A public lecture at a medical conference and symposium during the Ebola Virus Disease Outbreak Response in Nigeria, 2014

1. Ebola Virus Disease
Outbreak: the Facts,
Response & Way
Forward.
Dr. Abraham Idokoko
Ebola Emergency Operations Centre (EEOC),
Lagos.

2. 2

3. Yearly trend of Emergence of New Infectious Diseases
• Globally, an average of one
new infectious disease has
emerged each year.
3
• Most are zoonoses

4. WHO HAZARD GROUP 4 VIRUSES OF CONCERN TODAY
• EBOLA
• MARBURG
• LASSA
• They are naturally zoonotic
• Transmitted directly from person to person
• Persons at high risk are workers engaged in the diagnosis of the
disease and the care of patients HEALTH WORKERS

6. Evolution of the current EVD Outbreak
Vast spatial distribution
2 December 2013
Guekedou, Guinea
17 - 31 March 2014
Monrovia, Liberia
17th April, 2014
Freetown, S/Leone
65 sites within 6 months
30 August 2014 Senegal
20 July 2014,
Lagos & Port Harcourt,
Nigeria26 August 2014
Democratic
Republic of Congo

7. EVD SitRep as at 22 September 2014
Country
TOTAL HCW
Cases Deaths CFR (%) Cases Deaths CFR (%)
Guinea 1008 632 62.7 67 35 52.2
Liberia 3022 1578 52.2 174 85 48.9
Sierra Leone 1813 593 32.7 96 61 63.5
Nigeria 20 8 40.0 11 5 45.5
Senegal 1 0 0 0 0 0
Congo DR 68 41 60.2 8 8 100
Total 5864 2852 48.6 356 194 54.5

8. Who is an Ebola Contact?
A person without any symptoms who has had physical contact with
a case or the body fluids of a case within the last three weeks.
The notion of physical contact may be proven or highly suspected
such as having shared the same room/bed, cared for a patient,
touched body fluids, or closely participated in a burial (physical
contact with the corpse).

9. A Suspected Ebola Case Definition
 Any person, alive or dead, who has (or had) sudden onset of high fever and had contact
with a suspected, probable or confirmed Ebola case, or a dead or sick animal OR
 Any person with sudden onset of high fever and at least three of the following
symptoms: headache, vomiting, anorexia / loss of appetite, diarhoea, lethargy, stomach
pain, aching muscles or joints, difficulty swallowing, breating difficulties, or hiccups; OR
 Any person with unexplained bleeding OR
 Any sudden, unexplained death
The distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.

10. A Probable Ebola Case Definition
Any suspected case evaluated by a clinician OR
Any person who died from ‘suspected’ Ebola and had an
epidemiological link to confirmed case but was not tested and did
not have laboratory confirmation of the disease
The distinction between a suspected case and a probable case in practice relatively
unimportant as far as outbreak control is concerned.

11. A Confirmed Ebola Case Definition
A probable or suspected case is classified as confirmed when a
sample from that person test positive for Ebola Virus in the
Laboratory
The distinction between a suspected case and a probable case in practice relatively unimportant as far as
outbreak control is concerned.

12. Challenges of this Outbreak
First complex mix transmission pattern : Rural, Urban,
Cross-border outbreaks
Unusual number of health care workers among the
cases and deaths [health facilities serving as amplifier
of the EVD]
Community resistance, strong traditional beliefs and
cultural practices fuelling the outbreak

13. The Facts
about Ebola
Virus
Disease?

14. Ebola Virus
• Virus:
– Begins in animals
– Infect humans
– Human-to-human infection
(outbreak)
• Discovery in 1976
– Yambuku, Zaire along Ebola River
14

