Post-Arrival, Active Monitoring Update
As of January 4, 2016, the Virginia Department of Health has zero (0) travelers under post-arrival, active monitoring.
*On December 29, 2015, the World Health Organization declared Guinea free of Ebola virus transmission. CDC no longer recommends active monitoring of persons who have traveled to Guinea. Travelers entering the United States from Guinea will continue to enter through one of the designated U.S. airports conducting enhanced entry screening. CDC and VDH recommend these travelers watch their health for 21 days after leaving Guinea, and to contact their state or local health department or seek health care if they develop fever or any other symptoms that might be consistent with Ebola.
*On November 9, 2015, CDC and VDH recommended that active monitoring of persons who have traveled only to Sierra Leone be discontinued.
*On June 17, 2015, CDC and VDH recommended that active monitoring of persons who have traveled only to Liberia be discontinued.
This document was updated on December 29, 2015, and the latest changes are demarcated as “NEW.”
Content will be updated as the situation changes.
*NEW UPDATE on travelers from Guinea*
On December 29, 2015, theWorld Health Organization (WHO) declared Guinea free of Ebola virus transmission. This means that 42 days (two 21-day incubation periods) have passed since the last Ebola patient in Guinea tested laboratory-negative twice. CDC no longer recommends active monitoring of persons who have traveled to Guinea. Travelers entering the United States from Guinea will continue to enter through one of the designated U.S. airports conducting enhanced entry screening. CDC recommends these travelers watch their health for 21 days after leaving Guinea, and to contact their state or local health department or seek health care if they develop fever or any other symptoms that might be consistent with Ebola.
General Information on Ebola
What is Ebola or Ebola virus disease?
- Ebola is a severe, often deadly disease that affects humans and some animals (like monkeys, gorillas, and chimpanzees). It is also referred to as Ebola virus disease.
- Since March 2014, West Africa has experienced the largest outbreak of Ebola in history, with multiple countries affected.
- In late September 2014, the first-ever case of Ebola was diagnosed in the United States when a patient who had traveled from West Africa to Texas became sick.
The latest updates from CDC can be found at this link: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html
Where did the Ebola virus come from?
- There are five identified Ebola virus species, four of which are known to cause disease in humans.
- Ebola viruses are found in several African countries.
- Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.
- The natural reservoir host of Ebola virus remains unknown. However, based on evidence and the nature of similar viruses, researchers believe that the virus is animal-borne and that bats are the most likely reservoir. Four of the five virus strains occur in an animal host native to Africa.
What are the symptoms of Ebola?
- Elevated body temperature or subjective fever
- Severe headache
- Muscle pain
- Stomach pain
- Unexplained bleeding or bruising
How soon after exposure do symptoms occur?
- Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
- A blood test is done find out if someone has Ebola. The test result may be a false negative during the first 3 days that symptoms develop, so someone may have to repeat the test after that timeframe as elapsed.
What about someone (with an appropriate travel history) who comes to our clinic without a fever, but who says they had a fever (or intermittent fevers) at some point in the past three weeks? NEW
- Because there are no longer any countries with widespread transmission of Ebola, a person’s travel history does not automatically categorize him or her as a suspected Ebola patient.
- For any patient returning from Africa and presenting with non-specific signs and symptoms that may be consistent with Ebola, providers should use clinical judgment, taking into account the patient epidemiological history, for management, diagnostic testing and treatment.
- Asking every patient about their recent travel history is important when considering many infectious diseases as part of a differential diagnosis.
- Any person who feels feverish or has a fever within 21 days of travel from a country with “former widespread Ebola transmission and current, established control measures” (Guinea, Liberia, or Sierra Leone) should be evaluated without delay for other causes of travel-related illness, including malaria (primarily Plasmodium falciparum), acute diarrhea and viral respiratory infections.
- Travelers from countries with “former widespread Ebola transmission and current established control measures” with signs/symptoms that may be consistent with Ebola should be placed in a private room with a private bathroom; the patient can be removed from isolation after a risk assessment is conducted and Ebola is determined not to be among the differential diagnoses.
