NIGERIA: Third Victim Succumbs to Ebola

The protocol officer, Mr. Jatto Asihu Abdulqudir, who picked up the index case, Patrick Sawyer, from the Murtala Muhammad International Airport, Lagos, has died from the deadly Ebola virus, bringing the total number of persons who have succumbed to the disease in Nigeria to three.

Sawyer, the Liberian national who flew into Lagos with the virus, died on July 24, while the nurse who treated him at a private hospital also died last week.

Making this known, the Minister of Health, Prof. Onyebuchi Chukwu, in an exclusive interview with reporters yesterday said: “With the death of the protocol officer yesterday, the number of people who have succumbed to the virus has gone up to three.”

Chukwu said the officer was the man who “went to welcome the man in the airport when he arrived”.

“Now, we have the index case, Mr. Sawyer who brought the Ebola, the nurse and the protocol officer,” Chukwu said.
The minister further informed reporters that the ministry had received the N1.9 billion intervention fund from the federal government to tackle the Ebola disease.
He said: “We have received the money and we are putting it into our contingency plan for the health response for Ebola.”

Chukwu commended the prompt intervention of President Goodluck Jonathan in releasing the funds, adding that the president’s gesture was meant to pre-empt the danger or risk associated with Ebola.
He also explained that the money was not part of this year’s annual budget, adding, “It was not in the 2014 budget; that is why we asked for the contingency.”

Chukwu explained that the funding would be used for different programmes, ranging from the procurement of temperature equipment and vehicles, among other medical equipment.

“We are buying more equipment to curtail the virus; we are also buying body scanners,” he said.
The Office of the National Security Adviser (ONSA) had earlier written to his ministry alerting it to take proactive measures against the virus, Chukwu said the letter came as a post-mortem when the first index case had already been recorded.

“The letter they wrote was after the first index case,” Chukwu asked.
Appearing slightly irritated, he said: “If it is security, let them do their job. I can’t do their job. What is important is that I’ve been briefing those I need to brief.

“They have spoken with me on the phone. I don’t want to reply them on the leaked letter, because they have not said that to me. They have my number and I have their own. I feel we should have proper communications not through the media.”

On the request by the Nigerian government for the experimental drug, ZMapp, used on two US aid workers who have shown signs of recovery from the Ebola virus, the minister said his ministry was still awaiting the response of the US health authorities.

“But even as we await their response, we are not sitting and doing nothing as research is on-going in Nigeria for a cure for the virus, because as you know the US drug company no longer has the drug. So we are doing our best with our experts to find a cure that can eradicate the virus,” he stated.

Also confirming the death of the protocol official, the ECOWAS Commission Liaison Office said last night that Abdulqudir was one of those that rushed to the aid of Sawyer when he collapsed on arrival at the Lagos airport from Monrovia.

The commission, in a statement, said Abdulqudir had been in quarantine since it was revealed that Sawyer died of the Ebola disease.

“The commission wishes to use this opportunity to express its gratitude to Nigerian government authorities and others who contributed to managing the late official while under quarantine,” the statement read.

Last week, the commission had announced the temporary closure of its Lagos office to allow for fumigation of the premises, as the vehicle in which Sawyer was conveyed to the hospital was parked within the premises for several days.

The ECOWAS staff, including the driver, who had also assisted him had returned to the office and may have made contact with others. They were subsequently placed under quarantine for observation.

ECOWAS expressed condolences to the late Abdulqudir's family and colleagues and disclosed that it had already intensified awareness among its staff while seeking solidarity and mutual assistance.

Liberia Gets Trial  Drug

But as the West African region grapples with the spread of the virus, it was announced yesterday that Liberia would receive untested experimental drug from the US.
The drug will be used to treat two infected doctors, the first Africans to receive the treatment.
Liberian Information Minister, Lewis Brown said his government had received written consent from the two doctors -- whom he identified as Zukunis Ireland and Abraham Borbor -- for the treatment, which has not been fully tested in humans.
“The drug maker could not export the drug without the approval of the FDA (US Food and Drug Administration).  So our authorities approached the FDA and received specific approval for the treatment of these two doctors,” Brown told Reuters by telephone.

