The Ebola outbreak is widespread in Sierra Leone, Guinea and Liberia, with one imported fatal case in Lagos. There has been a rapid response to this case and containment measures have been introduced with follow up of possible contacts. Read the rest of the report …
Ebola: Advice for travellers
The Ebola outbreak continues.
The current Ebola Virus Disease (EVD) outbreak began in Guinea in December 2013. This outbreak now involves transmission in Guinea, Liberia, Nigeria, and Sierra Leone.
A total of 8399 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 7 affected countries (Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the USA) up to the end of [8 Oct 2014]. There have been 4033 deaths.
Following the WHO Ebola Response Roadmap structure, country reports fall into two categories: those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and those with an initial case or cases, or with localized transmission (Nigeria, Senegal, Spain, and the USA).
The WHO has not recommended any general ban on international travel or trade restrictions except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Refer to the section on the recommendations of the WHO Emergency Committee below.
There are no Ebola cases in South Africa to date. Travellers to outbreak affected countries have low or very low risk of contracting Ebola given that the virus is only transmitted by close direct contact with blood, body fluid or tissue of infected patients. The virus is not airborne, and there is no risk from healthy contacts. Returning travellers who are well do not pose a risk to family and do not need to be quarantined or tested. Should a fever develop it is extremely important to exclude malaria: consult a medical practitioner and provide information regarding travel history.
Travellers to the area, working in whatever industry, must be aware of other health risks and take the necessary precautions – vaccines which will include yellow fever, hepatitis A and typhoid must be considered. Personal protection is essential both during the day and at night so as to minimise the risk of dengue fever and malaria. Malaria chemoprophylaxis is of paramount importance and must not be ignored. Malaria, dengue fever, typhoid fever, hepatitis A, Lassa fever and tick-related illnesses must be included in the differential diagnosis of a traveller to this area who presents with a fever.
Lassa fever is well described in all three countries and Nigeria. It is transmitted from excreta from rodents where there is chronic urinary carriage of the virus and needs to be considered in the differential diagnosis in travellers with a severe febrile illness who have been to rural areas where rodents are common.
Source: NICD, WHO, ProMed Mail
Updated October 10 2014
WHO EMERGENCY COMMITTEE ON EVD RECOMMENDATIONS
The Emergency Committee advised the following:
1. States with Ebola transmission
- The Head of State should declare a national emergency
- Health Ministers and other health leaders should assume a prominent leadership role in coordinating and implementing emergency Ebola response measures
- States should activate their national disaster/emergency management mechanisms and establish an emergency operation centre
- States should ensure that there is a large-scale and sustained effort to fully engage the community
- It is essential that a strong supply pipeline be established to ensure that sufficient medical commodities, especially personal protective equipment (PPE), are available to those who appropriately need them.
- In areas of intense transmission (e.g. the cross border area of Sierra Leone, Guinea, Liberia), the provision of quality clinical care, and material and psychosocial support for the affected populations should be used as the primary basis for reducing the movement of people, but extraordinary supplemental measures such as quarantine should be used as considered necessary.
- States should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused by EVD. Any person with an illness consistent with EVD should not be allowed to travel unless the travel is part of an appropriate medical evacuation.
- There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation. To minimize the risk of international spread of EVD:
- Confirmed cases should immediately be isolated and treated in an Ebola Treatment Centre with no national or international travel until 2 Ebola-specific diagnostic tests conducted at least 48 hours apart are negative;
- Contacts (which do not include properly protected health workers and laboratory staff who have had no unprotected exposure) should be monitored daily, with restricted national travel and no international travel until 21 days after exposure;
- Probable and suspect cases should immediately be isolated and their travel should be restricted in accordance with their classification as either a confirmed case or contact.
- States should ensure funerals and burials are conducted by well-trained personnel. The cross-border movement of the human remains of deceased suspect, probable or confirmed EVD cases should be prohibited unless authorized in accordance with recognized international biosafety provisions.
- States should ensure that appropriate medical care is available for the crews and staff of airlines operating in the country.
- States with EVD transmission should consider postponing mass gatherings until EVD transmission is interrupted.
2. States with a potential or confirmed Ebola Case, and unaffected States with land borders with affected States
- Unaffected States with land borders adjoining States with Ebola transmission should urgently establish surveillance for clusters of unexplained fever or deaths due to febrile illness.
- Any State newly detecting a suspect or confirmed Ebola case or contact, or clusters of unexplained deaths due to febrile illness, should treat this as a health emergency.
3. If Ebola transmission is confirmed to be occurring in the State, the full recommendations for States with Ebola Transmission should be implemented.
4. All States
- There should be no general ban on international travel or trade; restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented.
- The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.
- States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola.
Source: WHO (edited)http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/