Health
Unregistered tiger nut drinks caused Lagos cholera outbreak – Govt
Special Adviser to the Lagos State Governor on Health, speaks on the cholera outbreak in the state.
What are the primary causes of the recent cholera outbreak in Lagos State?
There have always been cases of cholera in Nigeria. We typically have isolated cases that we treat. However, we observed a surge in cholera cases between the 10th and 11th of June 2024. This increase qualifies it as an outbreak. The top three affected local government areas are Lagos Island, Kosofe, and Eti-Osa. The Nigeria Centre for Disease Control and Prevention anticipates cholera outbreaks, particularly during the rainy season, as is the case now. Firstly, this doesn’t surprise us. Secondly, we know the necessary steps to take when such outbreaks occur. It largely relates to environmental conditions and what I refer to as the social determinants of health. There are areas lacking adequate clean water, relying instead on wells. Open defecation is also prevalent. When it rains, these factors result in faecal matter contaminating water sources like wells. Other contributing factors include flooding when canals overflow and poor sanitation practices. What we observed was a sudden increase followed by a decline due to our prevention campaigns and efforts to raise awareness, encouraging regular handwashing. So, that’s the crux of the matter.
What specific factors contributed to the increased prevalence of cholera in those particular areas and regions you mentioned?
When there’s an outbreak like this, we have Environmental Health Services officials from the Ministry of Health and the Ministry of Environment who go around ensuring that the environment is kept clean. So when we noticed an increase in cases in Eti-Osa Local Government Area of Lagos specifically, we went there to investigate. We carried out a survey and found that the common denominator, which was one of the deadly factors, was a tiger nut drink. People who came to the hospitals all identified that they had drunk tiger nut drink. We couldn’t just take their word for it, so we had to take that drink and test it to see what was in it. We immediately sent people out to look for those selling it so we could take a sample. We found empty bottles with a name on them, but we discovered that it wasn’t even registered with the National Agency for Food and Drug Administration and Control, the regulatory body that ensures the safety of consumables. There was a phone number and a name on the bottle, and we started tracing. We did contact tracing, similar to what we did with COVID-19. We combed the area to ask people where they got the drinks from. We couldn’t find any full bottles. We only found empty ones, which were of no use because we could not test them. The phone number on the bottle was not reachable. From our investigations, we realised that the beverages were not registered, so the producers hadn’t gone through the processes to ensure that what they were producing was safe for the public to consume. We traced it to that. Of course, cholera is also water-borne, so we took samples of the water to test it. The bottom line is that we took stool samples because different things cause diarrhoea. It could be anything else. We found out that it was confirmed cholera, specifically Vibrio cholera subtype 01, which is the most infectious and aggressive type. There are different types, but we identified this one. In Lagos Island, Eti-osa, and Kosofe, we recorded the highest number of cases that went to the hospital. I’m not talking about reported cases. These are the people who did the right thing by going to the hospital to complain of symptoms, and they were treated. That’s when we were alerted. When the hospitals report cases, we are notified, and we set up an emergency office in Yaba to swing into action. That’s what we’ve been doing since. We continue to test everyone’s stool specimens. Unfortunately, we can’t test everyone because most have already taken antibiotics, which doesn’t give us a good sample. We test those who just came and have not taken anything at home. Hence, part of our campaign is to advise people not to take antibiotics. Pharmacists should not sell them antibiotics. They should come straight to the hospital for testing. We provide oral rehydration therapy, which is crucial during cholera symptoms. It doesn’t mean the other local governments didn’t have cases, they did, but the numbers started decreasing. We were quite relieved because there was a day when we didn’t have any new cases. However, we anticipated an increase after the Ileyah celebrations, which indeed happened. Unfortunately, we also had an increase in deaths. That’s the unfortunate part. More people have died, and about three of them were already dead upon arrival from home. From our history, we realised they had diarrhoea and vomiting for the past two or three days, but they never came to the hospital. They were probably treating themselves locally, which we advise against. That’s how we know. We’re hoping for a decline as we continue our efforts in the community.
The earlier data before the festivities recorded 15 fatalities. What is the case now?
