Questions and Answers on Ebola

Note to readers: With the ongoing Ebola outbreak in Africa and with now several cases of Ebola either treated or diagnosed in the U.S. there’s so much information flowing that it is difficult to keep up with the latest news in a Question and Answer section. Significant changes or new issues will be updated and marked as “NEW”, but any case count or references to locations will be accurate on the day they are posted. For the current information, we have a pdf document that will be updated in a more timely fashion to reflect the latest guidelines, policies and other news. The Nebraska Department of Health and Human Services website posted at the bottom of the page will also contain the latest available Ebola information.

Background

The 2014 Ebola outbreak is the largest Ebola outbreak in history and the first in West Africa. The current outbreak is affecting three countries in West Africa: Guinea, Liberia and Sierra Leone. So far, there have been over 13,000 cases diagnosed and almost 5,000 deaths from Ebola. Of course, those three countries lack a well-functioning health and public health system and cultural and social practices in the region put more people at risk for contracting the disease than exist elsewhere in the world.

Over the past several months at least eight Americans who contracted the disease have received care at one of the four specialized or regionally designated hospitals set up to treat highly infectious diseases such as Ebola. Two of the patients were treated in Omaha. In late September, in Dallas, Texas, a visitor from Liberia was diagnosed with Ebola., Unfortunately, two of the nurses who treated the patient later contracted the disease, but they have since recovered, been released and are now at home. In October, a doctor who had returned from treating patients in Africa was diagnosed with Ebola and he is now in a New York hospital. These four cases, having been diagnosed in the U.S., have raised the fear level among the general public that Ebola poses a significant risk to the United States despite the low risk to the general population. The sections that follow are intended to share facts about the Ebola virus disease (EVD), cases of Ebola in Africa, the risk level for residents in America and other related information about the current outbreak.

The best way to control Ebola is to stop the disease at its source so the U.S. government has sent both military and financial aid to help set up hospitals in West Africa and assist with the three African nation's efforts to control the spread of Ebola. In light of the several recent cases diagnosed in the U.S., and the concerns that state and national agencies are not doing a good job, the President has designated an official to coordinate Ebola planning and control and to work with the many departments and agencies addressing the situation in America. The Centers for Disease Control and Prevention (CDC) is the lead federal agency. The CDC is also working with other U.S. government agencies, the World Health Organization (WHO), as well as other domestic and international partners to help stop the outbreak and minimize any spread of the disease. Teams of public health experts have been called together by the CDC and deployed to West Africa to assist in control efforts. While the CDC is our partner should we need any assistance and expert knowledge, our local and state public health systems are responsible for utilizing local resources to control the spread of disease in the community. Should we have a local case of Ebola, Lincoln’s medical providers and non-profit, private hospitals will see to it that any Ebola patients are cared for with the best medical care they can provide.

What is Ebola?

Ebola, also known as Ebola virus disease (EVD), is a rare and deadly disease caused by infection with one of several Ebola virus strains. Ebola viruses are found in several African countries. Ebola was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in several African countries.

Signs and Symptoms

What are the signs and symptoms of Ebola?

Signs and symptoms of Ebola include fever (greater than 38.0°C or 100.4°F) and severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising. Signs and symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, although 8 to 10 days is most common.

How Ebola Spreads

How is Ebola spread?

The virus is spread through direct contact (through broken skin or mucous membranes) with blood and body fluids (urine, feces, saliva, vomit, and semen) of a person who is sick with Ebola, or with objects (like needles) that have been contaminated with the virus. Ebola is not spread through the air or by water. The disease is also not spread, in general, by food; however, in Africa, Ebola may be spread as a result of handling bush meat (wild animals hunted for food) and contact with infected bats.

Who is most at risk of getting Ebola?

Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in direct contact with the blood or body fluids of sick patients. Even for close contacts such as family, there may not be a high risk. However, close family contacts are likely to be asked to self-quarantine (stay away from others, refrain from shopping, travel or going out in public), and monitor their temperatures several times a day for at least 21days, which is considered to be outside of the normal incubation period for Ebola.

In some places in Africa that are affected by the current outbreak, care may be provided in clinics with limited resources (for example: no running water, no climate control, no floors, and inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different personal protective equipment (PPE) than what is used when providing care for infected patients in a hospital.

Can I get Ebola from a person who is infected but doesn’t have fever or any symptoms?

No. A person infected with Ebola is not contagious until symptoms appear.

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months.

Can Ebola be spread through mosquitoes?

There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Could Ebola be brought to the U.S. through imported animals?

Because of the tough restrictions the U.S. federal government has in place for importing animals from Africa, it is highly unlikely for Ebola to be brought into the U.S. through imported animals.

