Should travelers be concerned?
A Growing Threat
In its summary of the Ebola/Marburg outbreaks, The Centers for Disease Control (CDC) illustrates that the current outbreak (currently 626 confirmed cases) is more severe than any in history.
While previous outbreaks affected one small area at a time, the current pandemic is spread accross three countries: Guinea, Liberia, and Sierra Leone.
The next two largest outbreaks took place in single countries, Uganda, in 2000-2001, affected 425 individuals and killed 53% of them. The first recorded outbreak in Zaire (now the Democratic Republic of the Congo) occurred in 1976, killed 88% of 318 infected individuals, and 315 people were infected during another outbreak in Uganda in 1995, killing 250.
The June 24, 2014 Risk Assessment published by the World Health Organization (WHO) estimates that continued and growing numbers of infected individuals is high.
Risk to Travelers
The World Health Organization (WHO) divides risk to travelers into categories of reason for travel:
Tourists and businessmen/women returning from affected areas in a country
“The risk of a tourist or businessman/woman becoming infected with Ebola virus during a visit to the affected areas and developing disease after returning is extremely low, even if the visit included travel to the local areas from which primary cases have been reported. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animal, all unlikely exposures for the average traveller. Tourists are in any event advised to avoid all such contacts.”
Visiting families and relatives
“The risk for travellers visiting friends and relatives in affected countries is similarly low, unless the traveller has direct physical contact with a sick or dead person or animal infected with Ebola virus. In such a case, contact tracing should confirm the exposure and prevent further spread of the disease through monitoring the exposed traveller.”
Patients travelling with symptoms and fellow travellers
“There is a possibility that a person who had been exposed to Ebola virus and developed symptoms may board a commercial flight, or other mode of transport, without informing the transport company of his status. It is highly likely that such patients would seek immediate medical attention upon arrival, especially if well informed, and then should be isolated to prevent further transmission. Although the risk to fellow travellers in such a situation is very low, contact tracing is recommended in such circumstances.”
Risk for health care workers posted in affected areas
“There is a risk for healthcare workers and volunteers, especially if involved in caring for EVD patients. However, if the recommended level of precaution for such settings is implemented, transmission of the disease should be prevented. The risk level can be considered very low to low unless these precautions are not followed, e.g. no personal protective equipment, needle stick injury etc.”
Preparedness and Response for Health Care Workers
What you should know if you are a health care worker traveling to or preparing to work in the outbreak areas.
The World Health Organization (WHO) has prepared a manual for public health workers in the field who are responding to Ebola/Marburg outbreaks.
Here is a description from the WHO website:
“Ebola and Marburg virus disease epidemics: Preparedness, alert, control and evaluation. (English) (French)
“The main target audience of this document are district-level health-care workers (doctors, nurses, and paramedics), as well as intermediate- and central-level health-care workers responsible for epidemic control, and International Health Regulations (IHR) National Focal Points (NFPs).
“The objective of this document is to describe preparedness, prevention, and control measures that have been implemented successfully during previous epidemics. These measures must be implemented during the following four phases:
- Pre-epidemic preparedness;
- Alert (identify, investigate, evaluate risks);
- Outbreak response and containment operations;
- Post-epidemic evaluation.”
What is Ebola Virus Disease (EVD, formerly known as Ebola Hemorrhagic Fever)?
WHO publishes a comprehensive FAQ on the disease here.
The WHO summary of EVD
“Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees).
“Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.
“The origin of the virus is unknown but fruit bats (Pteropodidae) are considered the likely host of the Ebola virus, based on available evidence.”
How EVD is spread
“Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has occurred through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats, monkeys or apes) including not picking up dead animals found lying in the forest or handling their raw meat.
“Once a person comes into contact with an animal that has Ebola, it can spread within the community from human to human. Infection occurs from direct contact (through broken skin or mucous membranes) with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people. Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.”
[Previous reporting on Public Health Preparedness Blog on the current outbreak was on 4/1/14]