It has increased. As of Thursday morning, we had 21 cases. During an emergency meeting around 11 pm on Wednesday, we received information that someone had died within an hour or two of arriving at the hospital from home. This individual did not just develop diarrhoea on that day but had been at home. The incident could have occurred before Ileyah or around that time, but we are reporting the death now because it happened recently. It’s not a new case that occurred on Wednesday; it’s a new case that has been reported, unfortunately resulting in death.
Aside from diarrhoea and vomiting, what other cholera symptoms should residents know?
It begins with abdominal pain. That’s the initial symptom. Following that, there is diarrhoea. Some cases may also present with fever, though not all. Additional symptoms include vomiting, muscle pains, and cramps, primarily due to the loss of electrolytes. Others include a rapid heart rate and general malaise. Fatigue and tiredness are also common due to the significant loss of water, which carries essential electrolytes like potassium, vitamins, and magnesium. These losses lead to muscle pain and cramps. While watery diarrhoea is the most typical symptom, not all instances of diarrhoea indicate cholera. Some people experience diarrhoea that resolves, but true cholera manifests as profuse watery diarrhoea, almost like water itself, as the bacteria in the small intestine absorb water from the body, causing it to pass quickly through the intestines.
How quickly do these symptoms typically appear after infection, and how is cholera diagnosed?
It varies depending on the amount of bacteria in the body. Symptoms can start within a few hours if the bacteria are already present in your system after consuming contaminated food or water. The onset also varies among individuals, similar to COVID-19 where the virus multiplies differently in different people. Some may experience symptoms within two to five days, but with cholera, symptoms can manifest in as little as 24 hours. Once symptoms appear, it’s crucial to seek medical attention immediately. During outbreaks like the current one, we typically suspect cholera based on symptoms, but confirmation requires a stool specimen. The Nigeria Centre for Disease Control and Prevention has distributed rapid diagnostic tests to all hospitals, enabling immediate testing on-site. Samples are also sent to labs for confirmatory tests.
Upon arrival at the hospital, anyone presenting with diarrhoea or vomiting receives immediate intravenous infusion for rehydration, regardless of test results. Hydration is prioritised to replace lost fluids and electrolytes, crucial for kidney function and overall health. Some patients arriving late required dialysis to manage dehydration-related complications. For those unable to reach a hospital promptly, we recommend oral rehydration with boiled, clean water, a pinch of salt, and a teaspoon of sugar mixed thoroughly. This temporary measure helps maintain electrolyte balance until professional medical care is accessed, ensuring their well-being until they receive proper treatment at a hospital.
In the areas affected in Lagos, how significantly has this outbreak impacted their health and daily lives?
Due to the sensitisation and campaigns, we’re conducting in all those communities, people know they have to be careful because of the outbreak. We revisited the Eti-osa area and did not find a single person selling tiger nut drinks. So the communities are devoid of all those beverages right now. People are aware, and that’s our goal. We want that awareness so that people are careful. We hope people are boiling their water, ensuring they’re washing their hands, and also taking responsibility by informing others not to defecate outside in the streets. Sadly, people continue these practices in their daily lives. Lagosians are very resilient, and we believe this has spread to other states. We know of a case where someone travelled from Lagos to Oyo State and then started showing symptoms, resulting in cases in Oyo State. So the NCDC is monitoring the situation across Nigeria, not just in Lagos State. Lagos State is typically where things originate due to our overpopulation and clustering of people. Many people have travelled to Lagos for festivities and returned to their states, contributing to the spread. It has also been reported in other states, with Bayelsa being the first after Lagos. Therefore, the NCDC is working diligently, providing support for Lagos and all other states.
The NCDC has stated that it may declare an emergency on cholera. What are the implications of this?
An emergency has not yet been declared. The NCDC is monitoring the trends and conducting risk assessments. We are actively involved in this effort. Dr Jide Idriss is the DG of NCDC, and his team members are in Lagos. We are collaborating closely with them, as well as with the Ministry of Environment and the Ministry of Education, particularly concerning children. We are working diligently to ensure that the spread is contained. Risk assessments are ongoing, and further action will depend on whether the NCDC decides to declare an emergency. Hopefully, this will not be necessary as we aim to avoid causing panic. People are going about their daily lives; everyone is going to work, and schools remain open. If an emergency were declared, schools would have been closed. There are established protocols in place. Within the Ministry of Education, we have a quality assurance system that monitors developments and keeps us informed. There have been no reports of schoolchildren vomiting in schools. Teachers have been sensitised and instructed on what symptoms to look for and what actions to take. Hydration measures are also in place in schools. We are actively managing the situation. This is typical in outbreaks; cholera is not new in Nigeria. It’s during outbreaks that the NCDC is particularly vigilant, and we implement these measures.