15. Reservoir Unknown
• Bats?
• Birds?
• Insects?
• Plants?
• Primates

16. Where Does it Come From?
• Not entirely clear, but likely bats
16

17. Where Does it Come From?
• Bats may infect other animals
17

18. Where Does it Come From?
• Any of these can infect humans
18

19. Where Does it Come From?
• Once a human is infected, it can spread from
this person to other human beings
19

20. Quiz
Please, answer TRUE or FALSE?
Can Ebola be passed from person to person through the air?
20

21. Quiz Answer
21
Answer = FALSE!
Ebola is only transmitted through:
• Touching body fluids (blood, urine, vomitus, sweat, saliva, breastmilk,
semen, etc.) of a person who is sick with or has died from Ebola
• Touching or using objects contaminated with Ebola

22. Human to Human Transmission
• Ebola is transmitted
through
– Touching body fluids of
a person who is sick
with or has died from
Ebola,
– Touching or using
objects contaminated
with Ebola
22

23. Signs of Ebola Virus Disease
• Signs generally begin 2-21 days after contact
with a person who is sick with Ebola
– Most commonly 1-2 weeks
– People who do not show signs of disease cannot
spread the disease
23

24. Signs of Ebola Virus Disease
• General:
– Fever, headache, chills, weakness,
tiredness
• Gastrointestinal symptoms:
– Vomiting, diarrhea, abdominal pain
• Possible other symptoms:
– Sore throat, hiccups
24

25. Other signs of Ebola Virus Disease
• Redness in the whites of the eyes
• Rash on the trunk
• Bleeding in 45% of cases (historically)
– Mild: nose bleed, bruising
– Severe: gastrointestinal bleeding, shock
25

26. Ebola shares symptoms with many
diseases!
• Malaria
• Typhoid fever
• Cholera
• Hepatitis
• Meningitis
• Shigellosis
• plague
• Other viral hemorrhagic fevers (e.g., Lassa, YF)
• Most people sick with fever, vomiting, and diarrhea do not have Ebola
26

27. Care of Ebola Patients
• Not all patients with Ebola will die!
• Several Nigerian Patients have survived
• Patients who recognize the symptoms early and seek
immediate medical care have a better chance of recovery
• Ebola treatment centres provide the best care for
patients with Ebola
• Friends and Family should alert health authorities
immediately Ebola infection is suspected
• On no account should anyone attempt to care for Ebola
patients on their own without the health authorities
27

28. Recovering patients
• Remain weak for a long time & will need rest
• Need good food, safe water, love and the support of family,
friends and the community
• Once a doctor determines that a patient has recovered, it is
safe for the patient to go home and return to work!
28

29. Handling of the Dead
• Do not touch dead bodies
if you think they died of
Ebola
• You can easily get Ebola
from the bodies of people
who have died from Ebola
29
This is
unacceptable
& Fatally
dangerous

30. Health authorities work with the
communities in handling the dead bodies
To ensure Safe Burial rites – & Safe burial kits

31. The EVD Response
in Nigeria:
A peep into
Emergency
Operations Centre

32. 32

33. Ebola
Emergency
Operations
Centre
(EEOC)
POE
Epidemiology,
Contact
Tracing and
Surveillance
Social
Mobilization
and
Communicatio
ns
Case
Management,
Infection
Control &
Prevention
Operational
Research

34. 34

35. Moving
Forward in
Nigeria

36. EVD Realities in Nigeria as at Today
• NO known confirmed case within our borders
• No suspected case
• No probable case
• All known contacts are under surveillance
• No localised community transmission
• All known cases and contacts linked to the imported index case
• The only cause for concern remain the deteriorated situation in
Liberia, Sierra Leone, Guinea and DRC 36

37. Moving Forward: What must we do?
• Maintain Alertness, Awareness and re-enforce key messages among the
general public
• Sustain Surveillance of EVD in all our communities
• Strengthen Port health Capacity at all POE
• Strengthen the Infection Control and prevention practices of Health care
workers
• Research.! Research.!! Research..!!!
37

38. For further information on EVD or to report a suspected case,
please contact:
0800 EBOLA HELP
0800 32652 4357
Ebola.mobilizers@gmail.com
www.ebolaalert.org

39. Email: abrahamidokoko@yahoo.co.uk

40. Acknowledgements
• All material owned by the partners on the EEOC
• FMOH
• NCDC
• WHO
• CDC
• MSF
• UNICEF
• UNFPA