The Nigeria Centre for Disease Control and Prevention (NCDC) is aware of the first-ever outbreak of Marburg virus disease (MVD) announced in Equatorial Guinea on 13th February 2023. The death of nine people prompted laboratory testing on samples of individuals experiencing symptoms of fever, fatigue, blood-stained vomit, and diarrhoea in two communities of the country’s western Kie Ntem province. So far, one confirmed case, nine deaths and 16 suspected cases of MVD have been reported in Equatorial Guinea.
MVD is a viral haemorrhagic fever (VHF) caused by a virus from the same family as the Ebola virus disease. The primary route of transmission is from fruit bats to humans. Human-to-human transmission is possible through contact with the body fluids of an infected person. Currently, there are no available vaccines or therapeutics for the prevention and treatment of this strain of the virus. The early initiation of supportive treatment has been shown to significantly reduce the probability of death due to MVD.
There are currently no cases of Marburg virus disease in Nigeria, however, the NCDC, relevant Ministries, Departments, Agencies, and partners have taken proactive measures to mitigate the risk of cross-border importation. The multi-sectoral National Emerging Viral Haemorrhagic Disease Technical Working Group (NEVHD TWG) led by NCDC, is responsible for coordinating the national response to all VHFs across pillars including surveillance, laboratory, case management and risk communication. The NEVHD TWG like it has always done in the past following news of MVD outbreaks conducted a dynamic risk assessment to inform Nigeria’s preparedness following this recent outbreak in Equatorial Guinea on the 17th of February 2023.
Based on available data, the overall risk of importation of the Marburg virus and the impact on the health of Nigerians has been assessed as MODERATE for the following reasons:
• The extent of the outbreak in Equatorial Guinea has not yet been ascertained.
• The likelihood of importation to Nigeria is high due to the direct flight between Nigeria and Equatorial Guinea.
• The proximity of Equatorial Guinea to Nigeria
• The likelihood of spread in Nigeria following importation is high due to the gatherings and travel associated with upcoming national elections.
• The case fatality rate of MVD ranges between 24 to 88%.
• MVD does not currently have an effective drug for treatment or a licensed vaccine for prevention.
The risk assessment also shows that Nigeria has the capacity – technical, human (health workforce), and diagnostic – required to respond effectively in the event of an outbreak. Nigeria has also responded to viral haemorrhagic fever epidemics like the Ebola Outbreak in 2014 and built up her preparedness and response capabilities over the years. We have the diagnostic capacity to test for MVD presently at the National Reference Laboratory (NRL) in Abuja and the University of Lagos Teaching Hospital laboratory Centre for Human and Zoonotic Virology (CHAZVY). However, diagnostic capacity will be scaled up to other laboratories in cities with important points of entry (POE) and others as may be required. An effective response system is in place with the availability of control capacities (trained rapid response teams, and an effective infection prevention and control programme) to limit the risk of spread in the event of a single imported case.
Several measures have been taken to strengthen preparedness for the MVD in Nigeria. These include:
• The NCDC Incident Coordination Centre (ICC) has been activated to alert mode.
• Development of an emergency incident action plan for MVD has commenced.
• A review to update case definitions for MVD if necessary.
MVD guidelines currently under development
• The NRL and CHAZVY have the capacity to promptly test and diagnoses cases of MVD if needed.
• Follow-up of persons of interest (POIs) on arrival from Equatorial Guinea has commenced.
• Point of entry surveillance has been heightened using the passenger’s pre-boarding health declaration and screening form.
• Trained Rapid Response Teams are on standby to be deployed in the event of an outbreak.
• A medical countermeasures plan is being developed.
• 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.
The NCDC advises Nigerian citizens and residents to AVOID ALL BUT ESSENTIAL TRAVELS to Equatorial Guinea at this time. Persons with recent travel history to or transit through Equatorial Guinea 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 NOT go to any health facility but call 6232 or their State Ministry of Health hotline IMMEDIATELY for assessment and testing.
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