The news of the virus reaching the country is assuming an alarming pace since the first recorded incidence appeared in neighbouring West African countries of Guinea and Liberia. The alarm was also on Friday raised in nearby Ghana where Nigerians throng to on a daily bases for business and vacation raising questions on Nigeria’s vulnerability to the devastating virus that claimed 111 lives with at least 101 people dying from the bleeding disorder in Guinea and 10 people in neighboring Liberia according the World Health Organisation (WHO).
The World Health Organisation said early this week that it expects the deadly virus spread to continue for several more months in West Africa.
With several cases of Ebola reported in Mali, Gambia, Ghana and Sierra Leone, West Africa is seeing the most challenging outbreak since the disease was discovered 38 years ago.
“This is one of the most challenging Ebola outbreaks we have ever faced,” Keiji Fukuda, assistant director-general, WHO said.
More worrisome is the fact that Ebola hemorrhagic fever is one of the deadliest viruses known to mankind, killing around two-thirds of those who contract the disease. While the most severe cases of the illness have a 90 percent fatality rate, there is no vaccine, cure or specific treatment.
New figures released by the WHO on April 8 indicate there have been 157 suspected cases, including 101 deaths recorded. In Liberia, there have been 21 cases, including 10 fatalities, of which five have been confirmed as Ebola. Mali has seen nine suspected cases, with tests so far showing two of them did not have the virus. Also, one death has been recorded in Ghana after the outbreak started.
The global health body has however not recommended any travel or trade restrictions to Guinea, Liberia, Mali or Sierra Leone based on the current information available.
Other countries across West Africa are bracing against the epidemic, with Senegal closing its border with Guinea. The situation is especially worrying for the country, which depends on the tourist heavily industry, with 1 million visitors in 2011.
Meanwhile, the Federal Government on Wednesday admitted that Nigeria was in danger with the rate at which the Ebola Virus Disease (EVD) had been moving eastward towards the country. Speaking after the Federal Executive Council (FEC) meeting, Onyebuchi Chukwu, minister of health, raised alarm that the threat being posed by the Ebola virus was real.
Though Nigeria had not reported any case of Ebola, the minister warned Nigerians not to wait for three days as customary of malaria fever before seeking medical attention, saying such a period was enough for an infected person to die.
According to Chukwu “Ebola has been moving eastward towards Nigeria as well and we are already facing danger from the Central African Republic, even with what is happening in Congo, people are also migrating to Chad and Cameroon are also in our borders. So, Nigeria is in danger but we have recently said that in addition to the leaflets that we are producing for Lassa and other fevers, we will now emphasise Ebola fever.”
Ebola was first discovered in 1976 in the Democratic Republic of Congo (formerly Zaire). The virus is named after the Ebola River where one of the first recorded outbreaks occurred.The largest-ever outbreak was in 2000-01 in Uganda, with 425 cases, about half of whom died, according to WHO estimates
Experts’ concern
Nigeria is at risk of Ebola epidemic if the Federal Government does not act fast to secure the nation’s borders and prevent entry of the deadly virus, which is characterised by sudden onset of fever, intense weakness, muscle pain, sore throat and death. These fears are borne out of latest outbreaks of the virus in neighbouring West African countries.
“Anywhere you have movement of people from one location to the other. The likelihood of having the virus spread is high. That calls to attention the need for us to check our borders,” said Osahon Enabulele, president, Nigerian Medical Association (NMA).
Pointing out that the virus is highly infectious and has no known cure, Enabulele revealed that when contracted, the virus must be detected quickly and supportive measures made to ensure the affected person is rehydrated. He explained that the incubation period, that is, the time interval from infection with the virus to onset of symptoms, is two to 21 days.
“More often than not, when there are movements of people from the affected countries, especially when you have a very defective, weak surveillance system at the entry points – land, air and sea – people from infected regions or localities can be given access into your country. That leads to the possibility of having it spread into new territories, especially if there is contact with those infected persons.
“If those surveillance mechanisms are not on ground and if the level of suspicion is not high, then you could have an infected person coming into your environment. An Ebola patient will start manifesting the symptoms no more than 25 days after he contracts the virus,” he said.
Innocent Ujah, director-general, Nigerian Institute for Medical Research (NIMR), Yaba, Lagos, explained that although there was as yet no specific treatment for Ebola virus, emphasis should be on maintaining high environmental and personal hygiene in the country.
“With the absence of effective treatment and human vaccine, there is the need to raise awareness of the risk factors for Ebola infection and protective measures individuals can take. That is the only way to reduce human infection and death.
“Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. There is presently a laboratory at Lagos University Teaching Hospital (LUTH), Idi-Araba, that can isolate Ebola virus,” Ujah said.
Studies have shown that the virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission, with fruit bats of the Pteropodidae family considered to be the natural host.
