Ebolavirus disease (EVD) outbreaks in West Africa - Important Information for Travellers, Patients and Consumers

An outbreak of Ebolavirus disease (EVD) first reported in March 2014, now larger and more serious than any previous outbreak, has become a humanitarian crisis.

Page last updated: 17 October 2014

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What is the current situation?

The outbreak of Ebolavirus disease (EVD) in West Africa is now larger and more serious than any previous outbreak. The situation has developed into a humanitarian crisis, and was declared by the WHO to be a Public Health Emergency of International Concern on 8 August 2014.

Widespread and intense transmission in Guinea, Liberia and Sierra Leone is continuing, and the situation in Liberia and Sierra Leone is deteriorating. As of 12 October 2014 (11 October in Liberia), there were 8,997 clinically-compatible cases acquired in West Africa, of which 5,006 cases were laboratory confirmed, and 4,493 had died (case fatality rate 50%). This includes the imported case in the United States, and the first healthcare worker case in the United States, but does not include the second health care worker case in the United States.

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Table. Number of clinical, confirmed and fatal cases of Ebolavirus disease acquired in West Africa, by country. Source: WHO Roadmap situation update 15 October 2014, data as of 12 October 2014 (data for Liberia to 11 October 2014).

Country Clinical cases Confirmed cases Healthcare worker clinical cases Deaths
Countries with widespread and intense transmission
Guinea
1472
1184
76
843
Liberia
4249
950
209
2458
Sierra Leone
3252
2849
129
1183
Countries with imported cases or limited transmission
Nigeria
20
19
11
8
Senegal
1
1
0
0
Spain
1
1
1
0
United States of America
2
2
1
1
Total
8997
5006
427
4493

The reported number of deaths and the case fatality rate for West Africa is likely to be an underestimate of the true proportion of cases that are fatal, due to the delay between onset and outcome, and a lack of follow-up of the outcome. The true number of clinical cases in the community may be underestimated due to cases being reluctant to seek or unable to access health care.

Refer to the WHO website for the latest information.

Map: Areas of Guinea, Liberia and Sierra Leone in West Africa affected by outbreaks of Ebola as of 12 October 2014 (11 October 2014 in Liberia) (from the WHO website accessed 7 October 2014)

Map: Areas of Guinea, Liberia and Sierra Leone in West Africa affected by outbreaks of Ebola as of 12 October 2014 (11 October 2014 in Liberia) (from the WHO website accessed 16 October 2014)

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What is Ebolavirus disease?

Ebolavirus disease (EVD) is a serious and often fatal disease caused by the Ebolavirus, which is in the same family as Marburg virus. There are several strains of the Ebolavirus. EVD was previously called Ebola haemorrhagic fever.

Fruit bats are considered to be the natural host of Ebolavirus, with outbreaks amongst other species such as chimpanzees, gorillas, monkeys and forest antelope from time to time. There have been 24 outbreaks of Ebolavirus in Africa since the first outbreaks in 1976.

There is no evidence that Ebolavirus is present in Australian bats or other animals.

To date, there have been no human EVD cases in Australia.

What are the symptoms?

  • Ebolavirus can cause a serious illness, with a sudden onset of fever, muscle aches, weakness and headache.
  • The next stage may include vomiting, diarrhoea, sore throat, cough, rash and malfunction of liver and kidneys.
  • Cases may progress to multi-organ failure, sometimes with profuse internal and external bleeding.
  • Many cases will die of the disease, with the case-fatality rate for previous outbreaks ranging between 50–90%.

How is it spread?

Ebolavirus is introduced into the human population through direct contact (through mucous membranes or broken skin) with the blood, secretions, or other bodily fluids of infected animals (often therefore through hunting or preparation of "bushmeat"). In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebolavirus then spreads through person-to-person transmission via direct contact (through mucous membranes or broken skin) with:

  • the blood or bodily fluids (including but not limited to urine, saliva, faeces, breast milk, vomit, and semen) of people with EVD, and the bodies of people who have died of EVD.
  • objects (e.g. needles, syringes) contaminated with blood or bodily fluids of people with EVD.

Transmission through sexual contact may be possible for up to three months after clinical recovery. Participating in traditional burial ceremonies in affected areas of Africa is a known high risk activity for transmission.

The risk of transmission in healthcare settings can be significantly reduced through the use of appropriate infection control precautions and environmental cleaning.

Airborne transmission to humans, as occurs for tuberculosis or measles, has never been documented.

Who is at risk?

People who are living in or travelling to affected areas of Africa may be at risk of infection; however, this risk is extremely low unless there has been direct exposure to the bodily fluids of an infected person (including unprotected sexual contact with confirmed cases up to three months after they have recovered), or infected animal (alive or dead).

