The Ebola virus was imported into Nigeria via an infected air traveller, who entered Lagos on 20 July and died 5 days later. One close contact of the Lagos case fled the city, where he was under quarantine, to seek treatment in Port Harcourt.
This close contact was treated, from 1 to 3 August, at a Port Harcourt hotel by a male physician who developed symptoms of weakness and fever on 11 August and died of Ebola on 22 August.
The case history of this physician, the index case for Port Harcourt, is important, as it reveals multiple high-risk opportunities for transmission of the virus to others.
After onset of symptoms, on 11 August, and until 13 August, the physician continued to treat patients at his private clinic, and operated on at least two. On 13 August, his symptoms worsened; he stayed at home and was hospitalized on 16 August.
Prior to hospitalization, the physician had numerous contacts with the community, as relatives and friends visited his home to celebrate the birth of a baby.
Once hospitalized, he again had numerous contacts with the community, as members of his church visited to perform a healing ritual said to involve the laying on of hands. During his 6 day period of hospitalization, he was attended by the majority of the hospital’s health care staff.
On 21 August, he was taken to an ultrasound clinic, where 2 physicians performed an abdominal scan. He died the next day.
The additional 2 confirmed cases are his wife, also a doctor, and a patient at the same hospital where he was treated. Additional staff at the hospital are undergoing tests.
Given these multiple high-risk exposure opportunities, the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos.