NPHIs In Action: NIMR Responding to Cholera Epidemic

(December 22, 2010) In response to the most deadly and widespread cholera outbreak in Nigeria in 20 years, Prof. I.A.O Ujah, director general of the Nigerian Institute of Medical Research (NIMR), has deployed its Emergency Response Team (NIMRERT) to provide humanitarian services and identify the source, cause, and course of the infection. The team was deployed to Borno, Bauchi, and Gombe states, all in northern Nigeria and the worst hit by the epidemic.

The cholera epidemic, first reported in Taraba state, quickly spread to 17 more states, including some in southern Nigeria. By November, more than 38,000 people had been sickened while about 1,700 had died of cholera, an official source of the federal Ministry of Health said. Reported cases almost triple those of 2009, and 80% are women and children.

NIMRERT collected samples of stool, water and vomitus for laboratory diagnosis at the NIMR outstation laboratory and the headquarters laboratory in Lagos to test for Vibrio cholerae, according to NIMR Director of Research Oni Idigbe. The institute now has the capabilities to help fight various infectious diseases ravaging the country, such as cholera, tuberculosis, and malaria. NIMR uses molecular techniques to identify the strains, the source, and mode of transmission by comparing the genotypic resemblance and, most important, drug resistance patterns to assist in effective management of the infection. “We thank IANPHI for its support in setting up these molecular techniques,” Prof Ujah says.

During the course of the intervention by NIMRERT, cross-border transmission was observed in Borno state, which shares boundaries with Chad, Cameroun, and part of Niger, areas where the epidemic was more pronounced. The severity and spread of the infection could be attributable to lack of potable water as the strains identified in the water sources were identical to the ones from the infected patients’ samples (stool, vomitus).
NIMR also participated in making supplies available wherever the team visited and developed education programs and campaigns in the three main languages spoken in Nigeria. In turn, the states and communities are further translating these education messages into some of Nigeria’s 50 other dialects, the NIMR DG said. Whatever the language the underlying message is the same: prevent cholera through better hygiene, boiling water, hand washing, and safe waste disposal.

The government has provided care for the affected populace by providing camps, treatment, and potable water. With the support of its partners—WHO, CDC, and IANPHI—NIMR is poised to increase its capacity for national response to other outbreaks, including lead poisoning and other health hazards in mining communities in the north. “NIMR is in the best position to develop a formal outbreak response unit,” Ujah says and “we will continue to work with our partners to further build our capacity for rapid response”.

While the rainy season will soon end in Nigeria, Ujah knows that the dry season, which begins in January, will bring other public health challenges such as meningitis. NIMR hopes to have the equipment, reagents, expertise, and other logistical support ready to assist in combating and identifying the causes of emerging problems in order to respond effectively.

NIMR now has the capabilities—including molecular techniques—to help fight various infectious diseases ravaging the country, such as cholera, tuberculosis, and malaria.

Read how Nigeria has boosted its molecular epidemiology lab capacity to detect multidrug-resistant TB strains.