28 August 2014

Nigeria: Ebola Kills Doctor in Port Harcourt

Photo: MSF
Ebola infections can only be diagnosed definitively in a laboratory using five different tests. A blood sample is taken and the laboratory determines the result within a few hours.

Abuja, Lagos, Port Harcourt — At a time when most Nigerians are relieved that the country has only one confirmed case of the dreaded Ebola Virus Disease (EVD), a new death and 70 suspected cases were Thursday confirmed in Port Harcourt, Rivers State.

At a press conference in Abuja Thursday, the Minister of Health, Prof. Onyebuchi Chukwu, said the dead person was a medical doctor who treated one of the surviving primary contacts with the index case, Mr. Patrick Sawyer, who defected to Port Harcourt.

According to Chukwu, the doctor's widow is now down with the virus and has been placed under quarantine. Chukwu also said that 70 persons that had primary contact with the doctor, who died on August 22, 2014, the widow and the surviving primary contact had now been placed under surveillance.

The Guardian's investigation revealed that the dead doctor, Dr. Ike Sam Enemuo, allegedly contracted the virus from an Ebola patient he treated secretly.

The reported death of Enemuo due to Ebola virus triggered panic yesterday at the University of Port Harcourt Teaching Hospital (UPTH) where his body was said to be in the morgue.

The Guardian learnt that the surviving primary contact that infected the dead Port Harcourt doctor was an official of the Economic Community of West African States (ECOWAS) who had contact with the late Sawyer during his infamous trip to Nigeria.

The surviving primary contact was said to be on the surveillance list. But he allegedly escaped surveillance officials in Lagos and headed to Port Harcourt where he approached a private doctor for treatment. The doctor in question allegedly did not report the case to the national management team, but successfully managed the case.

It is not clear if the doctor knew that the ECOWAS official was infected with Ebola before or during the treatment. But rigorous tests, according to government, confirm that the ECOWAS official had the virus but has recovered.

According to the minister, the total number of deaths from EVD in Nigeria, therefore, is now six, the index case (Sawyer), the four primary contacts who died in the isolation ward in Lagos, and a doctor who died in Port Harcourt whose blood sample tested positive after death. "Also, 70 persons have been placed under surveillance in Port Harcourt," he said.

The suspected cases of the nurse who escaped to Enugu are likely going to be discharged today after spending the mandatory 21 days without symptoms.

Chukwu said the total number of cases of EVD cases so far reported in Nigeria stands at 15. A breakdown shows: The total number of cases treated at the isolation ward is 13; the total number of those discharged is seven; the total number of deaths from those treated in Lagos is five; and the total number currently under treatment is one, and the person is stable and improving clinically.

With regard to Enugu, the minister said all secondary contacts would be followed up till tomorrow (today) when they are all expected to be discharged from surveillance.

Chukwu said the Incident Management Committee had already deployed a very strong team in Port Harcourt to work with the health authorities of Rivers State. He said as the situation had effectively been managed in Lagos and Enugu, that in Port Harcourt would also be effectively managed and they had begun to do so.

The consultant surgeon charged the residents of Port Harcourt not to panic over this situation as the experience gathered from Lagos and Enugu respectively indicated that there was no cause for alarm.

Besides, the World Health Organisation (WHO) yesterday issued a roadmap to scale up international response to the Ebola outbreak in West Africa.

The WHO in a statement said the aim was to stop ongoing Ebola transmission worldwide within six to nine months, while rapidly managing the consequences of any further international spread. It also recognises the need to address, in parallel, the outbreak's broader socioeconomic impact.

Researchers said yesterday that safety trials on an Ebola vaccine were being fast-tracked, meaning it could be given to healthy volunteers from Britain, Gambia and Mali as early as September.

Researchers hope the trials could finish by the end of 2014. If they are successful, the vaccine could then be given to people infected with Ebola, which is spread through bodily fluids.

The move was announced by pharmaceutical giant GlaxoSmithKline (GSK), which is developing the vaccine with the United States National Institute of Health (NIH), and London-based medical charity Wellcome Trust, which is contributing to a grant to pay for the trials.

The minister explained: "You will notice that the number of cases has increased from 13 to 15. You will also notice that this additional two were not treated in the isolation ward in Lagos. One of them is a primary contact of the index case (Mr. Patrick Sawyer). Even though presently he does not have EVD but further laboratory tests indicate that he had suffered EVD.

"This primary contact of Mr. Sawyer's evaded our surveillance team in the last week of July 2014 and travelled out of Lagos to Port Harcourt where, as we now understand, he consulted with a doctor and was apparently treated for some symptoms. After four days, following a manhunt for him, he returned to Lagos by which time he was found to be without symptoms.

"This case would have been of no further interest since he had completed the 21 days of surveillance without any other issue, but for the fact that the doctor who treated him died last Friday, 22nd August, 2014.

"Following the report of this death by the doctor's widow the next day, the case had been thoroughly investigated and laboratory analysis showed that this doctor died from EVD. As a result, several contacts have now been traced, registered and placed under surveillance. However, because the widow is now symptomatic, she has been quarantined pending the outcome of laboratory tests on her."

As part of precautionary measure to curb the spread of the dreaded diseases, the Rivers State government yesterday said it had placed no fewer than 100 persons under surveillance. The government, however, refused to reveal the location of the isolation centres and the hotel where the man who brought the virus to the state stayed.

Though there had been a speculation in the past two weeks that an Ebola patient fled to Port Harcourt, it was yesterday that the Rivers State Commissioner of Health, Dr. Sampson Parker, specifically acknowledged the death of Enemuo from Ebola virus disease. The late doctor was said to be the owner of a private hospital at Rumuokoro in Port Harcourt.

