Tuesday 20 February 2018

Ebola: What is it? How can I travel safely? Will it come to Ireland?

A health worker conducts an Ebola prevention in Monrovia. (Photo DOMINIQUE FAGET/AFP/Getty Images)
A health worker conducts an Ebola prevention in Monrovia. (Photo DOMINIQUE FAGET/AFP/Getty Images)
UNDATED: In this handout from the Center for Disease Control (CDC), a colorized transmission electron micrograph (TEM) of a Ebola virus virion is seen. As the Ebola virus continues to spread across parts of Africa, a second doctor infected with the disease has arrived in the U.S. for treatment. (Photo by Center for Disease Control (CDC) via Getty Images)
An MSF health worker holds a child suspected of having Ebola in Paynesville, Liberia. The girl and her mother were awaiting test results for the virus. Photo by John Moore/Getty Images
A health worker writes the name of a doctor on his protective suit this October at MSF's Ebola treatment center in Monrovia. (Photo PASCAL GUYOT/AFP/Getty Images)
NEW YORK, NY - OCTOBER 09: Workers with the union 32BJ, many of them airline cabin cleaners, terminal cleaners and wheelchair attendants, participate in a class on how to better protect themselves from infectious diseases in the wake of increased concerns around the Ebola virus on October 9, 2014 in New York City. The infectious disease training classes will be ongoing and teach members how to wear protective clothing and to safely handle potentially harmful body fluids they may come in contact with. It was announced on Wednesday that five airports across the United States will start screening passengers arriving from Ebola-affected countries in West Africa.(Photo by Spencer Platt/Getty Images)
Pól Ó Conghaile

Pól Ó Conghaile

A tropical medical expert answers your questions, and Pól Ó Conghaile provides the latest travel advice on Ebola.

What is Ebola?

Ebola is a rare and deadly virus. It takes its name from the Ebola River in the Congo, where the first known case appeared in 1976.

What are the symptoms?

Symptoms include fever (36.8+ degrees), severe headache, muscle pain, weakness, diarrhoea, vomiting, stomach pain and unexplained bleeding or bruising. The initial cold/flu-like symptoms appear between two and 21 days after infection.

Why is it in the news?

The current outbreak in West Africa is the largest in history.

Over 4,400 people have been killed by the virus, with cases also being treated in the US, Spain and Germany. The US Centre for Disease Control's (CDC) worst-case scenario predicts at least 550,000 cases by January 2015.

Why is it so dangerous?

Ebola virus, Getty.jpg
The Ebola virus (Photo by Center for Disease Control via Getty Images)

"This disease is one of the most infectious diseases known to man and has an extremely high mortality rate in comparison to other more commonly considered diseases," says Dr. Graham Fry of the Tropical Medical Bureau in Dublin.

After symptoms present, death can occur very rapidly - "either from the shock state or associated with secondary infections."

The current outbreak has a fatality rate of up to 70%, according to the WHO.

By contrast, SARS had a 10% mortality rate.

The Ebola outbreak is the "most severe acute health emergency in modern times", the World Health Organisation has warned.

Could Ebola come to Ireland?

"Yes, in the same way as any other country throughout the world," Fry says.

"Basically the 'challenge' is that individuals may travel within the incubation period (up to 21 days) when they are perfectly healthy and well and not known to be capable of passing the disease on to others, and then get ill themselves some days later."

Addressing the Joint Oireachtas Committee on Health and Children on Ireland’s readiness for a case of Ebola, Minister for Health Leo Varadkar said: "Should a case occur, it is likely that there will be only one or two cases and they can be handled in the National Isolation Unit in the Mater."

"The case is likely to be somebody who is evacuated from abroad here," he added.

Ireland has been "stepping up preparedness, in particular training, dry-runs and provision of equipment".

Read more: Are we really ready if Ebola virus strikes?

How is it spread?

