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Ebola virus disease (EVD) is a very rare but severe acute viral illness1 and is often deadly. Reports suggest that of those people diagnosed with Ebola, up to nine in 10 people have died2.

EVD is often characterised by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. As the infection gets worse some people may experience shortness of breath, vomiting and diarrhoea, confusion, and internal and external bleeding3. This can lead to multi-organ failure, shock and death4.

There is no licensed vaccine to protect against EVD, though several are currently being tested5. There is also no standard treatment for EVD and very ill people will need intensive supportive therapy that consists of balancing the patient’s fluids, maintaining oxygen status and blood pressure, and treating them for any complications such as infection6.

More information is available from this World Health Organization (WHO) Factsheet.

In Africa, particular species of fruit bats are thought to be possible natural hosts for Ebola virus, with primates (monkeys, apes) including humans likely to be accidental hosts7. The Ebola virus can be passed between humans through direct contact with bodily fluids, such as blood or other bodily secretions, from an infected person. It can also be passed on from direct contact with corpses of a deceased person who had EVD.8.

The incubation period, that is the time lag from infection with the virus to onset of symptoms, ranges from 2 to 21 days9. The disease can’t be passed on to others during the incubation period. It can only spread once an infected person presents with symptoms10. People are infectious as long as their blood and bodily secretions contain the virus. Men who have recovered from EVD can still pass the virus on through their semen for up to 7 weeks after recovery11.

The highest risks of infection are associated with people caring for infected patients, particularly in hospital settings, unprotected exposure to contaminated bodily fluids, and unsafe medical procedures, including exposure to contaminated medical devices, such as needles and syringes12 13. Transmission to healthcare workers is most likely when appropriate infection control measures have not been implemented or adhered to14 15.

It is not always possible to identify patients with EVD early because initial symptoms may be non-specific, and may be applicable to a range of other diseases16. Healthcare workers should apply standard infection control precautions consistently with all patients in all work practices at all times, including: basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection and safe burial practices17.

A summary of WHO infection control recommendations when providing direct and non-direct care to patients with suspected or confirmed Filovirus haemorrhagic fever, including Ebola, is available on  http://www.who.int/. Please note this is currently under review.

An outbreak of EVD has been confirmed by the World Health Organization (WHO) in Sierra Leone, Guinea and Liberia18. And on 7th August 2014 the International Health Regulations Emergency Committee came to the unanimous view that definition of a Public Health Emergency of International Concern (PHEIC) had now been met19. The current outbreak is the largest in terms of both cases and deaths, with 1,711 (confirmed, probable and suspected) cases and 603 confirmed deaths reported to date in four countries20.

Cross border transmission is occurring and the spread of EVD to countries bordering or near Guinea, Liberia, Sierra Leone is high; the risk to the sub-region is moderate; and to overseas is low. Despite the outbreak being declared a public health emergency, the WHO is still not recommending any general bans or international travel restrictions at this time, but individual countries may make different recommendations21 22.

The risk of a traveller becoming infected with EVD during a visit to the affected areas and then developing the disease after returning is extremely low. Transmission requires direct contact with blood, secretions, organs, or other bodily fluids of infected and symptomatic living or dead persons or animals, which is not usually anticipated for tourists or business persons visiting an area23 24. The risk for travellers visiting friends and family is also considered very low, unless they have direct contact with a symptomatic person or corpse infected with the virus25.

Travellers to areas with on-going cases are advised to take the following precautions26 27 28:

 

  1. Avoid contact with symptomatic people or corpses and their bodily fluids;
  2. Avoid contact with any objects contaminated with blood or bodily fluids e.g. needles;
  3. Avoid contact with live or dead wild animals (including monkeys, forest antelopes, rodents and bats), or their raw or undercooked meat;
  4. Avoid consumption of "bush meat";
  5. Practise safe sex, including avoiding sexual intercourse with a person infected with or recovering from EVD for at least 7 weeks;
  6. Wash and peel fruits and vegetables before consumption;
  7. Follow strict hand washing routines.

 

Travellers to the affected West African countries and who have been potentially exposed to Ebola virus should seek medical attention immediately if they experience any symptoms consistent with the disease within the first 21 days of return home.

  • fever,
  • headache,
  • achiness,
  • sore throat,
  • diarrhoea,
  • vomiting,
  • stomach pain,
  • rash, or red eyes

Receiving timely medical care is essential as it increases the likelihood of surviving the infection29. Travellers should also make sure to inform their treating clinician of their recent travel and/or possible exposure(s) to EVD30.

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