in readiness for proper disposal of his remains. His death brings to six the total number of persons who have died from EVD in Nigeria,” he said.
The third case not quarantined in Lagos, according to Chukwu, is a female patient who was on admission in the same hospital where the late Port Harcourt doctor was also admitted. The minister said she was under treatment in the isolation ward in Rivers State.
Chukwu said two other contacts of the late Port Harcourt doctor- one of the doctors who managed him and a pharmacy technician working in the late doctor’s hospital- are symptomatic and have been admitted in the isolation ward in Rivers State. “They have tested negative to the EVD but the laboratory tests will be repeated to reconfirm their status,” he said.
The minister further explained: “Now as of 31st August, 2014, the number of contacts under surveillance in Lagos stands at 72 while in Port Harcourt, the total number of contacts under surveillance stands at 199. There is nobody under surveillance in Enugu presently and no case of EVD in Enugu State. As of 31st August, 2014, 278 contacts in Lagos State had completed the 21 days surveillance and have been discharged from surveillance while in Enugu, all the six identified contacts have completed the 21-day observation period and have been discharged from surveillance. No contact in Port Harcourt has completed the 21-day observation period.”
Chukwu said it was likely that a few more contacts would develop the EVD especially in Rivers State before the country would see the last case of the disease. But, according to him, while it is encouraging that so far, all confirmed cases of EVD in Nigeria have their roots in the index case, Sawyer, great vigilance is required particularly at the country’s ports of entry to ensure the nation does not have cases of EVD from other sources other than the late Liberian diplomat.
The minister said the Lagos State Incident Management Committee had deployed a strong team in Rivers to work with the state government and that as the situation had been effectively managed in Lagos and Enugu, that of Port Harcourt would similarly be effectively managed.
Medical experts say doctors and nurses fighting the world’s biggest outbreak of the Ebola virus in West Africa should get incentives including better pay, insurance and access to the new Ebola drug ZMapp.
The hemorrhagic fever, spread through the blood, sweat and vomit of the sick, has killed more than 1,550 people since March, including more than 120 health workers. Many work long hours with no access to proper protective equipment.
On the strategies and action employed by the country in managing EVD, Chukwu said: “Our strategies for containing the EVD in Nigeria have remained the same, focusing on appropriate information, education and communication; sustaining our surveillance systems; provision and equipping of isolation wards/centres; provision of adequate care for confirmed cases; active and aggressive contact tracing; and reduction in harmful practices that promote the spread of the virus.”
The minister, however, said that in line with the resolutions of the last emergency NCH, the country had made the following progress: “We have further strengthened our Emergency Operations Centre in Lagos with support from the Dangote Foundation which has made available one hundred and fifty two million naira (NGN152 million) for the operations of the EOC. On our part, we have continued to ensure that workers at the EOC have requisite knowledge to stay safe while helping to keep track of and provide care for EVD patients. We have also ensured that the workers have been receiving their incentives.”
Chukwu said the Federal Government with support from development partners had now concluded plans to conduct two major trainings in all the states. He said the states were, however, expected to take these trainings down to the Local Government Areas (LGAs) with support from the development partners.
These trainings, according to Chukwu, are as follows: Training of Trainer (TOT) for health workers on the Ebola Virus Disease (EVD) outbreak and other Viral Haemorrhagic Fevers (VHFs); and TOT for state health educators on awareness creation, community sensitisation and mobilisation. Arrangement has been made to include the military and para-military in the training.
The minister also said the Nigeria Centre for Disease Control (NCDC) had received approval for the re-production of copies of the protocols and SOPs for management of EVD cases as well as protocol for submitting samples to the laboratories and burying of EVD victims. “These will be circulated shortly after this meeting to all the states,” he said.
Chukwu said the Federal Government considered it very important to have the right Personal Protective Equipment (PPE) in ensuring adequate protection for health care workers.
He explained: “We have also decided that all PPEs to be bought should be in line with specifications provided by the WHO. It was also decided that PPEs will only be procured from WHO recommended manufacturers/suppliers. WHO has already supplied us with over 6000 PPEs which we are currently using. However, we have already initiated discussions with the WHO for the procurement of 4000 basic PPEs and 500 Heavy Duty PPEs (for use by the morticians).”