- Travelers from Guinea no longer routinely require enhanced Ebola-specific infection control precautions. Healthcare facilities should implement their facility’s routine precautions that are appropriate for the patient’s clinical presentation.
- CDC recommends travelers from Guinea, Liberia, or Sierra Leone contact their state or local health department or seek health care if they develop fever or any other symptoms that might be consistent with Ebola.
More information can be found at the following CDC link: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/
How is Ebola spread?
- Ebola is spread from person to person through direct contact (through broken skin or mucous membranes) with blood or body fluids (like urine, feces, saliva, vomit, sweat, breast milk, or semen) of a person who is sick with Ebola or has died from Ebola.
- Ebola may also be spread through indirect contact with surfaces or objects (like needles) that have been contaminated with the blood or body fluids of a person sick with Ebola or has died from Ebola.
- Ebola is not spread through the air, water, or food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats.
- Ebola cannot be spread through casual contact in public places with people who do not appear to be sick.
- Ebola virus has been found in the semen of some men who have recovered from Ebola infection. It is possible that Ebola could be transmitted through sex. Until more information is known, the Centers for Disease Control and Prevention (CDC) and WHO recommend to avoid contact with semen from a male survivor. If male survivors have sex (oral, vaginal, or anal sex), a condom should be used correctly and consistently every time. The risk of getting Ebola from semen is considered to be very low and likely decreases over time. It is not known if Ebola can be spread through sex or other contact with vaginal fluids from a woman who has had Ebola.
- CDC and other public health partners are continuing to study Ebola transmission and will share what is known as it becomes available.
Can someone with Ebola spread the virus if they don’t have symptoms of illness?
- No. A person with Ebola can’t spread the disease until symptoms appear.
How long is someone who has Ebola considered contagious?
- A person with Ebola is considered contagious as long as the virus can be detected in their blood.
- A special blood test called PCR must be negative on 2 consecutive days for someone to be considered non-contagious. An Ebola survivor will be considered non-contagious and ready for discharge when they meet that criteria.
- Corpses are highly contagious.
Can Ebola be transmitted by contact with contaminated surfaces or objects?
- Yes, it is possible for Ebola to be spread by contact with surfaces or objects (such as needles) previously contaminated with Ebola virus. However, the risk getting Ebola from surfaces/objects is low and can be reduced even more by cleaning and disinfection.
- EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, and poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses. Products containing chlorine bleach should be used on surfaces and not consumed.
- Based on experience from investigating Ebola outbreaks over the past 40 years, including the current outbreak in West Africa, nearly all cases of Ebola have resulted from direct contact with a person with symptoms or the body of someone who has died from the disease.
How long can Ebola live outside the body?
- The length of time Ebola can live on surfaces or objects depends on several factors including temperature, humidity, and presence of body fluids.
- Ebola virus on dried surfaces, such as doorknobs or countertops, can live for several hours; however, virus in blood or other body fluids can live up to several days at room temperature.
- Ebola virus can be killed with hospital-grade disinfectants (such as household bleach): these products are for use on surfaces and should not be consumed.
What if an individual with Ebola leaves sweat on a chair? Is there a risk to others?
- Persons who are symptomatic and infectious with Ebola are likely to be in a hospital, and therefore would not pose a risk to the general public. People who do not have symptoms are not contagious. Persons with Ebola become more contagious later in the course of the disease, when they appear very ill. They are less likely to be contagious early in the course of their illness when they have mild symptoms.
- Ebola virus can be found in sweat, so there is a possibility that an infection could be acquired through contact with the sweat of someone with Ebola. However, Ebola transmission requires that the body fluids of a person who is sick from Ebola come into contact with another person’s mucus membranes (including the eyes, nose, or mouth) or a break in their skin.
- By far, the most common way to acquire Ebola is through direct contact with blood, vomit, or feces.
- If a person comes into contact with any body fluid from someone with Ebola, s/he should wash the skin with soap and water immediately.
- Any exposure should be taken seriously and immediately reported to a doctor and the local health department for further investigation.
Because Ebola virus is spread by body fluids, including saliva, what if someone sick with Ebola coughs or sneezes on you?