Is there any collaboration with national or international health organisations in managing this crisis? If so, can you elaborate on these partnerships?
Many people have been mobilised, and we’re working with numerous partners. UNICEF has been fantastic. They excel in providing information. The Red Cross has also been extremely helpful. Additionally, WHO consistently monitors the situation to prevent it from escalating into a pandemic, although we are confident it won’t. We are currently in a monitoring phase. As I mentioned earlier, we anticipated a potential increase following the Ileyah Festival when everyone returns home and settles down, and that’s indeed what we’ve observed. Therefore, we are closely monitoring the situation day by day. We convene every night to discuss developments, where people provide their reports based on the pillars we are focusing on. We analyse electronic real-time data, conduct risk assessments, and oversee community surveillance, among other aspects. Currently, the situation is not deemed an emergency, and we are urging people not to panic. Treatment for suspected cholera cases at hospitals is entirely free of charge. We understand that some individuals may be concerned about medical expenses, but they need not worry as it is a public health concern. Treatment, including diagnosis, medications, and admission, is provided free of charge at all public government-owned hospitals and primary healthcare centres. No one will be asked for payment. While hospitalisation may not be necessary for everyone, we understand the economic challenges people face, which may deter them from seeking medical care.
The Federal Government has intensified emergency measures to contain the possible spread of Ebola Virus Disease in Nigeria, with plans to establish treatment and isolation centres in states hosting designated ports of entry.
The development follows an increase in the number of persons identified as contacts of Nigeria’s confirmed Ebola patient from 44 to 53.
The national incident management system has also been activated under the coordination of the Minister of Health and Social Welfare, Prof Muhammad Ali Pate.
The confirmed case involves a woman who travelled to Nigeria after visiting Uganda, following an earlier trip to the Democratic Republic of the Congo.
She reportedly developed symptoms on October 7, sought medical attention in Abuja on October 11 and tested positive for the Bundibugyo strain of Ebola on October 20.
The World Health Organisation is investigating the possible source of the infection.
Health authorities have urged Nigerians to remain calm, maintain proper hygiene, avoid direct contact with the bodily fluids of suspected Ebola patients and promptly report suspected infections.
The NCDC also warned against stigmatising persons undergoing monitoring, stressing that public cooperation, early detection and effective contact tracing remain critical to preventing further transmission.
The woman who tested positive for Ebola in Nigeria has been identified as the wife of a Swiss diplomat stationed in Abuja, with preliminary investigations suggesting that she contracted the deadly virus during a recent trip to Uganda.
According to Reuters, Switzerland’s Federal Department of Foreign Affairs confirmed on Thursday that the 42-year-old Ugandan-born woman tested positive on October 20, marking Nigeria’s first confirmed Ebola case in over a decade.
The Swiss authorities disclosed that the patient had spent approximately one week receiving treatment at a private hospital in Abuja after developing symptoms before laboratory tests confirmed the infection.
The ministry explained that the woman was believed to have contracted the virus during a visit to Uganda about two weeks earlier.
Her husband, who accompanied her on the trip, has since been placed in isolation as a precautionary measure, although he has not exhibited any symptoms of the disease.
However, uncertainty remains over the actual source of the infection, as international health agencies intensify efforts to reconstruct the patient’s travel history and identify possible exposure routes.
Ugandan authorities had suggested that the woman visited eastern Democratic Republic of the Congo before travelling through Uganda, but the World Health Organisation (WHO) and Africa Centres for Disease Control and Prevention (Africa CDC) said the claim had not been independently verified.
Africa CDC official Wessam Mankoula disclosed during an online briefing that Nigerian and Ugandan health authorities were exchanging information to establish the patient’s movements.
