Ebola virus is the latest in a string of viral concerns that has threatened travellers, along with raising both awareness and concern for epidemic and pandemic outbreaks. We have put together some of the facts, relevant medical advice and specific actions for travellers and managers who may be exposed to this most recent travel threat. While the overall threat to travel remains very low, there are select locations and individuals that are at higher risk, primarily due to the location of travel.
Background & Origins
Ebola Virus Disease (EVD) also known as Ebola hemorrhagic fever is a severe, often fatal illness, with a death rate of up to 90% which affects both animals and humans.
It was first identified in 1976 in two simultaneous outbreaks in the Democratic Republic of Congo and in Sudan (www.who.int).
According to World Health Organization (WHO), Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals.
Ebola Virus Symptoms
Symptoms typically start two days to three weeks after contracting the virus, with a sudden onset of:
- Intense weakness
- Muscle pain
- And sore throat.
This is followed by
- Impaired kidney
- Liver function
- And in some cases, both internal and external bleeding.
Those at Risk
According to Centers for Disease Control and Prevention (CDC), during outbreaks of EVD, those highest at risk include health care workers and the family and friends of an infected individual.
There is an ongoing epidemic of the EVD this year in West Africa. The outbreak began in Guinea in February 2014 and has spread to Liberia and Sierra Leone. It said to be the most severe in recorded history, both in the number of cases and fatalities, where a suspected 1440 cases with 826 deaths have been reported by the WHO as of July 20, 2014.
The current Ebola Virus Disease outbreak is reportedly centered in Africa, particularly on Guinea, Liberia, Sierra Leone, Democratic Republic of the Congo, Gabon, South Sudan, Ivory Coast, Uganda, Republic of the Congo, and South Africa (www.cdc.gov).
Medical Advice on the Ebola Virus
According to WHO, the risk of travellers becoming infected with the 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.
Ebola Virus Transmission
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. Direct physical contact is still required for possible infection of the EVD.
But there still possibilities that a person who had been exposed with the disease and developed symptoms may board a commercial flight, or other mode of transport.
Notable Cases Ebola Cases
One reported incident was when Patrick Sawyer, a Liberian government consultant, travelled to Nigeria for a conference then collapsed upon arrival in Lagos on July 20. He began vomiting and having diarrhea mid-flight, according to witnesses. He was quarantined in the airport and succumbed to Ebola a week after.
Sawyer’s case alarmed international travellers who were boarded in his plane, which might cause the spread across to Europe, Asia and the Americas.
However, WHO attested that there is no risk transmission during the incubation period. Historically, several cases of EVD were diagnosed after long distance travel but none developed the symptoms during the international travel. Long-distance travellers in between continents who might be infected in affected areas could arrive while incubating the disease and develop symptoms of Ebola after arrival.
Moreover, international travel organizations and health officials are downplaying the threat of a global pandemic spreading through air travel, because the nature of the virus and its method of spreading. So this should not cause panic to the travel industry in general (http://www.voanews.com).
Despite ofthis, it is important that the public should be well-informed about the disease which may help in controlling the spread and transmission of EVD. Authorities of airports and other points of entry especially in affected areas should make appropriate precautionary measures for travellers coming in and out of the country.
Furthermore, returning visitors from the countries mention and have developed symptoms of the EVD within three weeks after their return should seek immediate medical attention and mention their recent travel to the attending physician.
Ebola Prevention and Control Advice
Here are some additional tips for prevention and control of EVD:
- Avoid direct contact with blood or bodily fluids of a patient or a corpse and with objects possibly contaminated;
- Avoid close contact with wild animals and consumption of ‘bush meat’;
- Avoid having unprotected sexual intercourse;
- Those who are providing medical care or are involved in the evaluation of an outbreak should wear protective clothing, including masks, gloves, gowns, eye protection and practice proper infection prevention and control measures.
Related Epidemic and Pandemic Risks
The world has responded differently to the facts and the threat. For example, some countries and airports have started temperature screening. While largely ineffective for the threat [due to incubation period, along with temperature not being the only telltale symptom] it has been the ‘standard’ response to viral outbreaks and alarms. This will undoubtedly lead to many individuals being quarantined and isolated for a host of unrelated illnesses and medical conditions over the coming weeks.
Travellers and managers should be aware of this inconsistent screening and countermeasure, and may be subjected to screening or detention, even though not having travelled to or near the affected areas. Conversely, those returning from affected areas, may go undetected for a longer period of the live in an area not immediately aware of the threat or considering Ebola as a likely consideration during diagnosis.
As is the case with all epidemics and pandemics, the time from identifying and affected area/group and reporting the information is rarely instantaneous. This means that a number of people may get sick or perish as a result of the virus, and never be diagnosed nor documented as a related case, due to poor medical screening and reporting in less developed areas. While this contributes to less than actual data, it can also contribute to a sudden spike in reporting and cases, not infection rates, due to this new focus and capability within an area suspected as affected. Travellers and managers should also take this into consideration when receiving or reviewing updates.