Over time, the world has battled life-threatening viruses and diseases. Smallpox is an example of a disease which caused over 300 million deaths across the globe. Thankfully, in 1980, the World Health Organisation declared that smallpox had been eradicated.
More recently were the Ebola virus and poliomyelitis, otherwise known as polio. The virus targeted infants and children below the age of five years across the world. At its peak in the 1940s and 1950s, polio killed and paralysed over half a million people worldwide annually. However, today, alongside the WHO, Rotary International among others have been at the forefront of eradicating polio. On August 25, 2020, Nigeria became the last country in Africa to be certified free from wild polio, after the continent’s last case was reported in Borno State, in 2016, which leaves Afghanistan and Pakistan as countries with the virus on earth.
Nigeria as a country has had its fair share of deadly diseases and viruses ranging from polio, Ebola, Lassa fever, and more recently, monkeypox and the Marburg virus which has put the nation’s health department on high alert.
On March 23, 2014, the WHO reported cases of Ebola in the forested rural region of southeastern Guinea. The identification of the early cases marked the dawn of the West Africa Ebola epidemic, the largest in history.
On August 8, 2014, WHO declared the deteriorating situation in West Africa a Public Health Emergency of International Concern, designated only for events with a risk of potential international spread or requiring a coordinated international response. Reports noted that over the duration of the epidemic, EVD spread to seven more countries which included Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States. Later secondary infection, mainly in a healthcare setting, occurred in Italy, Mali, Nigeria, and the United States. The PHIEC was later lifted in March 2016.
Ebola had a significant impact on the world and most especially in West Africa where a total of 28,616 cases were reported and 11,310 deaths were recorded in Liberia, Guinea and Sierra Leone alone; being countries with the widespread transmission. A total of 28,652 cases were recorded globally with 11,325 deaths while Nigeria recorded 20 cases with eight deaths.
WHO reported that in Nigeria, from 3 to 30 January 2022, 211 laboratory-confirmed Lassa fever cases including 40 deaths; denoting a case fatality ratio of 19 per cent, was cumulatively reported in 14 of the 36 Nigerian states and the Federal Capital Territory across the country. Of the cases, five deaths were reported among health workers in two of the states.
Lassa fever is said to be endemic in Nigeria and its annual peak cases in the country are during the dry season of between December and April. Thus, the infection is said to rise every dry season in the country.
In June 2022, the Nigeria Centre for Disease Control stated that from January to June, 62 cases of monkeypox were confirmed in 18 states and the Federal Capital Territory.
The African Union Centre for Disease Control and Prevention reported that since the beginning of 2022, 1,715 cases (1,636 suspected; 79 confirmed) and 73 deaths (case fatality ratio: 4.3 per cent) of monkeypox were reported from eight endemic and two non-endemic African Union Member States. The report further noted that during COVID-19 pandemic (February 2020 to date), Africa documented 12,141 cases and 363 deaths of monkeypox. The number of cases has continued to rise on the continent.
Meanwhile, another deadly and extremely dangerous virus, the Marburg virus disease was said to have been reported in Ghana, a west-African country where Nigeria shares a maritime border.
The development made the Federal Government to place the nation’s Ministry of Health’s Port Health Services at the country’s borders on red alert following Ghana’s confirmation of its first outbreak of the highly infectious Marburg virus.
In a statement to our correspondent by the WHO on July 17, Ghana announced the country’s first outbreak of Marburg virus disease, after a WHO collaborating centre laboratory confirmed earlier results.
The statement added that the Institut Pasteur in Dakar, Senegal, received samples from each of the two patients from the southern Ashanti region of Ghana – both deceased and unrelated – who showed symptoms including diarrhoea, fever, nausea and vomiting.
It stated, “The laboratory corroborated the results from the Noguchi Memorial Institute for Medical Research, which suggested their illness was due to the Marburg virus. One case was a 26-year-old male who checked into a hospital on 26 June 2022 and died on 27 June. The second case was a 51 -year-old male who reported to the hospital on 28 June and died on the same day. Both cases sought treatment at the same hospital within days of each other.’’
“WHO has been supporting a joint national investigative team in the Ashanti Region as well as Ghana’s health authorities by deploying experts, making available personal protective equipment, bolstering disease surveillance, testing, tracing contacts and working with communities to alert and educate them about the risks and dangers of the disease, and to collaborate with the emergency response teams. In addition, a team of WHO experts will be deployed over the next couple of days to provide coordination, risk assessment and infection prevention measures.
“Health authorities have responded swiftly, getting a head start preparing for a possible outbreak. This is good because without immediate and decisive action, Marburg can easily get out of hand. WHO is on the ground supporting health authorities and now that the outbreak is declared, we are marshalling more resources for the response,” Dr Matshidiso Moeti, WHO Regional Director for Africa, was quoted as saying in the statement.
