The Nigeria Centre for Disease Control and Prevention (NCDC) has warned healthcare workers nationwide to heighten surveillance and preparedness for Ebola Virus Disease (EVD), citing a “high” risk of importation into Nigeria due to ongoing outbreaks in the Democratic Republic of the Congo (DRC) and Uganda.

The agency, however, said Nigeria has not recorded any confirmed Ebola case linked to the current regional outbreak as of 28 May.

In a public health advisory issued on Thursday, the NCDC said the World Health Organisation’s (WHO) declaration of the outbreak as a Public Health Emergency of International Concern (PHEIC), rising infections in neighbouring African countries, and increased cross-border movement have raised concerns about Nigeria’s vulnerability.

The advisory highlights concerns over delayed detection, healthcare-associated transmission, and the vulnerability of frontline health workers if the virus enters Nigeria.

“This assessment estimated the risk of Ebola importation into Nigeria as high due to the ongoing transmission in the DRC and Uganda, international travel and population movement, uncertainty regarding the full magnitude of the outbreak, and the potential for delayed recognition because symptoms may overlap with endemic diseases such as malaria and Lassa fever,” the agency stated.

It said high-risk states, border communities, major transport hubs and points of entry had already been identified through its national risk assessment.

Existing outbreak response systems

The NCDC said Nigeria still retains important outbreak response structures developed after previous viral haemorrhagic fever outbreaks, including the 2014 Ebola outbreak, which was successfully contained in Lagos.

According to the agency, the country currently maintains laboratory capability, trained rapid response teams, Emergency Operations Centres (EOCs), established Viral Haemorrhagic Fever preparedness systems, and prior outbreak response experience.

However, it admitted that existing systems require constant review and strengthening.

It also warned healthcare workers that Ebola patients or suspected cases could present at health facilities anywhere in Nigeria.

“The key operational question is therefore how healthcare workers should recognise, respond to, and safely manage such situations,” it said.

The agency stressed that healthcare workers remain one of the most vulnerable groups during Ebola outbreaks because of direct exposure during patient care.

Symptoms

The agency warned that Ebola symptoms may initially resemble several common illnesses frequently seen in Nigerian hospitals, increasing the risk of delayed recognition.

It listed malaria, typhoid fever, Lassa fever, gastroenteritis, COVID-19, influenza, sepsis and other severe bacterial infections among illnesses with symptoms similar to Ebola.

According to the advisory, Ebola has an incubation period of two to 21 days.

Early symptoms may include fever, weakness, headache, muscle pain, sore throat, vomiting and diarrhoea. While severe illness may involve unexplained bleeding, organ dysfunction, confusion, shock and collapse

Patients with non-specific febrile illness could initially appear similar to people suffering from more common diseases, “potentially delaying recognition and increasing exposure risk within healthcare settings.”

No approved vaccine

The current outbreak involves the Bundibugyo strain of the Ebola virus, which differs from the Zaire strain responsible for the 2014 West African epidemic.

The Bundibugyo virus is a Risk Group 4 pathogen and one of the less common Ebola virus strains.

“Unlike the Zaire strain, there are currently no approved vaccines or specific antiviral therapies for Bundibugyo virus disease,” the agency said.

The absence of approved vaccines or targeted therapies could complicate response efforts if infections are detected in Nigeria.

Ebola not airborne

The agency clarified that Ebola is not considered an airborne disease under normal circumstances.

Transmission occurs through direct contact with infected blood, body fluids, secretions, organs, contaminated materials, or infected animals.

The advisory listed vomit, diarrhoea, urine, saliva, sweat, breast milk and semen among infectious body fluids capable of transmitting the virus.

The agency warned that transmission risk is highest when infected patients become symptomatic and actively produce infectious body fluids.

It added that healthcare-associated transmission remained a major concern during Ebola outbreaks, citing reports by the WHO of infections and deaths among healthcare workers linked to gaps in infection prevention and control measures.

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Hospital surveillance

The NCDC directed healthcare facilities to strengthen triage systems for early identification and isolation of suspected cases.

It urged workers to maintain “a high index of suspicion,” especially among persons with recent travel history to affected countries or epidemiological links to confirmed or suspected cases.

It also asked them to carefully assess patients’ travel history, exposure history, contact with sick persons, and attendance at burial or funeral activities where relevant.

It advised hospitals to minimise unnecessary exposure while ensuring safe clinical care.

It also asked the healthcare workers to strictly implement infection prevention and control measures at all times, including hand hygiene before and after patient contact, appropriate use of personal protective equipment (PPE) and safe injection practices.

Others are environmental cleaning and disinfection, safe waste segregation and disposal and safe handling of laboratory specimens.

It further asked to avoid direct contact with blood or body fluids without PPE, prevent needle-stick injuries, follow safe burial guidance, and ensure proper decontamination of equipment and surfaces.

In addition, the health workers are instructed to promptly report occupational exposure incidents and participate in refresher infection prevention and preparedness training programmes.