How Did Nigeria Quash Its Ebola Outbreak So Quickly?
What we can learn from the boot leather, organization and quick response times that stopped Ebola from spreading in this African nation

October 18, 2014 |By Katherine Harmon Courage

On July 20 a man who was ill flew on commercial planes from the heart of the Ebola epidemic in Liberia to Lagos, Nigeria's largest city. That man became Nigeria's first Ebola case—the index patient. In a matter of weeks some 19 people across two states were diagnosed with the disease (with one additional person presumed to have contracted it before dying).

But rather than descending into epidemic, there has not been a new case of the virus since September 5. And since September 24 the country's Ebola isolation and treatment wards have sat empty. If by Monday, October 20 there are still no new cases, Nigeria, unlike the U.S., will be declared Ebola free by the World Health Organization (WHO).

What can we learn from this African country's success quashing an Ebola outbreak?

Authors of a paper published October 9 in Eurosurveillance attribute Nigeria's success in "avoiding a far worse scenario" to its "quick and forceful" response. The authors point to three key elements in the country's attack:

* Fast and thorough tracing of all potential contacts
* Ongoing monitoring of all of these contacts
* Rapid isolation of potentially infectious contacts

The swift battle was won not only with vigilant disinfecting, port-of-entry screening and rapid isolation but also with boot leather and lots and lots of in-person follow-up visits, completing 18,500 of them to find any new cases of Ebola among a total of 989 identified contacts.

Such ground-level work may sound extreme, and the usually measured WHO declared the feat "a piece of world-class epidemiological detective work." But as William Schaffner, chair of the Department of Preventive Medicine and an infectious disease expert at Vanderbilt University, says, "Actually what Nigeria did is routine, regular—but vigorous and rigorous—public health practice. They identified cases early—fortunately they had a limited number—and they got a list of all of the contacts, and they put those people under rigorous surveillance so that if they were to become sick, they wouldn't transmit the infection to others," he says.

Art Reingold, head of epidemiology at the University of California, Berkeley, School of Public Health agrees. The steps are basic: "isolation, quarantine of contacts, etcetera," but governments must "get in quickly and do it really well." It was Nigeria's vigorous and rapid public health response that really stopped the spread. Because when Ebola lands one August afternoon in a city of 21 million, things could go very, very differently.