Public Health Advisory following declaration of Ebola Virus Disease Outbreak in Uganda

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The Nigeria Centre for Disease Control and Prevention (NCDC) has been aware of the ongoing outbreak of the Sudan strain Ebola virus disease (EVD) in Uganda since it was first officially declared on 20th September 2022. As of 29th October 2022, the Uganda Ministry of Health had reported 128 confirmed cases and 34 deaths.

The NCDC, through the National Emerging Viral Haemorrhagic Disease Technical Working Group, met on the 26th of September 2022 to assess the risk of importation of EVD to Nigeria and the potential impact to inform in-country preparedness activities. Based on available data and risk assessment conducted, Nigeria is at HIGH risk of importation of the virus. This risk is due to the large volume of air travel between Nigeria and Uganda and the mixing of passengers, especially at the regional travel hubs of Nairobi, Addis Ababa, and Kigali airports and the additional risk from other neighbouring countries that share a direct border with Uganda should cases arise in other countries in the region.

The outputs from this risk assessment are being used to initiate preparedness activities in-country.

Several measures have been put in place to prevent and mitigate the impact of a potential EVD outbreak in Nigeria.

•  The NCDC Incident Coordination Centre (ICC) is now in alert mode.
•  Development of an incident action plan for the first few cases of EVD has commenced
• POE surveillance has been heightened using the passenger pre-boarding health declaration and screening form in the Nigeria International Travel Portal (NITP) platform.
• Passengers arriving from Uganda and persons who transited in Uganda are being followed up for 21 days after they arrived in Nigeria for their health status.
• Trained Rapid Response Teams are on standby to be deployed in the event of an outbreak.
• All State Public Health Emergency Operations Centres (PHEOCs) are in alert mode.
• A medical countermeasures plan is available.
• Amplification of risk communication and engagement with states and partners to strengthen preparedness activities which include– a review of risk communication protocols, plans, and messages in the event of an outbreak.
• Nigeria has an active infection prevention and control (IPC) programme nationwide with guidelines and training packages developed for healthcare workers.

INFORMATION ON EBOLA

The Ebola virus can be transmitted via direct contact with bodily fluids of a person who is sick with or has died from EVD. The virus can enter the body stream through broken skin or mucous membranes in the eyes, nose, or mouth. This can also be spread through contact with objects contaminated by infected persons as well as direct contact with the blood, body fluids and tissues of infected fruit bats, monkeys, or chimpanzees.

SIGNS AND SYMPTOMS OF EVD

Just like other types of Ebola virus, people infected with the Sudan strain cannot spread the disease until the development of symptoms. Symptoms may appear anywhere from 2 to 21 days after exposure to the virus but are typically 8 to 10 days on average. Symptoms include:

• Fever
• Fatigue
• Muscle pain
• Headache
• Sore throat
• Vomiting
• Diarrhoea
• Rash
• Impaired kidney and liver function
• Internal and external bleeding

PREVENTIVE MEASURES

To prevent the spread of Ebola, the NCDC advises members of the public to adhere to the following precautions:

• Wash your hands frequently using soap and water or use hand sanitisers when soap and water are not readily available, and your hand is not visibly soiled.
• Avoid physical contact with anyone who has symptoms of an infection with an unknown diagnosis.
• Healthcare workers are advised to always adhere to standard precautions. This includes the use of personal protective equipment always when handling patients and always maintaining a high index of suspicion.

TRAVEL ADVICE

The NCDC advises Nigerian citizens and residents to AVOID ALL BUT ESSENTIAL TRAVEL to Uganda for now until public health authorities have determined the outbreak to be contained. When travel to Uganda is unavoidable, travellers are advised to avoid contact with obviously sick persons or suspected cases of Ebola.

The Port Health Services of the Federal Ministry of Health has scaled up the screening of passengers returning from Uganda at POEs.

Travellers to Nigeria with recent travel history to Uganda

Persons already in Nigeria but with recent travel history to or transit through Uganda within the past 21 days who experience symptoms such as fever, muscle pain, sore throat, diarrhoea, weakness, vomiting, stomach pain, or unexplained bleeding or bruising should promptly call 6232 or state ministry of health hotlines for assessment and testing. Such persons SHOULD NOT visit health facilities by themselves to avoid further spread through the shared transport system (public or private). They would be visited at home by dedicated responders for assessment and transported through the designated transport arrangement to the designated treatment centre when required. Intending travellers to Nigeria with the above-stated symptoms before departure SHOULD NOT travel to Nigeria but call to report promptly to Port Health Authorities and/or designated health authorities in the country of departure for testing and care.

Inbound travellers to Nigeria with a recent travel history to or through Uganda without symptoms on departure but who become unwell while on transit are required to avoid contact with people and to report to the Port Health Services on arrival at the point of entry to Nigeria.

Travellers with a travel history to Uganda who show no symptoms on arrival should provide accurate information on the NITP platform to ensure follow-up from health workers. If any of the earlier-mentioned symptoms develop anytime within 21 days of arrival in Nigeria, please:

• Self-isolate immediately by staying indoors.
• Avoid contact with others including your immediate family.
• Call the NCDC 24/7 toll-free line IMMEDIATELY on 6232 or the emergency number of the state ministry of health (SMOH).
• Early initiation of supportive treatment has been shown to significantly improve outcomes including reduced deaths.
• Please note that local and/or international travel is NOT recommended until the completion of the 21-day follow-up period.

Distributed by APO Group on behalf of Nigeria Centre for Disease Control and Prevention (NCDC).