Isolate, trace and respond: How a new emergency operations centre has improved outbreak response in Kebbi

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Dr. Assad Hassan had just graduated from the prestigious Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) when he received the urgent call to take on the role of State Epidemiologist to head up the newly established Public Health Emergency Operations Centre (PHEOC) in Kebbi State. He and his newly assembled team had probably never imagined that they would soon be investigating the first outbreak of Lassa fever in the state. No cases had previously been reported from Kebbi State, although the state had developed expertise in managing meningitis outbreaks, as it lies in the hot arid region referred to as the meningitis belt in Nigeria.


Outbreak of Meningitis across Nigeria in 2017. Image source: Dailytrust.com


In late 2018, the Nigeria Centre for Disease Control (NCDC) offered to support the state in setting up its first State PHEOC. Just as the brand-new institution was settling in, it was greeted with an unexpected case of Lassa fever right in the capital city, Birnin Kebbi. A man had presented to the Federal Medical Centre with a high fever and diarrhoea towards the end of January 2019. When he did not respond to the treatment of the initial malaria diagnosis, the PHEOC was immediately alerted, he was isolated and samples sent to the NCDC’s reference laboratory in Abuja. By the first week of February, results confirmed he was infected with Lassa fever. Dr. Hassan swung into action and activated the PHEOC for the first time.  His team was faced with their first emergency – to control an outbreak of Lassa fever.
 
Using information obtained from the patient, Dr. Hassan and his team began tracing anyone who may have come into contact with the ill patient, identifying about 56 people in total. Each contact was followed up and closely monitored to see if they developed any symptoms of Lassa fever. Two more people who had been in contact with the first patient were identified, duly isolated and treated. This helped to limit the number of people who could have possibly been infected. After their discharge, the PHEOC continued following up with the patients to provide needed counselling, with support from the NCDC.
 
The PHEOC’s first task was drafting an epidemic preparedness and response plan for two major epidemic-prone diseases – Meningitis and Lassa fever. Dr. Hassan said that the Centre focused on the two diseases because of the state’s history with Meningitis and the fact that Lassa fever cases were on the rise across the country. “Our priority really was meningitis, but we decided to include Lassa fever just in case”, he said. Having a preparedness and response plan in place helped the Kebbi state PHEOC contain the Lassa Fever outbreak.


Dr. Assad Hassan, State Epidemiologist and Head of the Public Health Emergency Operations Centre, Kebbi state. Photo credit: Nigeria Health Watch

 
Infectious disease outbreaks are some of the most unpredictable events that states and countries have to deal with. While some outbreaks could be seasonal in endemic areas and some occur as a result of natural disasters and conflicts, most tend to occur randomly. Rising globalisation and ease of movement between communities and countries have also made it possible for outbreaks to spread faster than ever. The United States Centre for Disease Control estimates that it takes an average of 36 hours for an infectious disease outbreak to travel from one country to another. It would take much less time to travel from one community or state to another within a country. This highlights the importance of having strong surveillance systems at local and state levels that can help detect and respond to an infectious disease outbreak in a timely manner. Establishing and operating public health systems with the necessary capabilities to tackle disease outbreaks at the state level requires considerable investment in infrastructure and human resource development to enable surveillance and support rapid response activation.
 
The NCDC, Nigeria’s public health institute responsible for coordinating surveillance and response to infectious disease outbreaks, has been supporting states across the country to establish PHEOCs with the aim of helping them detect, prevent,  monitor and respond to infectious disease emergencies. So far, PHEOCs have been established in 14 states. Aside from supporting and coordinating the work of local Disease Surveillance and Notification Officers (DSNOs) who provide surveillance at the community level, the PHEOCs also facilitate information sharing and situation reporting with the NCDC. They serve as the first port of call in the event of any suspected outbreak in the state, and lead on response, tracking and reporting.


Map of Nigeria showing states with public health emergency operations centres. Image source: NCDC


According to the Director General of the NCDC, Dr. Chikwe Ihekweazu, states with emergency operations centres are better prepared to respond effectively to infectious disease outbreaks than states without PHEOCs, as they have a structured way of organising their response when outbreaks occur. ‘’That is why we are working to have an EOC in every state of the country”, he said. To ensure that this happens quickly, state governments should collaborate with NCDC by providing structures and human resources.  NCDC provides the equipment, sets up the facility and trains the staff.
 
The Kebbi State PHEOC’s successful response to the Lassa fever outbreak is a testimony of the vital role that systems at state and local level play in detecting, preventing and responding to infectious disease outbreaks. Alhaji Umar Kambaza, the state Commissioner for Health, said Dr. Hassan and his team have been mandated by the state government to develop a plan to respond to cholera outbreaks, another epidemic-prone disease. Kambaza also serves as the chairman of the newly constituted Kebbi State Preparedness and Response Committee that had its first quarterly meeting at the PHEOC in April.
 
The PHEOC is also establishing an emergency preparedness and response committee in every local government of the state. These committees will be led by LGA chairmen with representatives from every group, including traditional and religious leaders and community health workers. When established, the committees will serve as the coordination focal points for the PHEOC at the local level. Members will meet regularly to assess how prepared their communities are to prevent infectious disease outbreaks and report to the PHEOC in order take necessary action in the event of an outbreak.
 
The Kebbi State PHEOC, managed by a vibrant team of 12, has made a good start. Things can only get better with continued support and commitment from the state government. If the state completes and equips its public health laboratory, this will enable the PHEOC to receive early confirmation of cases, to improve public health response. The public health laboratory will also provide an avenue for building the capacity of health workers in the state on the diagnosis of epidemic-prone infectious diseases.
 
Minister of Health Prof. Isaac Adewole said at the launch of the NCDC’s 2018 annual report, “It is certain that there will always be infectious disease outbreaks… what we need is effective preparedness.’’
 
The NCDC’s goal of a Public Health Emergency Operations Centre in every state of the federation is a step towards effective preparedness. Kebbi State’s ability to effectively isolate, trace and respond to the Lassa fever outbreak supports the need for each state to have PHEOCs.  While the NCDC is mandated to support all the 36 states and 774 LGAs in prevention and response to the outbreak of infectious diseases, response to any disease outbreak must start at the local government and state level, where the people live. State governments, therefore, must increase the funding they provide for epidemic preparedness activities, such as establishing a PHEOC. Without this commitment to fund preparedness, an outbreak has a greater chance of quickly spreading to the entire Nigeria, and disrupting our lives, our economy, and our health security.


According to preventepidemics.org, Nigeria’s preparedness score for the next epidemic is 39%. Image source: preventepidemics.org

 
Even as states must increase funding, the Federal Government must continue to show the political will to protect Nigeria from infectious disease outbreaks by earmarking, budgeting and releasing adequate funding to develop robust emergency preparedness plans for the country. When the next infectious disease epidemic hits, we cannot be without a plan. That is not the time to be looking for funding. Just as the Kebbi State PHEOC was set up just in the nick of time ahead of a Lassa fever outbreak, other states and the NCDC as the institute at the frontline of preparing for epidemics must be adequately prepared to isolate, trace, and respond to national outbreaks, and this begins with adequate funding. A safe country has a better chance of ensuring we have a strong economy, offering citizens the possibility to live healthy productive lives.
 
 
Is your state putting plans in place to protect you against infectious diseases? Let us know how in the comments and on our social media handles.

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