By Fred Ezeh, Abuja Nigeria Centre for Disease Control (NCDC) has sounded an alarm to Nigerians on the expected epidemics and possibly pandemic outbreaks that might be recorded in 2025, advocating public support and collaboration to minimize the catastrophic effect of the outbreaks. It predicted that more cases of these epidemic diseases would be recorded this year base on certain strong signs available to it, hence the early preparations for response actions against the notable epidemics in Nigeria, and in some cases, pandemic that might struck the world unprepared like the COVID-19. Already, the world is battling with Human Metapneumovirus (HMPV), which originated from China. The rise in cases in China and beyond triggered increased anxiety among the world population. But the NCDC and others are taking measures against the outbreak of the disease. Nigeria is faced with the challenges of epidemic management all year round. It starts with Lassa fever and Mpox that accompany dry season. Afterwards, the outbreak of cerebrospinal meningitis (CSM) is recorded, and as usual, cholera, malaria and few others come at the peak of the rainy season. Intermittently, some disease outbreaks that threaten the health of the public are also recorded; hence contingency plans are always made for such an outbreak that might occur in any part of the country base on their peculiar challenges, which could include weather, human activities, environmental factors, and several others. Lassa fever NCDC acknowledged the fact that Lassa fever remains endemic in Nigeria, posing a significant public health risk across some key endemic states. Though, the disease is reported throughout the year, but the transmission peak is during the dry season when human exposure to rodents is highest. NCDC has also warned against bush burning and other unfriendly environmental activities that distort the rodents, which are the major carrier of the virus. In 2024, 9,492 suspected cases of Lassa fever were recorded; 1,154 were confirmed cases, with 190 deaths. Six states made up 89 per cent of the confirmed cases, namely: Ondo (29.7 per cent), Edo (22.7 per cent), Bauchi (17.9 per cent), Taraba (8.8 per cent), Benue (5.6 per cent), and Ebonyi (4 per cent). 10 LGAs (Owo, Etsako West, Esan West, Kirfi, Ardo-Kola, Toro, Ose, Akure South, Jalingo, and Idah) accounted for almost 59 per cent of the confirmed cases. The data showed an increase in cases of Lassa fever cases when compared to the previous year despite all the sensitization efforts on prevention. NCDC had also indicated that Lassa fever cases, and perhaps, deaths, might be recorded in 2025 due to certain reasons particularly the improvement in case reporting. However, NCDC said it has put up measures with state governments for effective and efficient response to the epidemic, thus minimising casualties therein. Cerebrospinal meningitis (CSM) CSM is another epidemic that Nigeria is faced with. It is an acute inflammation of the covering of the brain and the spinal cord, and can be caused by infection with bacteria, viruses, parasites, or fungi. Injuries and certain drugs can also increase the chances of such inflammation CSM is an epidemic-prone disease with cases reported all year round in Nigeria. But weather conditions like the dry season that comes with dust, winds, cold nights, and frequent upper respiratory tract infections increase the risk of infection, especially with crowding and poor ventilation. The highest burden of CSM in Nigeria occurs in the “Meningitis Belt” which includes all 19 states in the Northern region, the FCT, and some southern states such as Bayelsa, Cross River, Delta, Ekiti, Ogun, Ondo, Osun. In 2023/2024, Nigeria recorded 4, 915 suspected and 380 confirmed cases with 361 deaths across 174 Local Government Areas (LGAs) in 24 states, including the FCT. Similarly, there are predictions that more cases would be recorded also because of consistent efforts in case reporting in collaboration with the state governments, perhaps, through the state epidemiologist. Cholera is one of the epidemics that ravage Nigeria every year resulting in casualties. Cholera outbreak was recorded in Nigeria last year, and that might also be the case this year. Experts have predicted that the effects of climate change will be felt more this year, particularly in human interaction with the nature. Cholera has remained a serious public health issue, particularly in communities with poor Water, Sanitation, and Hygiene (WASH) systems. In Nigeria, cholera is an endemic and seasonal disease, occurring annually mostly during the rainy season and more often in areas with poor sanitation. As at October 2024, a total of 14,237 cholera cases were reported across 339 local government areas in 35 states and the FCT. 378 deaths were recorded indicating more than double figures when compared to the same time last year. Officials linked the development to the massive floods that were recorded in Lagos, Adamawa, Kebbi, Yobe, and Maiduguri, amongst others. There were two waves of cholera in 2024, and similar experience might be recorded in 2025. The most surges were reported during the week of September 29 (Epi Week 39), which was attributed to the heavy rains and subsequent flooding. NCDC Director General, Dr. Jide Idris, however, confirmed that the Agency has commenced plans to respond to some diseases that accompany the dry season, especially Lassa fever, meningitis, and few others, assuring that less causalities would be recorded. There might not be troubling cases of the disease in 2025 because of some measures that were taken by Gavi the vaccine alliance in response to the recognition of Mpox as a public health emergency in 2024 by the World Health Organization (WHO) due to the rising cases of the diseases in Africa. Mpox is a known viral zoonotic disease that can be transmitted from animals to humans and between humans. It is endemic in parts of Africa, especially in the tropical rain forests of Central and West