He said the drug was expected to reach Liberia within the next 48 hours.
The US company that makes the experimental drug said Monday it had sent all its available supplies following a request to the US from Liberian President Ellen Johnson Sirleaf.

The World Health Organisation (WHO) said about 1,013 persons have died from Ebola in West Africa, but this is coming after it had approved the use of the trail drug on the Spanish Catholic priest, Miguel Pajares, who had contracted the disease from Liberia. However, the 75-year-old priest succumbed to the disease yesterday.
Citing medical confidentiality rules, hospital officials in Madrid declined to say whether the priest had ultimately been treated with ZMapp, but the Spanish Health Ministry said on Monday that it had obtained the medication for him.
US government officials said their role had been to put Liberian officials in contact with ZMapp manufacturer, Mapp Biopharmaceutical. The pharmaceutical company said its supply of the drug was exhausted after they were sent to West Africa, AFP said.
The drug was “provided at no cost in all cases,” the company added.
ZMapp has been used in the US on two aid workers who have shown signs of improvement.
The drug has only been tested on monkeys and has not yet been evaluated for safety in humans.

WHO Approves Use of Trial Drugs

Even as the US sent the trail drug to Liberia, WHO yesterday endorsed the use of untested drugs to combat the Ebola virus.
The provision of ZMapp to foreign aid workers evacuated from West Africa had raised broad ethical questions about the disparities in treatment between white outsiders and the Africans who form the overwhelming majority of the victims.
The two American aid workers, Dr. Kent Brantly and Nancy Writebol, who were evacuated to Emory University Hospital in Atlanta, received the drug as well, prompting questions from some African officials about why their nations had not received the medication.

In Geneva, WHO convened an ethics panel on Monday to debate the broader use of untested drugs. In a statement on its website yesterday, it said given “the particular circumstances of this outbreak,” the panel had reached a consensus that “it is ethical to offer unproven interventions with as yet-unknown efficacy and adverse effects, as potential treatment or prevention”.

The panel said the use of untested drugs should be guided by ethical criteria, including transparency about all aspects of the care provided, informed consent of the patient, freedom of choice and patient confidentiality.
WHO officials said another meeting would be held at the end of the month to deal with another delicate and politically charged question: how to allocate scarce treatments.

Dr. Marie-Paule Kieny, Assistant Director-General of WHO, said at a news conference in Geneva that there were several drugs and vaccines that have shown some promise in animal testing that might conceivably be deployed in the outbreak.
However, she said, none “is available in unlimited supplies right now.” She added, “I don’t think that there could be any fair distribution of something which is available in such a small quantity.”

Dr. Kieny said that intensifying public health measures to contain the outbreak was more important than drugs. “It is very important to not give false hope to anybody that Ebola can be treated now,” she said.
Mapp and the United States government, which has financed most of the company’s work, are making plans to increase supplies of ZMapp. But it is expected to take several months to increase supplies, and even then, there may be no more than a few hundred doses available, and perhaps less, according to federal officials and corporate executives.

Kieny said similar therapy might be provided using the blood of patients who have recovered from Ebola, because those patients apparently have effective antibodies. She said WHO was looking at helping blood centers in the affected countries gather such blood.
She said two vaccines to prevent disease could be ready for human testing by the end of September. If so, data would be available on their safety as early as the end of the year.

Death Certificate Before Burial

Meanwhile, in its bid to keep track of all contacts with Ebola in Nigeria, the National Council on Health (NCH), at the end of its emergency meeting, which stretched into the wee hours of yesterday, ordered that all corpses in the country must have death certificates before any burial ceremony is carried out.

In a communiqué released yesterday in Abuja, the council maintained that given the current status of Ebola outbreak, the three tiers of government must ensure that all necessary steps are taken to avert any further spread aside the primary and secondary contacts with Sawyer, the index case that brought the virus to Nigeria.

The communiqué read by Chukwu, said: “The council resolved that ideally all corpses should be accompanied with death certificates. All states are to be encouraged to have legislation to support this resolution. The corpses of all persons confirmed to have died of EVD must be buried according to standard WHO protocol.”