The WHO further said that more than 90 contacts, including health workers and community members, had been identified and being monitored.
The organisation described Marburg as a highly infectious viral haemorrhagic fever in the same family as the more well-known Ebola virus disease.
It said, “It is only the second time the zoonotic disease has been detected in West Africa. Guinea confirmed a single case in an outbreak that was declared over on 16 September 2021, five weeks after the initial case was detected.
“Previous outbreaks and sporadic cases of Marburg in Africa have been reported in Angola, the Democratic Republic of the Congo, Kenya, South Africa and Uganda. WHO has reached out to neighbouring high-risk countries and they are on alert.
“Marburg is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials. Illness begins abruptly, with high fever, severe headache and malaise. Many patients develop severe haemorrhagic signs within seven days.
“Case fatality rates have varied from 24 per cent to 88 per cent in past outbreaks depending on virus strain and the quality of case management. Although there are no vaccines or antiviral treatments approved to treat the virus, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves survival. A range of potential treatments, including blood products, immune therapies and drug therapies, as well as candidate vaccines with phase 1 data are being evaluated.’’
On Wednesday, the Kano State Government disclosed it recorded five Cholera-related deaths in the state, adding that strong preventive measures were taken to tackle the outbreak. The state noted that 189 cases were recorded in 20 Local Government Areas of the stare, out of which 184 had fully recovered, 0 active case and five deaths.
Commenting on the multiple diseases the country was battling, Head of Department, Community Medicine, University of Osun Teaching Hospital, Dr Kunle Salami, noted that an approach needed by the government was to have experts from related fields to work together in curtailing the outbreak of diseases in Nigeria.
He said, “The Federal Government needs to put adequate surveillance in place to look out for some of the diseases. If that is available, there will be an adequate response immediately when we have looming diseases. There should be minimal contact between humans and animals. Many of the dangerous diseases have one thing in common; they are from animals, especially wild animals. People should be advised to steer clear of contacts.”
In her contribution, a Professor of Medical Virology at the University of Maiduguri, Borno State, Marycelin Baba, noted that it was difficult to completely insulate Nigeria from viruses and diseases because the reservoirs for them were mostly animals who none have no control over.
She said, “For Marburg and Ebola, their reservoirs are bats while that of monkeypox are rodents such as rats and non-human primates like monkeys. The question is how would we eliminate the vectors? If we cannot eliminate them then it is impossible for us to completely insulate ourselves against them. Until now, nobody has identified COVID’s primary reservoir.’’
Baba further stated that not only Nigeria but the world at large needed to go into researching and producing antiviruses and diagnostics to make it easy to detect and treat them whenever there were outbreaks.
She noted, “Most of these viral diseases do not have treatments. No vaccines and in fact, recent research shows that some of the viruses are inhibited by some antibiotics, that’s why it is important to delve into antiviruses.
“Taking Nigeria as an example, how do we eliminate mosquitoes? How do we eliminate rats? How do we completely eliminate bats? And many more viruses which we have not even identified their reservoirs. The scary part is that many of the reservoirs live with us. The only way to insulate is if the reservoirs are known. Meanwhile, some of the reservoirs are even being consumed by humans. Bats as an example are highly consumed. There are many places where bats are delicacies.’’
She further said that the world should devise a way to translate what is in molecular science and molecular biology into diagnostics, therapeutics and vaccines.
She noted, “When these translations are done, we also need to have good preparedness so that when an outbreak occurs, the first measure will be a preventive measure and spread out such that people can prevent themselves.’’
Also, a public health physician, Dr Abimbola Adesanya, noted that the diseases were meant to be contained and not exported, stating that such had been difficult due to the fact that the vector of most of the viruses were animals.
She noted, “Nigeria has to be on high alert and ensure that its land, air and sea borders are not porous to the diseases in order not to be transported into the country. We also need to be adequately prepared to respond if at the end of the day the diseases cross into the borders.”
She further noted that the country’s health sector should start learning about the diseases, from their transmission to effects and those susceptible to the diseases. Adesanya recommended adequate education of the masses regarding the diseases, stating that where there were vaccines, people should get them.
She stated, “Those at the borders should be taught everything they need to know about each of the diseases, down to temperature level. Those who are susceptible and coming into the country should be isolated and quarantined immediately.”
Earlier, the Director-General, NCDC, in an interview with The PUNCH, Dr Ifedayo Adetifa, said a risk assessment had been conducted and the country was at moderate risk of the disease.
Adetifa said, “Earlier today (Tuesday), we conducted a risk assessment, done by the NCDC experts and other partners in the country. Our assessment shows that we are at moderate risk. Of course, we don’t share direct risk with Ghana. Port health is part of this intervention, not just for Marburg and even monkeypox. We are at alert, although not the same level as we have for COVID-19.”