An Account of the Ebola Virus Disease Outbreak in Nigeria: Implications and Lessons Learnt
Authors: Akaninyene Otu, Soter Ameh, Egbe Osifo-Dawodu, Enoma Alade, Susan Ekur, and Jide Idris
This study describes the events of the 2014 outbreak of the Ebola virus disease in Nigeria and evaluates the containment efforts. After quickly detecting an outbreak, the government traced contacts, offered incentives for medical volunteers, sent all cases to one hospital, and set up an Ebola Operations Center to manage the response. The center in turn sought help from international organizations. The government, which had already done extensive work educating the community, stepped up its efforts during the outbreak, working with the media to make sure the public always had up-to-date, accurate information. Overall, the country’s health system was geared more toward curative care than preventive medicine, but the fact that the Nigeria Centre for Disease Control had already begun training 100 doctors in epidemiology may have mitigated these weaknesses.
Nigeria’s Ebola Outbreak Response: Lessons for Future Epidemic Preparedness
Authors: Emmanuel Musa, Abdulsalam Nasidi, and Faisal Shuaib
In response to a 2014 Ebola outbreak in Lagos and Port Harcourt, Nigeria, the government activated an Ebola Emergency Operations Center, set up an alert and rumor management system, established treatment centers in both cities, tightened screening at ports of entry, and sent trained community mobilizers from house to house to increase awareness. Although some challenges with implementing proper treatment led to needless loss of life, Nigeria had developed excellent epidemiology systems and increased lab capacity in response to previous outbreaks, and the country was able to contain the epidemic effectively.
Managing Ebola from Rural to Urban Slum Settings: Experiences from Uganda
Authors: Sam I Okware, Francis Omaswa, Ambrose Talisuna, Jacinto Amandua, Jackson Amone, Paul Onek, Alex Opio, Joseph Wamala, Julius Lubwama, Lukwago Luswa, Paul Kagwa, Thorkild Tylleskar
This study compares five Ebola outbreaks in Uganda between 2000 and 2012. Because of early detection, an outbreak in Luwero District was contained in the first week. Detection was delayed in the other outbreaks, however, because many conditions in Uganda mimic Ebola and so community-based surveillance is challenging. The four rural outbreaks were much more easily contained than the urban outbreak, not only because of population density but also because informal settlements may lack the community spirit and social support often present in rural communities. The outbreak in Guru lasted the longest, but over time treatment measures and health care worker confidence both improved, leading to a case fatality rate reduction from 100 percent to 50 percent.
From SARS in 2003 to H1N1 in 2009: Lessons Learned from Taiwan in Preparation for the Next Pandemic
Authors: M.-Y. Yen, A.W.-H. Chiu, J. Schwartz, C.-C. King, Y.E. Lin, S.-C. Chang, D. Armstrong, P.-R. Hsueh
After the SARS epidemic in 2003, Taiwan made major changes to its preparedness and response systems. They began annual inspections of hospitals, provided incentives for health care workers to vaccinate against influenza, established six Communicable Disease Control Networks across the city, prepared isolation hospitals, developed a new warning-phase system, instituted new surveillance and reporting protocols, stockpiled medication, and began an ongoing program to train medical personnel. When the H1N1 pandemic struck, these investments enabled the country to swiftly detect and contain the disease; as soon as a vaccine was developed, a campaign targeting health care workers, refugees in communal shelters, and children increased the likelihood of preventing another H1N1 outbreak.
Response to the First Wave of Pandemic (H1N1) 2009: Experiences and Lessons Learnt from China
Authors: W. Liang, L. Feng, C. Xu, N. Xiang, Y. Zhang, Y. Shu, H. Wang, H. Luo, H. Yu, X. Liang, D. Li, C.-K. Lee, Z. Feng, Y. Hou, Y. Wang, Z. Chen, W. Yang
In 2009, before H1N1 reached China, officials set up a response planning committee. By the time the first case was confirmed, they had already developed diagnostic kits. Tightened screening at airports and isolation slowed transmission, buying time to improve surveillance, train health care workers, and develop medicines. China contained the pandemic effectively by reserving specific hospitals, training doctors, and triaging hospital services. It also treated effectively, providing medication to all high-risk close contacts, strengthening facilities and stocks in poor areas, and making sure ethnic minorities and rural areas had access to medical relief and social security systems. Though manufacturing capability was small, China partnered with the World Health Organization to manufacture a vaccine and began a massive immunization campaign to prevent future outbreaks.