Africa. Transmission from animals can occur through direct contact with infected animals, such as monkeys, squirrels, and rodents, or their body fluids. Human-to-human transmission is primarily through direct contact with an infected person or contaminated materials. As of September 2024, the NCDC report indicated that no death was recorded from Mpox, even though 67 cases were confirmed in 23 states and FCT, amidst plans to commence Mpox vaccination in October. NCDC, perhaps, working within the National Primary Health Care Development Agency (NPHCDA) is expected to intensify immunization exercise, particularly in some northern states, to prevent the outbreak of diphtheria as witnessed a few years ago. Diphtheria is more pronounced in children with poor immunization records, and could lead to death. The disease spreads through respiratory droplets when an infected person coughs or sneezes through close contacts with or by touching contaminated objects. Symptoms usually begin 2 to 5 days after infection and can include fever, chills, sore throat, difficulty breathing, swollen glands in the neck, nasal discharge, fatigue which can lead to breathing difficulties. Early recognition and prompt treatment are critical to managing the disease and preventing severe complications. Nigeria is expecting a drop in malaria emergencies in 2025, leveraging the malaria vaccine that was introduced into the National Routine Immunization exercise in 2024. In addition to that, the National Malaria Elimination Programme (NMEP) said it’s targeting 30 million individuals particularly children in 21 states in the Northwest, Northeast and North central, and part of Oyo state in its 2025 Seasonal Malaria Chemoprevention (SMC) exercise. National Coordinator, NMEP, Dr. Nnenna Ogbulafor, explained that SMC was introduced a few years ago in response to the high cases of malaria during the rainy season after it was confirmed that high number of children come down more with malaria during the rainy season in the endemic states. Evidently, the SMC intervention has significantly been helpful in preventing malaria cases, and that has resulted in reduced cases of malaria in the 21 endemic states led by Kebbi and Bayelsa States, particularly during rainy season when the reported cases are high. There are also some noticeable improvements in other interventions such as testing rates, the use of recommended antimalarial, uptake of intermittent preventive treatment by pregnant women, and the use of nets. But despite these achievements, there is still a lot more to be done in tackling the scourge of malaria in Nigeria; this, perhaps, necessitate the need for all stakeholders to redouble efforts to meet our goal of eliminating malaria in the country within the shortest possible time. The expected challenges The recent decision of the US President, Donald Trump, to pull the US out of the WHO will bring a major setback for the world’s response against public health challenges. WHO plays a crucial role in protecting the health and security of the world’s population including Americans, by addressing the root causes of disease, building stronger health systems, and detecting, preventing and responding to health emergencies, including disease outbreaks, often in dangerous places where others cannot go. WHO, in a statement, noted that the decision of the US President will bring a significant setback to the organisation and its quest to protect the health of the world population. The decision will obviously affect the activities of some international partners working on some diseases in Africa and other countries. Interventions from The Global Fund, the US Presidential Malaria Initiative (PMI), PEPFAR, USAID, and several others would be affected, and that could affect the already achieved gains. WHO noted that for over seven decades, it has saved countless lives and protected Americans and all people from health threats. “Together, we ended smallpox, Guinea worm, brought polio to the brink of eradication, among others. “American institutions have contributed to and benefited from membership in WHO. With the participation of the US and other Member States, WHO has, over the past seven decades, implemented the largest set of reforms in transforming our accountability, cost-effectiveness, and impact in countries. “We hope the United States will reconsider the decision, and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.” Advice to the public, health workers In all these, NCDC Director General advised the public to always maintain a high sense of hygiene and properly process their food before consumption. The publics were also advised to avoid overcrowded living areas as overcrowding leads to poor sanitation; and avoid self-medication to ensure proper diagnosis and early treatment. For some Lassa fever endemic locations, the NCDC boss advised the people to block all holes in their houses to prevent the entry of rats and other rodents, cover all dustbins and dispose of refuse or waste properly. He challenged communities to set up dumpsites far from their homes to reduce the chances of the entry of rodents into their homes, and in addition to that store food items such as rice, garri, beans, corn/maize, etc., in tightly sealed or well-covered containers, and avoid open drying of foodstuff. Healthcare workers were also advised to always practice standard infection prevention and control practices, i.e., using gloves and other appropriate personal protective equipment while handling patients or providing care for an ill patient. Healthcare workers were also asked to maintain a high index of suspicion for Lassa fever, i.e., being vigilant and consider a diagnosis of Lassa fever when seeing patients presenting with febrile illness. Most importantly, visit the nearest health facility in case of any unknown signs and symptoms for proper and adequate attention. This is essential because early identification and treatment of cases are more effective and can save lives.