Nigeria declared Ebola-free; 'spectacular success'

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How Nigeria Beat Its Ebola Outbreak

ABUJA, Nigeria (AP) -- Water laced with salt and sugar, and gallons of the nasty-tasting stuff.

Doctors who survived Ebola in Nigeria credited heavy doses of fluids with saving their lives as the World Health Organization declared the country Ebola-free Monday, a rare victory in the battle against the disease that is ravaging West Africa.

In the end, Nigeria - the most populous country in Africa, with 160 million people - had just 20 cases, including eight deaths, a lower death rate than the 70 percent seen elsewhere across the stricken region.

Officials are crediting strong tracking and isolation of people exposed to the virus, and aggressive rehydration of infected patients to counter the effects of vomiting, diarrhea and other symptoms.

Nigeria's containment of Ebola is a "spectacular success story," said Rui Gama Vaz, WHO director for Nigeria.

Survivor Dr. Adaora Igonoh said the treatment is not easy. It entails drinking, as she did, at least five liters (1.3 gallons) of the solution every day for five or six days when you have mouth sores and a sore throat and feel depressed.

"You don't want to drink anything. You're too weak, and with the sore throat it's difficult to swallow, but you know when you have just vomited, you need it," she told The Associated Press. "I had to mentally tell myself, `You have got to drink this fluid, whether it tastes nice or not.'"

Some 9,000 people have been infected with Ebola, and about 4,500 have died, mostly in hard-hit Sierra Leone, Guinea and Liberia, with the number of cases expected to increase exponentially in the coming weeks.

Dr. Simon Mardel, one of the world's leading experts on viral hemorrhagic fevers, said the number of deaths could be cut in half if infected people were taught to properly hydrate themselves and do not take anti-inflammatory drugs, which can actually harm Ebola victims.

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Nigeria declared Ebola-free; 'spectacular success'
Nigerian health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)
A student washes his hands to prevent the spread of the Ebola virus at a school in Lagos on October 8, 2014. Public and private schools in at least 11 states of the country resumed academic activities on October 8 in compliance with the directive of state governments and respective chapters of the Nigeria Union of Teachers (NUT) after an enforced extension because of the outbreak of the virus in the cities of Lagos and Port Harcourt.The federal government had ordered schools to resume on September 22, but teachers union some states refused to return to work until they were provided with anti-Ebola kits and other logistics required to prevent the spread of the Ebola virus. The Ebola outbreak in Nigeria is almost over, US health officials said on October 7, in a rare sign of authorities turning the tide on the highly contagious disease that has killed more than 3,000 in West Africa. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A Health official takes the body temperature of an Ukrainian sailor on the MV Pintail ship, as they check for signs of the Ebola virus at the Apapa Sea Port, in Lagos, on September 29, 2014. Health officials have begun the screening of cargo ship crews transiting through the ports of Nigeria to prevent cross border transmission of Ebola through sea and cargo ports. Nigeria has cleared all patients under surveillance for the Ebola virus, the federal health ministry said on September 24, 2014. 'There is nobody again under surveillance for the Ebola virus in any part of Nigeria. All those under surveillance have completed their mandatory 21-day period stipulated by the WHO,' ministry's spokesman Dan Nwomeh told AFP, referring to the World Health Organization. PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A teacher ckecks body temperature of pupils for the Ebola virus at a school in Lagos on October 8, 2014. Public and private schools in at least 11 states of the country resumed academic activities on October 8 in compliance with the directive of state governments and respective chapters of the Nigeria Union of Teachers (NUT) after an enforced extension because of the outbreak of the virus in the cities of Lagos and Port Harcourt.The federal government had ordered schools to resume on September 22, but teachers union some states refused to return to work until they were provided with anti-Ebola kits and other logistics required to prevent the spread of the Ebola virus. The Ebola outbreak in Nigeria is almost over, US health officials said on October 7, in a rare sign of authorities turning the tide on the highly contagious disease that has killed more than 3,000 in West Africa. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
Health officials takes the body temperature of an Ukrainian worker on the MV Pintail cargo ship, as they check for signs of the Ebola virus at the Apapa Sea Port, in Lagos, on September 29, 2014. Health officials have begun the screening of cargo ship crews transiting through the ports of Nigeria to prevent cross border transmission of Ebola through sea and cargo ports. Nigeria has cleared all patients under surveillance for the Ebola virus, the federal health ministry said on September 24, 2014. 'There is nobody again under surveillance for the Ebola virus in any part of Nigeria. All those under surveillance have completed their mandatory 21-day period stipulated by the WHO,' ministry's spokesman Dan Nwomeh told AFP, referring to the World Health Organization. PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
Pupils listen as teacher speaks about the Ebola virus during the assembly at a school in Lagos on October 8, 2014. Public and private schools in at least 11 states of the country resumed academic activities on October 8 in compliance with the directive of state governments and respective chapters of the Nigeria Union of Teachers (NUT) after an enforced extension because of the outbreak of the virus in the cities of Lagos and Port Harcourt.The federal government had ordered schools to resume on September 22, but teachers union some states refused to return to work until they were provided with anti-Ebola kits and other logistics required to prevent the spread of the Ebola virus. The Ebola outbreak in Nigeria is almost over, US health officials said on October 7, in a rare sign of authorities turning the tide on the highly contagious disease that has killed more than 3,000 in West Africa. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A teacher ckecks body temperature of pupils for the Ebola virus at a school in Lagos on October 8, 2014. Public and private schools in at least 11 states of the country resumed academic activities on October 8 in compliance with the directive of state governments and respective chapters of the Nigeria Union of Teachers (NUT) after an enforced extension because of the outbreak of the virus in the cities of Lagos and Port Harcourt.The federal government had ordered schools to resume on September 22, but teachers union some states refused to return to work until they were provided with anti-Ebola kits and other logistics required to prevent the spread of the Ebola virus. The Ebola outbreak in Nigeria is almost over, US health officials said on October 7, in a rare sign of authorities turning the tide on the highly contagious disease that has killed more than 3,000 in West Africa. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
Health officials takes the body temperature of an Ukrainian sailor on the MV Pintail ship, as they check for signs of the Ebola virus at the Apapa Sea Port, in Lagos, on September 29, 2014. Health officials have begun the screening of cargo ship crews transiting through the ports of Nigeria to prevent cross border transmission of Ebola through sea and cargo ports. Nigeria has cleared all patients under surveillance for the Ebola virus, the federal health ministry said on September 24, 2014. 'There is nobody again under surveillance for the Ebola virus in any part of Nigeria. All those under surveillance have completed their mandatory 21-day period stipulated by the WHO,' ministry's spokesman Dan Nwomeh told AFP, referring to the World Health Organization. PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
MV Pintail Ukrainian sailor Levgeny Sarayev uses a T-shirt to make a face mask as Nigerian health workers onboard check for signs of the Ebola virus at the Apapa Sea Port, in Lagos, on September 29, 2014. Health officials have begun the screening of cargo ship crews transiting through the ports of Nigeria to prevent cross border transmission of Ebola through sea and cargo ports. Nigeria has cleared all patients under surveillance for the Ebola virus, the federal health ministry said on September 24, 2014. 'There is nobody again under surveillance for the Ebola virus in any part of Nigeria. All those under surveillance have completed their mandatory 21-day period stipulated by the WHO,' ministry's spokesman Dan Nwomeh told AFP, referring to the World Health Organization. PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
ISTANBUL, TURKEY - SEPTEMBER 25: Medics carry a Nigerian patient Fabian Chiman Egeolu, suspected of being infected with the Ebola virus, during his transfer to another hospital in Istanbul, Turkey on September 25, 2014. (Photo by Metin Pala/Anadolu Agency/Getty Images)
FILE - In this Monday, Aug. 4, 2014, file photo, a Nigerian health official uses a thermometer on a worker at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria. (AP Photo/Sunday Alamba, File)
A teacher uses a thermometer to test students' temperature checking for signs of Ebola virus at Aiyetoro African Church Nursery and Primary school in Lagos, Nigeria, Wednesday, Oct. 8, 2014. Spotting symptoms early is a key factor in treating victims of Ebola, and in arresting the spread of this extremely contagious disease, according to health experts. (AP Photo/Sunday Alamba)
A Nigerian port health official uses a thermometer to screen Muslim pilgrims for Ebola at the Hajj camp before boarding a plane for Saudi Arabia at the Murtala Muhammed International Airport in Lagos, Nigeria Thursday, Sept, 18. 2014. ( AP Photo/Sunday Alamba)
Nigerian port health officials uses a thermometer on a worker at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Wednesday, Aug. 6, 2014. A Nigerian nurse who treated a man with Ebola is now dead and five others are sick with one of the world's most virulent diseases, authorities said Wednesday as the death toll rose to at least 932 people in four West African countries. (AP Photo/Sunday Alamba)
A Nigerian health official wearing a protective suit waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)
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In other developments:

- About 120 people in the U.S. are being monitored for symptoms because they may have had contact with one of Dallas' three Ebola victims. More than 40 others have been given the all-clear after the 21-day maximum incubation period for the virus ended.

- The European Union stepped up efforts to raise nearly $1.3 billion to combat the outbreak.

- President Barack Obama is working the phones with world leaders, appealing to them to join the fight.

- WHO director Margaret Chan said that an internal WHO report obtained by the AP that said the U.N. agency bungled efforts to control the outbreak was "a work in progress," and "the facts have not been fully checked."

Mardel, of Britain's University Hospital of South Manchester, called rehydration a low-tech approach that has been neglected by a medical system focused on groundbreaking research.

Nigeria's outbreak began in Lagos with a single infected Liberian diplomat who flew in in July, bringing the terrifying disease to Africa's biggest city, with 21 million people.

Many feared the worst in a city with large numbers of people living in crowded and unsanitary conditions in slums.

"The last thing anyone in the world wants to hear is the two words, `Ebola' and `Lagos,' in the same sentence," U.S. consul general Jeffrey Hawkins noted at the time, saying the development raised the specter of an "apocalyptic urban outbreak."

Instead, with swift coordination among state and federal health officials, the WHO and the U.S. Centers for Disease Control and Prevention, and with ample financial and material resources from Nigeria's government, isolation wards were constructed and Ebola treatment centers designated.

Health workers tracked down nearly 100 percent of those who had contact with the infected, paying 18,500 visits to 894 people.

The eight deaths included two doctors and a nurse.

Monday's announcement came 42 days - twice the incubation period - since the last case in Nigeria tested negative.

"The outbreak in Nigeria has been contained," WHO's Vaz said. "But we must be clear that we only won a battle. The war will only end when West Africa is also declared free of Ebola."

Nigeria's President Goodluck Jonathan said the success shows what Nigerians can achieve when they set aside their differences. He urged his people to replicate "the unity of purpose and all-hands-on-deck approach" in other areas of national life.

There is no licensed treatment for Ebola, so doctors focus on hydration and supportive care, even in developed countries. In some cases, doctors have been surprised that keeping patients hydrated has been enough to save them.

To improve survival rates, Mardel said, it is time to designate packaged rehydration solutions as part of the cure. He said more needs to be done to make the fluids palatable, such as making the solutions weaker or flavoring them.

Igonoh said she sometimes added orange juice.


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