The animals most commonly associated with Ebola are non-human primates (for example, apes and monkeys) and bats. Both the CDC and the U.S. Fish and Wildlife Service regulate importation of non-human primates and bats. These animals, products made from these animals, and research samples from these animals may only be imported into the United States with a permit. The permit specifies that the animals, animal products, or research samples are arriving ONLY for scientific, educational, or exhibition purposes. It is illegal to import these animals into the United States as pets or bush meat.

Treatment

How is Ebola treated?

No specific vaccine or medicine has been proven to cure Ebola. Signs and symptoms of Ebola are treated as they appear. The following basic interventions, when used early, can increase the chances of survival.

  • Providing fluids and replenishing electrolytes
  • Maintaining oxygen status and blood pressure
  • Treating other infections if they occur

Early recognition of Ebola is important for providing appropriate patient care and preventing the spread of infection. Healthcare providers should be alert for and evaluate any patients suspected of having Ebola.

Prevention

How do I protect myself against Ebola?

If you are in or traveling to an area affected by the Ebola outbreak, protect yourself by doing the following:

  • Wash hands frequently.
  • Avoid contact with blood and body fluids of any person, particularly someone who is sick.
  • Do not handle items that may have come in contact with an infected person’s blood or body fluids.
  • Do not touch the body of someone who has died from Ebola.
  • Do not touch bats and non-human primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.
  • Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.
  • Seek medical care immediately if you develop fever (temperature of 38 degrees C or 100.4 degrees F) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
  • Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

CDC has issued a Warning, Level 3 travel notice for three countries. U.S. citizens should avoid all non-essential travel to Guinea, Liberia, and Sierra Leone. CDC has issued an Alert, Level 2 travel notice for Nigeria. Travelers to Nigeria should take enhanced precautions to prevent Ebola. For travel notices and other information for travelers, visit the Travelers’ Health Ebola web page.

Infection Control

Can hospitals in the United States care for an Ebola patient?

Any U.S. hospital that is following CDC’s infection control recommendations and can isolate a patient in their own room‎ with a private bathroom is capable of safely managing a patient with Ebola at least until they can be moved or referred to a larger hospital for ongoing treatment.

  • These patients need intensive supportive care; any hospital that has this capability can safely manage these patients.
  • Standard, contact, and droplet precautions are recommended.
  • Staff members need to be trained with how to utilize PPE before treating an Ebola patient and be fully covered to avoid contact with blood or body fluids.

How can healthcare providers protect themselves?

Healthcare providers can take several infection control measures to protect themselves when dealing with Ebola patients and the best practice processes and trainings are being shared with hospitals that have yet to treat an Ebola patient. The guidelines in this area have changed significantly, and there is reason to treat the recommendations below as minimum protection. The CDC and the University of Nebraska Medical Center (UNMC have posted their latest guidelines for PPE and for donning and doffing PPE properly as well as specific guidelines for EMS providers:

  • Anyone entering the patient’s room should wear at least gloves, a gown, eye protection (goggles or a face shield), and a face mask.
  • Additional personal protective equipment (PPE) might be needed for nurses or physicians actively treating the patient in certain situations (for example, when there is a lot of blood, vomit, feces, or other body fluids).
  • Healthcare providers should frequently perform hand hygiene before and after patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves.

Travelers

Is there a danger of Ebola spreading in the U.S.?

Ebola is not spread through casual contact; therefore, the risk of an outbreak in the U.S. is very low. We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

Why were the ill Americans with Ebola brought to the U.S. for treatment? How is CDC protecting the American public?

A U.S. citizen has the right to return to the United States. Although CDC can use several measures to prevent disease from being introduced in the United States, CDC must balance the public health risk to others with the rights of the individual. In this situation, the patients who came back to the United States for care were transported with appropriate infection control procedures in place to prevent the disease from being transmitted to others.

Ebola poses no substantial risk to the U.S. general population. CDC recognizes that Ebola causes a lot of public worry and concern, but CDC’s mission is to protect the health of all Americans, including those who may become ill while overseas. Ebola patients can be transported and managed safely when appropriate precautions are used by EMS or other transport providers.

What is being done to prevent ill travelers in West Africa from getting on a plane?

In West Africa

CDC’s Division of Global Migration and Quarantine (DGMQ) is working with airlines, airports, and ministries of health to provide technical assistance for the development of exit screening and travel restrictions in the affected areas. This includes:

  • Assessing the ability of Ebola-affected countries and airports to conduct exit screening.
  • Assisting with development of exit screening protocols.
  • Training staff on exit screening protocols and appropriate PPE use.
  • Training in-country staff to provide future trainings.
  • Most recently, since October 27, all passengers coming to the U.S. from the three affected nations have had their travel itineraries re-routed to five U.S. airports in Washington, D.C., New York City, Newark, New Jersey; Atlanta and Minneapolis.

