The Nigerian index case of EVD was an individual who had visited and cared for a sibling who died from the disease in Liberia [7,8]. He travelled to Lagos, Nigeria, on a commercial flight, arriving on July 20, 2014, by which time he was acutely ill, and was admitted to a private hospital with fever, vomiting, and diarrhea [7,8]. He was initially treated for malaria having denied any exposure to EVD. His failure to respond to malaria treatment and his arrival from an EVD-affected country led to a suspicion of a case of EVD. Subsequent laboratory tests confirmed the diagnosis, and local public health authorities were alerted of the case of EVD [7,8]. The patient died on July 25, 2014.
The limited spread of EVD in Nigeria was a combination of fortuitous circumstances and the institution of a rapid and aggressive public health and infection control measures. The index case, a diplomat, was sick on arrival in Lagos, at a time when doctors were on strike and government hospitals closed. He was subsequently admitted to a private hospital, where he was the source of infection for nine of the hospital workers, and who were then sources of infection for five others [7,8]. This is in addition to two of the protocol officers who attended to him at the airport. One of those EVD infected protocol officers later escaped the Lagos Emergency Operations Centre (EOC) contact tracing network and travelled to Port Harcourt, where he initiated another chain of infections, involving three cases [7,8].
On July 23, 2015, the Nigerian authorities declared an EVD emergency, and activated the EOC to rapidly respond to the outbreak. In collaboration with partner agencies, the government, using existing public health assets, was able to set up six response teams, namely i) point of entry, ii) epidemiology/surveillance, iii) case management/infection control, iv) laboratory services, v) social mobilization, and vi) management/coordination, to rapidly contain the epidemic. When WHO declared Nigeria free of EVD [9] on October 20, 2014, the EOC had identified 894 contacts in three states (Lagos, Rivers, and Enugu), making approximately 18,500 face-to-face contact visits. There were a total of 20 confirmed or probable EVD cases, of whom eight died [7].
Therefore, despite the success of Nigeria in containing the EVD outbreak, the country had committed certain errors which cannot be repeated if future epidemics are to be rapidly contained. In these instances, there was a delay in providing funds for the early and crucial activities of the EOC. Official pre-outbreak information provided to the public was incorrect, creating a false sense of confidence regarding government preparedness for controlling EVD.