Halting EVD
Acknowledging that Nigeria is in danger, the minister of health said that in addition to the leaflets produced for Lassa and other fevers, that of Ebola fever is also emphasized.
“As I speak to you, we have already approved four jingles to be produced in various languages for the Nigerian Centre for Disease Control to be aired on radio and television stations and newspaper adverts. Then we are working with all groups, just like we are doing for polio. Religious bodies, communities, traditional rulers and the media which is most important in this venture will help us to play your role by educating Nigerians.
“There is no vaccine, so it is not a question of government has not produced vaccines for Ebola or Lassa fever. If there was vaccine, government will certainly buy a stock and keep; and there is no specific treatment.”
Chukwu explained that while a special type of rat spreads infection for Lassa fever, bats, he said, were responsible for Ebola. He said one could be infected by eating fruits that had been contaminated with the virus by bats, urging Nigerians to apply personal hygiene.
“The first thing I do after returning from work is to wash my hands before hugging my children or anybody. It is very important. The second thing is that before you eat, wash your hands again. The fruits must be washed; those things we eat from must be washed.
“We will soon review our adverts for things like anti-malaria because they still say if you have fever, take this for three days. If you don’t improve, go and see your doctor. But we are changing all that because now if you wait three days for Ebola, you are dead,” the minister added.
Jide Idris, Lagos State Commissioner for Health, noted that Lagos State Government in collaboration with Federal Ministry of Health is putting measures in place to prevent its entry and spread in the country. These measures, Idris explained, include sensitization of health workers, active search for cases of the disease and continuous sensitization of the public.
Ebola drug pipeline
Since Ebola virus was identified in humans by scientists in 1976, pharmaceutical researchers are yet to develop an effective drug or vaccine to combat. Experts believe that immense difficulty, lack of financial incentive among drugmakers and high cost of conducting human clinical trials for a potential drug or vaccine are some issues slowing the development of treatments and vaccines for Ebola.
While Ebola cases are generally far flung, rare and unpredictable, some scientists see the current outbreak of Ebola in Guinea as an opportunity to push the field forward and test potential vaccines or drugs.
Part of the problem is that the deadly virus is rare and its victims are often poor people living in rural areas of Africa without well-functioning health systems. There is also little incentive for major pharmaceutical companies to invest in medical solutions when there is little chance of a return. The number of doses sold is likely to be small.
Health officials believe the virus and its death toll could be better controlled with good basic hygiene and the eradication of dangerous bushmeat consumption.
“We can do basic research quite cheaply, but when you move from that to trying to develop drugs and vaccines, you get into the need for clinical trials and they are very costly – which is where you would normally start to engage with Big Pharma. Clearly, they are not going to invest unless there is likely to be some sort of decent return,” Jonathan Ball, a professor of molecular virology at Britain’s University of Nottingham explained.
While there is little commercial future in Ebola for drugmakers, some research groups in the United States are working in conjunction with the U.S. government to find treatments.
In March 2014, University of Texas and three other organizations got $26 million in funding from United States National Institutes of Health to find a cure for Ebola and another deadly virus Marburg in case they are ever used for bio-terrorism in the United States.
Tekmira Pharmaceuticals, which teamed up with United States Department of Defense on an injectable drug treatment for Ebola, started an initial Phase I trial in healthy volunteers in January. Several small biotech companies and U.S. university departments are also developing potential vaccines, but this work has yet to advance from animal studies into clinical trials in humans – so any use in people now would be very risky.
U.S.-based Inovio and privately held Vaxart are among those with experimental vaccines in animal testing, while GlaxoSmithKline last year acquired Swiss vaccine firm Okairos with an early-stage Ebola product.
“There are a few experimental vaccines, but the question is whether anybody would take on the costs of manufacture based on the likely number of doses they would eventually sell. The numbers of people infected are low, and at the end of the day somebody has to fund the production of a drug or vaccine. As things stand that is unlikely,” Ian Jones, a professor of virology at Reading University pointed out.
History of Ebola
First appearing in 1976 in 2 simultaneous outbreaks-in Nzara, Sudan and Yambuku, Democratic Republic of Congo, Ebola virus is introduced into the human population through close contact with blood, secretions, organs or other bodily fluids of infected animals.
In Africa, infection has been documented through handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill/dead in the rainforest.
The virus spreads through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Studies show that EVD is a severe acute viral illness often characterized by sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function.
In some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes. The incubation period (the time interval from infection with the virus to onset of symptoms) of the virus is 2 to 21 days.
With several vaccines being tested and none available for clinical use, severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.
In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and protective measures individuals can take is the only way to reduce human infection and death, Ujah pointed out.
Beside clinical management, calls have been made for WHO, Ministry of Health and other partners to implement measures to respond to outbreak, contact tracing, disease surveillance, laboratory work, logistics, information-sharing and communication for effective response.
Alexander Chiejina
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