West African Outbreak

On 25 March 2014, the World Health Organization (WHO) reported that Guinea's Ministry of Health had reported an outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths had been reported as of 24 March.^[3]

Researchers generally believe that a one-year-old boy,^[4] later identified as Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea, was the index case of the Ebola virus disease epidemic.^[5][6] His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages.^[7][8]

Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.^[6][7]

Index Case

The index case in Nigeria was a Liberian-American, Patrick Sawyer, who flew from Liberia to Nigeria's most populous city of Lagos on 20 July 2014.^[9] Sawyer became violently ill upon arriving at the airport and died five days later.^[10] In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country.^[11][12][13]

Sawyer was believed to have suspected he was infected with Ebola because he cared for his sister who died of the disease on July 8, he was hospitalised in Monrovia for fever and Ebola symptoms on July 17 before discharging himself (against professional medical advice) to fly to Lagos, where he lied to the staff of First Consultants Medical Centre that he had not had any exposure to anyone that had contracted Ebola.^[14][15]

Subsequent Transmission

On 6 August 2014, the Nigerian health minister told reporters, "Yesterday the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward."^[16] The nurse was Obi Justina Ejelonu.

The doctor who treated Sawyer, Ameyo Adadevoh, subsequently also died of Ebola.^[17]

Others that died included Mrs Ukoh (a Ward Maid at First Consultants Medical Center), Jato Asihu Abdulqudir (an acquaintance of Sawyer, who was on the plane with him and carried his bag when he was ill), a private hospital doctor in Port Harcourt who was treating Jato and an elderly patient at the hospital that treated the private hospital doctor for Ebola.^[18]

On 22 September 2014, the Nigeria health ministry announced, "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days." According to the WHO, 20 cases and 8 deaths had been confirmed, including the imported case, who also died.^[19] Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance.^[20]

Outbreak successfully contained

Nigerian health care workers at a training event, August 2014

On 9 October 2014, the European Centre for Disease Prevention and Control (ECDC) acknowledged Nigeria's positive role in controlling the effort to contain the Ebola outbreak. "We wish to thank the Federal Ministry of Health, Abuja, Nigeria, and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria." Nigeria's quick responses, including intense and rapid contact tracing, surveillance of potential contacts, and isolation of all contacts were of particular importance in controlling and limiting the outbreak, according to the ECDC.^[21] Complimenting Nigeria's successful efforts to control the outbreak, "the usually measured WHO declared the feat 'a piece of world-class epidemiological detective work'."^[22]

The WHO's representative in Nigeria officially declared Nigeria to be Ebola free on 20 October after no new active cases were reported in the follow-up contacts, stating it was a "spectacular success story^[23]".^[24]

Relief contributions to West Africa

On 14 August 2014 the Nigerian government said Aliko Dangote have donated $1 million to halt the spread of the Ebola virus outbreak.^[25] On 5 November 2014 volunteer medical workers arrived in Liberia and Sierra Leone from Nigeria. The first arrivals included 100 volunteers in Freetown, Sierra Leone and a further 76 in Liberia. Nigeria announced it would send 600 volunteers to help stem the spread of the disease.^[26]