Caring for relatives with EVD is a known risk factor for infection, and healthcare workers, particularly those in resource poor settings with inadequate infection control are also at risk.

What should I do if I am travelling in affected countries and feel unwell?

The Department of Foreign Affairs and Travel has advised Australians to reconsider their need to travel to affected countries in Africa. More information can be found on the Smartraveller website.

The current outbreak of EVD has overwhelmed many local health facilities and if you become ill while in these countries options for obtaining routine or emergency medical care may be severely limited. If you become unwell while in transit you should advise airline staff or border officers.

The Department of Foreign Affairs and Travel has advised that medical evacuations for any potential EVD patient – and particularly symptomatic EVD patients - will be extremely difficult, if not impossible, to conduct. Travellers should ensure that if they are in the region for work, that their employer has relevant contingency plans, and if you travel to the region independently, you should ensure that you travel insurance will cover medical evacuation and treatment if necessary.

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What should I do if I return from travel in affected countries and feel unwell?

If you arrive in Australia and you feel unwell, you should advise a border officer at the airport.

If you become ill while back in the community, you should go to the emergency department and mention you have been in West Africa, and mention if you know you have been in contact with someone who you know had EVD.

Even if you feel well on your return to Australia from the affected countries, you should see your doctor to discuss whether it might be necessary for you to monitor your health, particularly if you think you may have had direct contact with someone who may have had Ebola.

How is it prevented?

  • There is no proven safe and effective vaccine to prevent EVD.
  • People should avoid direct exposure to the bodily fluids of an infected person or animal (alive or dead). People should also practice careful hygiene, including regular hand washing.
  • Anyone travelling to affected areas to work or volunteer in a healthcare setting should seek advice and ensure they are fully informed about infection control procedures and recommendations. Aid workers who have volunteered in affected countries are required to monitor their health for 21 days after leaving the affected country, during which time they are not allowed to work in a clinical setting in Australia. For more information, refer to the Communicable Diseases Network Australia advice for public health units, the Ebola SoNG, available from the Department’s website.

How is it diagnosed?

  • EVD is usually diagnosed by finding evidence of the virus in blood, but a throat swab or urine may also be used. Serological tests to look for antibodies to Ebolavirus are also available.
  • In Australia, testing for EVD is done in a public health laboratory with special facilities to conduct the tests safely.

How is it treated?

There is currently no specific treatment that is proven to be safe and effective for people who are sick with EVD and care is largely supportive. Good supportive care and the management of complications can be life-saving.

What is happening at the Border?

Australian health authorities are closely monitoring this disease outbreak overseas and our border protection agencies are alert to watch for people who are unwell both inflight and at airports. As part of routine procedures, incoming flights to Australia have on-board announcements, asking passengers who are feeling unwell with fever, chills or sweats to alert a crew member. Crew members would alert border officers for health follow up.

All airport border agencies are aware of the Ebola outbreak and have been provided guidance by the Department of Health to identify any passengers presenting Ebola symptoms in flights or at airports. Border officers also provide information and advice to passengers at the border who are unsure of what they should do if they are feeling ill. The health of people who have originated their travel from affected parts of West Africa is being checked.

The Australian Government will continue to closely monitor the situation overseas and will continue to assess the efficacy of our border measures.

What is the public health response?

  • The WHO, the United Nations, other non-government organisations, as well as health and military organisations of some countries are working with the Ministries of Health in affected countries to provide personnel, systems and build infrastructure to minimise risk of spread and treat and find all cases.
  • Australia has contributed $18 million as of 3 October to the international response.
  • There have been no cases in Australia, but special procedures to prevent the spread of EVD would be put in place in the event of a suspected case.
  • Australia has a national protocol to guide public health staff in responding to a suspected or confirmed case. This document sets out the procedures for:
    • Laboratory and healthcare workers seeing patients or handling specimens to follow special safety guidelines.
    • Public Health authorities to follow-up any case to ensure that the disease does not spread.
    • Doctors and laboratories to report inform state/territory health departments of suspected cases.
    • Close contacts of people diagnosed or suspected of having EVD to be followed up and given information about the risk of infection, and tested for the disease if necessary.
  • EVD is a quarantinable disease in Australia, and as such can be controlled and eradicated through a range of quarantine measures, including enforcing appropriate disinfection measures on aircraft and ships or port facilities.
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Information for the Public

Information For Travellers

Information For Health Professionals

Information for GPs

Information for Humanitarian Workers

Current Situation

List of Affected Countries