During Travel

CDC works with international public health organizations, other federal agencies, and the travel industry to identify sick travelers arriving in the United States and take public health actions to prevent the spread of communicable diseases. Airlines are required to report any deaths onboard or ill travelers meeting certain criteria to CDC before arriving into the United States, and CDC and its partners determine whether any public health action is needed. If a traveler is infectious or exhibiting symptoms during or after a flight, CDC will conduct an investigation of exposed travelers and work with the airline, federal partners, and state and local health departments to notify them and take any necessary public health action. When CDC receives a report of an ill traveler on a cruise or cargo ship, CDC officials work with the shipping line to make an assessment of public health risk and to coordinate any necessary response.

In the United States

CDC has staff working 24/7 at 20 Border Health field offices located in international airports and land borders. On October 27, CDC’s public health authorities began active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea. These travelers are now arriving to the United States at one of five airports where entry screening is being conducted by Customs and Border Protection and CDC. Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. CDC staff are ready 24/7 to investigate cases of ill travelers on planes and ships entering the United States.

CDC works with partners at all ports of entry into the United States to help prevent infectious diseases from being introduced and spread in the United States. CDC works with Customs and Border Protection, U.S. Department of Agriculture, U.S. Coast Guard, U.S. Fish and Wildlife Services, state and local health departments, and local Emergency Medical Services staff.

Approximately 100 to 150 travelers per day enter the United States from these countries and all are screened for symptoms before boarding their flights in West Africa and also upon their arrival in the U.S.. Most people who become infected with Ebola are those who live with or care for people who have already caught the disease and are showing symptoms. CDC and healthcare providers in the United States are prepared for the remote possibility that a traveler could get Ebola and return to the U.S. while sick, but given the procedures almost all will be symptom free upon their arrival.

In the United States

Are there any cases of people contracting Ebola in the U.S.?

The first case of laboratory-confirmed Ebola to be diagnosed in the United States has occurred in Dallas, Texas in a Liberian man who was visiting family. The patient did not have symptoms when leaving Liberia, or in route to Dallas, but developed symptoms approximately four days after arriving in the U.S. on September 20, 2014. Unfortunately, the patient died from the disease. Two nurses who cared for the patient contracted the disease and a doctor in New York was recently diagnosed with Ebola that he contracted in Africa. Thus, there have now been only four cases of Ebola diagnosed in the U.S.

To date, at least eight U.S. citizens have been diagnosed with Ebola while in affected areas of western Africa and flown to hospitals in the U.S. All but one of the U.S. citizens who contracted Ebola in Africa and both of the nurses who contracted the disease in Dallas have been released from the hospital after laboratory testing confirmed that they no longer have any signs of Ebola virus. CDC has advised the hospitals that there is no public health concern with their release and that they do not pose a risk to household contacts or to the public.

CDC has received many calls from health departments and hospitals about suspected cases of Ebola in travelers from the affected countries. These calls have been triaged appropriately and some samples have been sent to CDC for testing. All samples sent to CDC have so far been negative.

Contact Tracing and Monitoring

Someone who comes in contact with a person who later is diagnosed with Ebola is at very little risk to come down with the disease unless the person was symptomatic at the time of their contact. Ebola is not spread by respiratory droplets so only those people who come in contact with an Ebola patient’s body fluids are at risk for contracting the disease. Despite the low risk for anyone who might have been on a plane or who might have passed close by that person before they showed any symptoms, it is standard practice for public health officials to identify individuals who were around or near the patient even when they did not have symptoms. It is only a precautionary move and people who had indirect contact can go about their regular routine. However, any change in their health should be shared with their local public health department to rule out any connection to a case of Ebola.

On October 27, the CDC made changes in their guidelines for monitoring travelers coming to the U.S. Current procedures dictate that travelers from West Africa who have been classified as having “some” risk or a “low, but not zero” risk of contracting the disease will be actively monitored for symptoms. If someone is at risk for Ebola the Lincoln-Lancaster County Health Department will be given the names of thoseindividuals deemed at risk (health care workers, family and friends of Ebola patients, other travelers who may have had some contact with someone who contracts Ebola) and staff will contact them. They will then be actively monitored by the department for any Ebola symptoms for the 21 days after their arrival. Also, depending on their risk level, they may be restricted in their contact with others in the community. If any person develops symptoms of Ebola during the 21 days we will be monitoring, staff from the Health Department will direct them to the proper facility for diagnosis and isolated there until test results are received that they have Ebola rather than another disease that has similar symptoms (e.g., influenza, malaria) in their early stages.

Information for Nebraskans

Nebraska Department of Health and Human ServicesDHHS