Imported Case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection from Oman to Thailand, June 2015
Authors: T Plipat, R Buathong, S Wacharapluesadee, P Siriarayapon, C Pittayawonganon, C Sangsajja, T Kaewpom, S Petcharat, T Ponpinit, J Jumpasri, Y Joyjinda, A Rodpan, S Ghai, A Jittmittraphap, S Khongwichit, DR Smith, VM Corman, C Drosten, T Hemachudha
In this case, the hospital faced initial challenges in both detection and containment but ultimately prevented an outbreak through extraordinary international cooperation. Detection was hampered by two false negative diagnostic tests using nasopharyngeal swabs. The patient was released from presumptive isolation on the basis of these results but returned immediately when an analysis of a sputum sample came back positive. This delay led to more complex contact tracing efforts; ultimately more than 200 contacts were identified, ranked by risk, and followed up. High-risk contacts in Thailand were quarantined, tested twice daily, and released only on the twelfth day after a negative test. The contact tracing involved steps ranging from viewing surveillance footage from a hotel in Bangkok to testing a herd of camels in Oman.
Zero Transmission of Middle East Respiratory Syndrome: Lessons Learned From Thailand
Authors: Surasak Wiboonchutikul, Weerawat Manosuthi, and Chariya Sangsajja
The authors, staff at Bamrasnaradura Infectious Diseases Institute (BIDI), survey the range of steps BIDI has taken to prevent hospital-based, or cosonomial, transmission of disease. These measures have paid off with successful treatment of three imported MERS cases and no cosonomial transmission. Following the SARS epidemic in 2003, BIDI created appropriate infrastructure and protocols. To improve detection and containment, BIDI trained staff to screen patients presenting with acute respiratory infection, built negative-pressure isolation rooms for patients flagged at screening, and built a biosafety level 2 laboratory for rapid, safe diagnosis. Despite uncertainties about precisely how MERS spreads, BIDI adheres to the strictest protocols, including precautions against airborne and fomite (via inanimate objects like doorknobs) transmission.
Lack of SARS Transmission among Public Hospital Workers, Vietnam
Authors: Le Dang Ha, Sharon A. Bloom, Nguyen Quang Hien, Susan A. Maloney, Le Quynh Mai, Katrin C. Leitmeyer, Bach Huy Anh, Mary G. Reynolds, Joel M. Montgomery, James A. Comer, Peter W. Horby, and Aileen J. Plant
During the treatment phase of Vietnam’s outbreak, patients were seen at two hospitals. In Hospital A, the disease spread from patients to staff and visitors—what is known as cosonomial transmission. In Hospital B, however, there was no cosonomial transmission. This paper, which seeks to explain this difference, offers several hypotheses, including: the presence of a “super spreader” at Hospital A; more severe disease in Hospital A requiring more aggressive respiratory intervention; less consistent use of personal protective equipment in Hospital A; more close contact with patients in Hospital A due to differences in nursing style; and poorer air circulation in Hospital A’s smaller, air-conditioned rooms.
SARS Transmission among Hospital Workers in Hong Kong
Authors: Joseph T.F. Lau, Kitty S. Fung, Tze Wai Wong, Jean H. Kim, Eric Wong, Sydney Chung, Deborah Ho, Louis Y. Chan, S.F. Lui, and Augustine Cheng
This study compares a group of 72 hospital workers who contracted SARS to a control group of 144 co-workers who had similar hospital experiences but did not contract SARS, suggesting some key factors contributing to transmission. All hospital workers wore masks, but those who became infected were less likely to wear other kinds of protective equipment (e.g., gloves, goggles, gowns, and caps) consistently and to undergo at least two hours of training in infection control. Close contact with SARS patients was not a significant factor, suggesting that adequate knowledge of infection control and use of personal protective equipment can keep hospital workers safe even in high-risk situations.
Epidemiology and Control of SARS in Singapore
Authors: Kee-Tai Goh, Jeffery Cutter, Bee-Hoon Heng, Stefan Ma, Benjamin KW Koh, Cynthia Kwok, Cheong-Mui Toh, Suok-Kai Chew
SARS was imported into Singapore in late February 2003 and spread from the hospital to which the first patient was admitted to four other hospitals; 90 percent of cases occurred in health care and household settings. The disease spread quickly, partially because no one knew it was so infectious and because the public health system did not have enough personal protective equipment or staff to do epidemiological investigation and contact tracing. However, once the extent of the outbreak was clear, strong political leadership, effective coordination, dedicated health care workers, and strong community support allowed for the quick containment of the disease.