Chukwu said the Federal Government had steadily been increasing the capacity to diagnose EVD. According to him, EVD can be diagnosed in the following locations: NCDC laboratory, Asokoro, Abuja; NCDC laboratory at Lagos University Teaching Hospital (LUTH), Lagos; NCDC laboratory at University College Hospital, Ibadan; Irrua Specialist Teaching Hospital Irrua, Edo State; Virology laboratory of Redeemers University, Ogun State; and the Irrua-based mobile laboratory which has now been relocated from Enugu to Port Harcourt.
The minister said plans were at an advanced stage to improve the following laboratories: NCDC laboratory at Aminu Kano Teaching Hospital, Kano; and NCDC laboratory at the University of Port Harcourt Teaching Hospital, Port Harcourt.
He said the Federal Ministry of Health planned to procure additional mobile laboratories to be based in the following locations: Abakaliki, Port Harcourt, Bauchi, Jos and Sokoto.
Chukwu disclosed that in addition to the support the Dangote Foundation was giving to the Ebola Emergency Operations Centre in Lagos, the foundation planned to support government’s efforts with whole body scanners to be deployed at ports of entry and exit. He said the United States government through its ambassador to Nigeria had earlier informed him that it would support Nigeria with 30 body scanners but they were yet to be delivered.
On the residency programme, Chukwu said: “Lastly, we are happy to report, as you all are aware, that the Nigerian Medical Association (NMA) has now suspended its strike as urged by council at its last meeting. Furthermore, following appeals by a number of Nigerians, the suspension of residency training programme in federal hospitals has been lifted and affected residents reinstated. The ongoing appraisal of the residency training programme will continue and a meeting of key stakeholders has been scheduled for Tuesday, 2nd September, 2014.”
Chukwu said following the Treatment Research Group (TRG)’s recommendation and in consultation with the National Agency for Food Drug Administration and Control (NAFDAC) and National Health Research Ethics Committee (NHREC), Nigeria had indicated interest to participate in the clinical trials for two candidate EVD vaccines and were considering a third that may be added to the list. “We have also applied for experimental drugs such as TKM-Ebola,” he said.
Chukwu said the TRG had submitted a detailed profile and brief on the oral antiviral agent, which the Japanese government had offered to make available to affected countries through the WHO.
He explained: “We are now considering this profile and brief to enable us to reach a final decision on making it available to our patients. Our initial knowledge of the agent is that it has been shown to have strong antiviral activity against the influenza virus. Following phases one and two human trials, it is now going through phase three clinical trials. It is shown to have strong antiviral property against Ebola Virus in vitro and in vivo. These and the fact that it is considered safe, having passed through phases one and two clinical trials, makes it a good candidate drug for use in emergency situations as the EVD.”
The Lagos State government confirmed progress in the effort to contain the deadly disease.
Governor Babatunde Fashola yesterday said a total of eight patients had so far been cleared as Ebola-free and discharged to go home while only two were still in the isolation centre undergoing treatment.
The governor, however, said that a number of suspected cases, with contacts traceable to the index case Sawyer were still under surveillance and closely monitored by the state health officials.
Receiving a consignment of Personal Protective Equipment (PPE) and other treatment accessories at the State House, courtesy of the Mobile Telecommunication Network Foundation (MTNF), Fashola said it was obvious that all the cases were traceable to Sawyer and therefore underscored the need for improved border control and hygiene nationwide.
He said: “What is most important now is managing our borders. We still have a lot of people going out and coming in. A lot of work needs to be done there. We must not drop the ball any more. Also of concern is what we do locally in terms of hygienic practices.”
He said that while Lagos residents could now heave a sigh of relief from panic earlier created by the disease, there were some socio-cultural practices that may have to change for public health reasons.
He gave an example: “How we treat dead bodies is very key. Some things must change; we cannot continue to bury people in the back of our homes. This is a time for cultural evaluation of ourselves because our cultural choices do have health consequences. This is the time for a rethink.
“I recall that when we passed the Cremation Law a couple of years ago, there was a lot of uproar. People were saying we wanted to start burning dead bodies, but we had to reassure people that it is a matter of choice. That facility has become very useful now to the benefit of hindsight. We must rethink how we live in order to prolong our collective lifespan.”
Fielding questions from reporters, Fashola hinted that the state last week received N200 million from the Federal Government in support of the effort to contain the disease.
Apparently grateful to the MTNF for their consistent support in the area of education and health, Fashola reflected that the main challenge in the containment effort was not lack of funds but of requisite medical specialties.