He maintained that there was currently no validated evidence confirming that the woman travelled to the Democratic Republic of the Congo.
Providing further clarification, WHO Representative in Nigeria, Pavel Ursu, said available records indicated that the patient travelled to Uganda on September 16 and returned to Abuja on October 3.
Ursu also confirmed that the woman remained hospitalised, adding that medical indicators showed signs of improvement.
Meanwhile, WHO Emergency Response Manager Patrick Otim said investigations were continuing to establish where the infection originated and identify health facilities the patient visited after developing symptoms.
The Nigerian case has been linked to an outbreak involving the Bundibugyo strain of Ebola, first reported in the Democratic Republic of the Congo in May.
Ebola is transmitted through direct contact with the blood or bodily fluids of infected persons, including deceased victims. Common symptoms include fever, vomiting and diarrhoea, while severe infections can result in death.
Health authorities are currently tracing the patient’s contacts and reviewing her movements to identify individuals who may have been exposed and prevent further transmission of the virus.
The Enugu State Government says it has strengthened its disease surveillance and puts health officials on alert within the 17 council areas in the state.
The Commissioner for Health, Prof. George Ugwu, said this on Wednesday in Enugu during a press conference on Actions of the State Government in Response to Confirmed Case of Ebola in Abuja.
Ugwu said that following the confirmation of the case, the government had reactivated and strengthened the Enugu State Public Health Emergency Operations Centre (PHEOC) to coordinate preparedness, surveillance and response activities.
“Specifically, the State has intensified disease surveillance across its 17 Local Government Areas and strengthened coordination with relevant agencies and partners.
“Surveillance activities around the Akanu Ibiam International Airport are also being strengthened in collaboration with Port Health Services and other relevant stakeholders.
“The state is further maintaining its Rapid Response Teams and relevant technical personnel on standby, while preparedness measures are being reviewed to ensure that the state is able to respond promptly should a suspected case be identified.
“Public awareness and risk communication activities are also being strengthened to ensure that members of the public receive accurate and timely information,” Ugwu, who is a Member of Presidential Committee on Ebola Prevention, said.
He said that health ministry would continue to work closely with Federal Ministry of Health and Social Welfare, its agencies and other partners to ensure effective preparedness, early detection, appropriate response and timely communication
The commissioner said that the government considers the health security of the state’s residents as a major priority and had taken appropriate precautionary measures without creating unnecessary fear or panic.
He urged health workers to maintain a high index of suspicion, strictly observe infection prevention and control measures, use appropriate protective equipment, and promptly report any suspected case through the established channels.
According to him, the government will continue to provide the necessary support and guidance to ensure health workers safety and effective response.
“To the good people of Enugu State, I urge you to remain calm and vigilant. There is currently no confirmed case of Ebola in Enugu State, and the measures being taken are precautionary.
“The public is advised to maintain good hand hygiene, avoid contact with the body fluids of sick persons, seek medical attention promptly when necessary, and report suspected sick person,” he said.
He specifically urged public and private health facilities across the state to remain on heightened alert and maintain a high index of suspicion for suspected cases, particularly among persons with relevant travel or exposure history.
“All suspected cases should be promptly isolated and immediately reported to the appropriate Disease Surveillance and Notification Officer (DSNO) or the State Public Health Emergency Operations Centre, while strict infection prevention and control measures are observed.
“I urge all health facilities to cooperate fully with the Enugu State Ministry of Health and other response agencies, as early detection and prompt notification are critical to preventing transmission,” he said.
It would be recalled that state government, through the Ministry of Health, for months had been undertaking Ebola Prevention Preparedness mesdures at Akanu Ibiam International Airport, Enugu, which is an international entry point.
The current Ebola Prevention measures at the airport is undertaking with collaboration of the Nigeria Centre for Disease Control and Prevention (NCDC), Federal Ministry of Health and Social Welfare, Port Health Services, airport authorities and other relevant partners.
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The Enugu State Government says there is no confirmed case of diphtheria in the state, urging residents to disapprove unfounded ongoing rumours.
The Commissioner for Health, Prof George Ugwu, made the clarification in a briefing on Wednesday in Enugu on update on the rumoured suspected case of a diphtheria patient in University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu.