Ebola becomes contagious once symptoms develop. It is spread through direct personal contact with body fluids (e.g. urine, saliva, sweat, faeces, vomit, breast milk and semen), with contaminated needles, infected animals or their meat.

Is it airborne?

No. Unlike the flu, Ebola is not spread through the air.

Could Ebola spread on board an airplane?

"The official line at present is that anyone sitting within six rows of an infected individual (usually identified after the flight) would be regarded as at higher risk and be quarantined or at least closely followed up by the health authorities," Fry says.

You can read the latest HSE travel advice here.

In the event of a suspected case on board an airplane, WHO guidelines recommend the distancing of that passenger from others on the plane, the use of a surgical facemask to cover their nose/mouth, hand-washing and limited contact with cabin crew wearing Universal Precaution Kits.

If a suspect case presents, airline crew should immediately notify the destination airport, which should arrange to isolate the passenger on arrival.

How can I stay safe when I travel?

The HSE advises against all non-essential travel to countries affected by the current West African outbreak (Liberia, Guinea, Sierra Leone).

Cases of Ebola were diagnosed in Nigeria and Senegal, but all contacts in both countries have now completed their 21-day follow up, with no further cases reported.

Generally speaking, travellers in outbreak countries can reduce risk by avoiding crowded places (e.g. cinemas, local transport, funerals, hospitals etc) and not shaking hands or making other avoidable personal contact, Dr Fry adds.

Travellers cannot catch the virus from mosquitoes, swimming or handling money or groceries, the HSE advises.

Ebola training, LaGuardia.jpg
New York: Airport workers participate in a class on how to protect themselves from infectious diseases in the wake of Ebola concerns. October, 2014.

Should I be worried about travelling to Spain?

No. "The risk to any individual at this time remains minimal unless the close contact issues mentioned above are disregarded," Dr Fry says.

Will there be screening at Irish airports?

No. Airport screening has been set up at US and UK airports, but there are currently no plans to screen for Ebola at Irish airports. Screening is costly, and with no direct flights from Africa, the chances of a case arriving here remain relatively low.

According to Health Minister, Leo Varadkar:

“First of all, patients who have Ebola and are not symptomatic won’t show up on screening. However, huge numbers of people will show up on screening who just have another illness or viral infection. So while exit screening leaving West Africa makes sense, screening everyone coming to Ireland does not.”

Where did Ebola come from?

"Because the natural reservoir host of Ebola viruses has not yet been identified, the manner in which the virus first appears in a human at the start of an outbreak is unknown," according to the US Center for Disease Control.

"The virus can infect various animals, including bats, who do not suffer from the disease," adds Dr. Fry. "Humans eating 'bush meat' may become infected and then spread the virus to others once they become ill themselves."

Ebola worker, Getty 4.jpg
'We have 59 citizens registered in Sierra Leone and Liberia.'

Why can the outbreak not be stopped more quickly?

"The incubation period (2-21 days) provides the ideal opportunity for an infected individual to unwittingly move from place to place and potentially infect others before they are isolated," Dr Fry says.

The response to the outbreak has also been far from optimum - with UN officials reporting that a $1 billion appeal to fight Ebola has only been 25pc funded.

What is worst case scenario now?

"The bottom line is that despite the fact that this is a horrific disease which is frighteningly infectious and contagious with a colossal mortality, Ebola is a small risk for the vast majority of the world's population at this point in time," Dr fry says.

He recommends that governments establish 24/7 advice lines and mobile emergency response teams who can travel to assess potential risk individuals.

"The worst case scenario is that many further cases are identified globally and fear spreads to the extent that medical staff are unwilling to tend sick patients who could in fact have a multitude of other diseases and not Ebola. Another major concern would be that the disease (also same problem for Avian Influenza) becomes air-borne." 

Further links and information:

Tropical Medical Bureau: www.tmb.ie

CDC: Ebola Advice

DFA: Travel Advice

HSE: Advice for Airports & Airlines

NB: This story is being updated as the Ebola outbreak develops.

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