He said: “While we understand and fully appreciate the humanitarian concerns that have propelled this effort, the real problem is the sufficiency of experienced virologists and Ebola specialists in managing this.
“When the sub-region, as it where, is challenged on many fronts, that capacity phased out. That really is the problem. This time it is not a money problem, nor really equipment problem. It is a human capacity problem.”
But according to Fashola, there would be no need to panic because the disease is not a death sentence, as a lot of knowledge is being gained on a daily basis.
The state Commissioner for Special Duties, Dr Wale Ahmed, assured Lagos residents that eight people who had been cleared were discharged after satisfying standard procedure of such exercise.
He said that re-infection might not be completely ruled out in all patients, lamenting that some of the discharged patients had not been seen in the public for fear of stigmatisation. He added that plans were on the way to bring the survivors to the public, to celebrate them “for all of you to see that they are not dangerous.”
“The Ebola virus disease is not resident here. It has a reservoir in fruit bats and in corpses. The reservoir of infection is in corpses of somebody who died of it and in those bats. Because it resides in corpses, that is why we traced those corpses specially,” Ahmed said.
In line with the World Health Organisation protocol, the body of Enemuo , who is the first Ebola fatality case in Rivers State and others considered to be high-risk bodies in the University of Port Harcourt Teaching Hospital mortuary are to be buried this week in Port Harcourt under the supervision of Ministry of Health officials and WHO.
Meanwhile, the Movement for the Survival of the Ogoni People (MOSOP) has called on the three tiers of government to work concertedly to urgently implement an aggressive education and sensitisation of rural communities in Rivers State on the implications of the EVD as part efforts to prevent its spread in the region.
The Rivers State Commissioner of Health, Sampson Parker, revealed yesterday that an elderly woman who had been quarantined at Ebola isolation centre at Oduoha because she shared the same ward with Enemuo when he was ill and receiving treatment at the Good Heart Hospital, Port Harcourt had tested positive for the Ebola virus.
He also disclosed that a doctor and pharmacist who once worked with late Enemuo at Samsteel Hospital, Port Harcourt, tested negative for the Ebola virus and had been discharged from the quarantine centre.
Parker explained that irrespective of the fact that the doctor and pharmacist tested negative, health officials had placed them under surveillance. He stated that health officials still intended to conduct another round of test on them because they were still within the 21 days’ circle of the Ebola virus.
Enemuo’s sister who resided with him until his demise penultimate Friday, was said to have become symptomic and had been quarantined after she returned from Abia State.
He said: “The sister (of Dr. Enemuo) that just came back, all she complained of was fever and we just put her in. We are not saying she is positive. We will screen her so that she does not infect other persons. We still want to encourage those persons that we have not seen to come up.”
He disclosed that after a meeting with the Country Director of the WHO and the Director, the National Centre of Disease Control yesterday, it was resolved that Enemuo and other high-risk bodies in the UPTH mortuary would be buried this week according to WHO protocol. He insisted that none of the bodies, which had already been decontaminated would be allowed to leave Port Harcourt.
“So, any of the high-risk corpses they want to send to Ahoada, Okomoko or any other state, we will not allow it. They will be buried under supervision of the EOC, Ministry of Health officials and other government officials from the WHO and all the rest, so that we don’t expose the relations to danger. We have different cultures of burial ceremonies and we do not want to endanger anybody. We will take care of all the safety protocols ourselves. The families will be there but will not be allowed to touch the corpses,” he said.
Parker said security operatives were on the trail of some of the persons who had primary and secondary contacts with Mr. Koye Olu-Ibukun, an official of ECOWAS who allegedly brought Ebola virus to Rivers State and the late Dr. Enemuo. He explained that some of these persons had travelled to Akwa-Ibom, Abia and Imo States and were yet to be seen and screened.
While reiterating that Ebola was not a death sentence, he urged those identified to have had contact with the index cases to come forth and be tested. According to him, the state wants those who have been identified to have had contact with Ibukun and Enemuo, to voluntarily submit themselves for screening.
He said the state had already trained 500 personnel in preparation for the Ebola outbreak, while four local doctors and six expatriate doctors were managing persons quarantined at the Ebola isolation centre in Oduoha in Emohua local government area of the state.
He further said that the morticians who handled Enemuo’s body had been placed under surveillance.
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