“In response to this, the Public health and Surveillance unit of the State Ministry of Health are already at alert and to ensure appropriate prevention control measure and early detection as may be necessary.
“A few days ago, there was a report of suspected case of diphtheria at the University of Nigeria Teaching Hospital (UNTH), Enugu which was followed by our team.
“However, the diagnosis of diphtheria could not be sustained or confirmed; while the patient, wito was rumoured and suspected to have diphtheria,
had tonsillitis,” he said.
The commissioner noted that accordingly, contact traces and other appropriate measures are ongoing and “yet diphtheria are not diagnosed or confirmed in the state.”
He explained that the suspected patient had been traced to his home in Achara Layout in Enugu and he did not have any record of travel and had not being to the northern part of the country as rumoured.
“Our surveillance and tracing teams have also contacted his family members and others but no trace of diphtheria established,” he said.
Ugwu noted that although the state had remained on high alert against infectious diseases, “Enugu State is never at high risk of contacting diphtheria”.
“For the state, we have a robust routine and mop up vaccination especially on Penta 3, which provides effective immunisation against diphtheria for a whole life time.
“In 2026 Vaccination, we had 91 per cent record of coverage on Penta 3 vaccination, which is even above the national target or threshold,” he said.
The commissioner urged residents to remain calm and avoid spreading rumours or unverified information as well as seek medical attention promptly if they develop symptoms of any sickness.
He said, “The ministry is calling on parents and caregivers to ensure children are fully immunised with diphtheria containing vaccines (Penta 3).
“Residents are urged to follow the advice of health authorities during contact tracing and monitoring.
“Healthcare workers are urged to maintain appropriate standard precautions, promptly notify suspected cases through the surveillance system and ensure appropriate infection prevention and control measures.
“The Enugu State Ministry of Health, in collaboration with UNTH and relevant international partners, continues to monitor the situation and will be proactive for further information as necessary,” he added.
It would be recalled that there is an outbreak of diphtheria in Nigeria and 19,799 suspected cases sent to molecular laboratory test; with 15,309 confirmed cases and 517 confirmed death across 26 states and 357 Local Government Areas.
The worst affected states accounting for over 98 per cent cases of diphtheria are Kano, Bauchi, Borno, Kastin, Sokato, Zamfara, Kaduna and Plateau according to Nigeria Centre for Disease Control and Prevention (NCDC).
Diphtheria is a serious but vaccine preventable bacterial disease that can spread though respiratory droplets and close contact.
Symptoms of Diphtheria include: fever, sore throat, difficulty or pain when swallowing, cough, difficulty breathing, swelling of the neck and greyish/white membrane in the throat.
The University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, has urged patients, visitors and members of the public to remain calm following the management of a clinically suspected case of diphtheria at the hospital.
The reassurance followed concerns over the admission and subsequent death of a paediatric patient at the hospital’s Children’s Emergency Room (CHER).
According to a statement issued by the hospital management on Wednesday, the patient received medical intervention immediately after admission but died two days later despite efforts by the attending medical team.
The hospital said a subsequent clinical post-mortem review suggested that the severe symptoms may have been caused by severe pharyngotonsillitis with massive exudate, rather than diphtheria as initially suspected.
However, as a precautionary measure, UNTH said comprehensive contact tracing had commenced to identify and monitor individuals who may have had close contact with the deceased.
The hospital also confirmed that the Children’s Emergency Room had undergone standard decontamination in line with established infection prevention and control protocols.
UNTH said it had previously managed sporadic cases of diphtheria successfully and possesses the specialist personnel, isolation facilities and medical equipment required to manage infectious disease cases.
The management urged members of the public to remain vigilant for symptoms associated with diphtheria, including persistent fever, severe sore throat and difficulty swallowing.
It advised anyone experiencing such symptoms, as well as parents whose children develop them, to seek immediate medical attention at a recognised healthcare facility and avoid self-medication.
Healthcare workers, patients and visitors were also advised to maintain proper hand hygiene and respiratory etiquette while within the hospital premises.
The hospital management assured the public that it would continue to prioritise community safety and public health, while providing updates based on verified medical information.
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