"The Governor of Rivers State, Rt. Hon. Chibuike Rotimi Amaechi has directed me to make this solemn announcement to you. And it is with a heavy heart that I announce to you that the Ebola virus has claimed its first victim in Rivers State. Dr. Iyke Sam Enemuo died last week Friday, August 22, 2014 as a result of what was suspected to be Ebola virus disease," he said.

Parker told journalists at his residence in Port Harcourt that the Rivers State Ministry of Health on becoming aware of the condition of Enemuo's death, immediately commenced investigations and contact tracing. According to him, about 100 contacts from a hotel, patients of Enemuo and patients of the hospital where the late Enemuo was treated until his demise, have been identified and restricted in Rivers State and that locations are being decontaminated.

Parker said: "From our investigations some facts have emerged. An official of the Economic Community of West African States (ECOWAS) on the team that received the late Dr. Patrick Sawyer, the Liberian American diplomat who died of Ebola haemorrhagic disease in Lagos, Nigeria made a trip to Port Harcourt where he checked into a hotel and met with Dr. Iyke Sam Enemuo. About a week after his departure, Dr. Iyke Enemuo took ill and was rushed to a hospital where he presented symptoms of fever, diarrhea and vomiting. In the course of treatment, the managing physician became suspicious and took samples for investigation.

"A few days after, Dr. Iyke Enemuo died on August 22, 2014. His body was deposited at a mortuary in Port Harcourt. Dr. Iyke Enemuo's widow, who is also a medical doctor and who cared for him during his illness has taken ill. She is being quarantined. A few hours ago, results of the test carried out on samples taken from Dr. Enemuo came back and were positive of Ebola viral disease. The diplomat who was seen by the late Dr. Iyke Enemuo is alive and well.

"I urge every Rivers State citizen and resident to remain calm and go about their normal businesses. Wash your hands regularly with soap and water and avoid unnecessary body contacts till further notice."

He explained that the government of Rivers State was doing everything possible to contain the effects and spread of the Ebola virus. As part of the preparation to curb the spread, the commissioner said all the material and human resources needed to fight and defeat the deadly virus were available.

According to him, officials of the Federal Ministry of Health and other international agencies are already in the state working with the state ministry of health.

A health worker close to the wife of the late Enemuo, and who pleaded anonymity told The Guardian that she had been suffering high fever and was at home and not at a quarantine centre. According to him, the woman who is a doctor at UPTH radiology department, and nursing a three-month-old child was contemplating hiring a private ambulance to convey her to Lagos where she intended to seek medical assistance.

"When I spoke to her this morning she complained of high fever. She told me that she had called the Ebola emergency personnel to come and quarantine her family but to no avail. I understand she took care of him while he was sick. In fact, she was also making effort to get an ambulance to take her to Lagos for treatment. When her husband died, several persons visited their house where she was still staying to condole with her. They might all be at risk now as well," he said.

A source at the UPTH disclosed to The Guardian that the report that Enumou's body had been deposited in UPTH morgue had created tension as staff were not informed. He said even the morticians that handled the body of Enemuo were still moving freely and probably spreading the virus.

At the state-owned Braithwaite Memorial Specialist Hospital in Port Harcourt, health workers have started screening patients seeking medical assistance for symptoms of Ebola.

The WHO statement reads: "It responds to the urgent need to dramatically scale up the international response. Nearly 40 per cent of the total number of reported cases have occurred within the past three weeks.

"The roadmap was informed by comments received from a large number of partners, including health officials in the affected countries, the African Union, development banks, other UN agencies, Médecins Sans Frontières (MSF), and countries providing direct financial support.

"It will serve as a framework for updating detailed operational plans. Priority is being given to needs for treatment and management centres, social mobilisation, and safe burials. These plans will be based on site-specific data that are being set out in regular situation reports, which will begin this week.

"The situation reports map the hotspots and hot zones, present epidemiological data showing how the outbreak is evolving over time, and communicate what is known about the location of treatment facilities and laboratories, together with data needed to support other elements of the roadmap.

"The roadmap covers the health dimensions of the international response. These dimensions include key potential bottlenecks requiring international coordination, such as the supply of personal protective equipment, disinfectants, and body bags.

"The WHO roadmap will be complemented by the development of a separate UN-wide operational platform that brings in the skills and capacities of other agencies, including assets in the areas of logistics and transportation. The UN-wide platform aims to facilitate the delivery of essential services, such as food and other provisions, water supply and sanitation, and primary health care.

"Resource flows to implement the roadmap will be tracked separately, with support from the World Bank."

The statement from GSK reads: "A candidate Ebola vaccine could be given to healthy volunteers in the UK, the Gambia and Mali as early as September, as part of a series of safety trials of potential vaccines."

A total of 3,062 cases have so far been reported but the WHO warned on Thursday that the caseload could eventually exceed 20,000.

The trials, which still need ethical and regulatory approval, will be funded by a £2.8 million (3.5 million euro, $4.6 million) grant from the Wellcome Trust, Britain's Medical Research Council (MRC) and the UK Department for International Development (DFID).

The Oxford study will involve 60 healthy volunteers, while those in the Gambia and Mali will each involve 40.

This will also allow GSK to make some 10,000 extra doses of the vaccine so that if the trials are successful, it could be made available to the WHO quickly.

Safety tests of the vaccine will take place at Oxford University alongside a U.S. trial run by the National Institute of Allergy and Infectious Diseases (NIAID).

Oghogho Obayuwana, Emeka Anuforo, Chukwuma Muanya, Wole Oyebade and Kelvin Ebiri

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