The body further directed that the transportation of corpses into Nigeria as well as inter-state transportation be banned until further notice except with approved waivers that may be issued by the Federal Ministry of Health.
It also mandated the Nigeria Centre for Disease Control (NCDC) to "re-circulate protocols and SOPs for management of Ebola cases as well as protocols for submitting samples to the laboratories and burying of Ebola victims”.

“The federal government should provide specifications and support states with special Personal Protective Equipment (PPE),” the communiqué added.
The council also stressed the need for the federal government "to support the establishment of additional laboratories for EVD management and also directed the NCDC to conduct detailed mapping of locations, capacities and categorisation of existing laboratories to inform this scale up plan”.

Part of the resolutions at the end of the emergency meeting also compelled “state governments to institutionalise a communication strategy to ensure mass awareness creation and sensitisation for individuals and communities on Ebola.
“Council directed that particular attention should be paid to vulnerable groups such as market women and other women’s groups, patent medicine vendors, road transport workers, fishermen in the riverine areas, hunters and bush meat sellers, school children, morticians and mortuary attendants, traditional healers and faith bodies.
“The Federal Ministry of Health is also to provide state Ministries of Health and HHSS FCTA as well as military and para-military groups with support to strengthen training of health care workers at the state and LGA levels on proper infection control and EVD containment strategies”.

In the same token, the council said the federal government would provide adequate incentives to health workers who participate in the management of Ebola patients to encourage them to be active in the containment of the virus. Council further directed that they should be provided with life insurance coverage.

The Port Health Services is likewise to ensure "the implementation of guidelines for cross-border monitoring of Ebola, particularly in riverine areas and states with international borders; states that have riverine areas are to ensure the provision of boat ambulances suitable for Ebola control”.
The council requested the navy, customs and immigration services to collaborate with the Port Health Services to strengthen border monitoring and patrol for Ebola.

It further directed that the full engagement to appraise challenges and proffer solutions to address the Ebola virus should be held between the Federal Ministry of Health and states with peculiar security challenges including but not limited to Adamawa, Bauchi, Borno, Kano, Taraba and Yobe States.
The council also called on the Nigerian Medical Association (NMA) to suspend its strike forthwith and contribute its quota to the on-going response to this national health emergency.

Lagos to Invoke Public Health Law

Also, the Lagos State Government said it will invoke the 2003 Public Health Law to apprehend any suspect of Ebola who declines to surrender himself or herself for screening or be in isolation.

The state government has also revealed that more than 200 persons, who had primary and secondary contact with the index case, are currently being observed and watched to ascertain their health status.
The state governor, Mr. Babatunde Fashola, gave the update on Monday at a meeting with the environmental health workers from the 57 local councils at the Adeyemi Bero Auditorium, Alausa.

The governor addressed the meeting alongside the Commissioner for Special Duties, Dr. Wale Ahmed, his information counterpart, Mr. Aderemi Ibirogba, and his Special Adviser on Public Health, Dr. Yewande Adeshina, among others.
At the meeting, the governor explained the danger of the deadly virus, which he said, required all the stakeholders to work together and ensure the virus did not spread beyond what could be controlled or managed easily.
He said under the Public Health Law, the state government, especially through the Commissioner for Health, has power “to compulsorily apprehend persons suspected to constitute a danger to the society”.

“I have directed the health commissioner to do so if necessary, to compulsorily apprehend persons suspected to constitute danger to the society because he or she can lead to the spread of epidemic in the state,” he said.

The governor acknowledged that any person, who might constitute threat to the society must be isolated, explaining that it “is a 2003 law and if there is need, we will exercise the power in the public health law”.
Also speaking, Adeshina said the state government health authorities were watching over 200 people who had primary or secondary contact with the index case and was embarking upon massive media campaigns on the disease.

She warned against touching corpses dumped on the road, adding that when such corpses are seen, contact should be made with the Ministry of Health or the State Environmental Health Management Unit (SEHMU).

Source: This Day
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