- There is no evidence that Ebola is spread by coughing or sneezing. Ebola is transmitted through direct contact with the blood or body fluids of a person who is sick with Ebola; the virus is not transmitted through the air (like measles virus). However, large droplets (splashes or sprays) of respiratory or other secretions from a person who is sick with Ebola could be infectious, and therefore certain precautions (called standard, contact, and droplet precautions) are recommended for use in healthcare settings to prevent the transmission of Ebola from patients to healthcare personnel and other patients or family members.
- Droplet spread happens when fluids in large droplets from a sick person splash the eyes, nose, or mouth of another person or through a cut in the skin. Droplets may cause short-term environmental contamination, like a soiled bathroom surface or handrails, from which another person can pick up the infectious material. Germs like plague and meningitis can be spread through large droplets. Ebola might be spread through large droplets but only when a person is very sick.
- Further information can be found here: http://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf
Risk of transmission: airborne, insects, or pets
Can the Ebola virus mutate and become airborne?
- Ebola is not spread through the air, like tuberculosis (TB). Extensive studies of the Ebola over several decades have proven this.
- On the contrary, good evidence of previous Ebola outbreaks shows that people became infected by direct, close contact with ill patients.
- Scientists don’t know of any virus that has dramatically changed the way it is spread. Rumors that Ebola might change so that it could easily spread among humans through the air are just speculation, and do not have any scientific evidence behind them.
Healthcare staff across the country have been shown wearing full suits with respiratory protection. How do we know Ebola is not airborne and that we will be protected?
- Ebola has been around for nearly 40 years, and airborne transmission has not been documented.
- In healthcare settings, Ebola is spread through direct contact (e.g., through broken skin or through mucous membranes of the eyes, nose, or mouth) with blood or body fluids of a person who is sick with Ebola or with objects (e.g., needles, syringes) that have been contaminated with the virus. For all healthcare workers caring for Ebola patients, PPE with full body coverage is recommended to further reduce the risk of self-contamination.
- In the event of an unexpected aerosol-generating procedure, CDC recommends healthcare workers use a powered air-purifying respirator (PAPR) or an N95 or higher respirator.
Can Ebola be spread by insects?
- There is no evidence that mosquitos or other insects can spread Ebola. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola.
Can you get Ebola from pets?
If you have been exposed
How do I know if I have been exposed to Ebola? NEW
If you have traveled to an area* with an Ebola outbreak or had close contact with a person sick with Ebola, you may be at risk if you:
- Had direct contact with blood or body fluids or items that came into contact with blood or body fluids from a person with Ebola.
- Touched bats or nonhuman primates (like apes or monkeys) or blood, fluids, or raw meat prepared from these animals.
- Went into hospitals where Ebola patients were being treated and had close contact with the patients.
- Touched the body of a person who died of Ebola.
* Currently, there are no countries with widespread Ebola transmission. Check the CDC website for an up-to-date list of Ebola-affected countries and areas: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html#areas
What is “close contact”?
- Close contact is defined as:
- being within approximately 3 feet (1 meter) of an Ebola patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., gloves, gown, and a face mask)
- having direct brief contact (e.g., shaking hands) with an Ebola patient while not wearing recommended personal protective equipment.
- Brief interactions, such as walking by a person or moving through a hospital, are not considered close contact.
How to get help
What if I get sick after I come back from an area with an Ebola outbreak?
- Get medical care right away if you have a fever, severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bruising or bleeding.
- BEFORE you go to the doctor’s office or emergency room, call ahead and tell your doctor about your recent travel or contact with a person who was sick with Ebola and your symptoms.
- Calling before visiting the doctor will help the medical staff care for you and protect other people who may be in the doctor’s office or emergency room.
- When traveling to get medical care, limit your contact with other people. This includes avoiding public transportation.
- If you don’t have a doctor:
- You can find physician referral services by calling a hospital to ask if they offer a consumer physician referral service. If they do, you can access the information you need during the call.
- Or, you can find a referral service by checking a hospital's yellow page advertisement for a physician referral service phone number. http://www.vhi.org/hguide_stepone.asp
What should I do if I traveled to one of the affected areas and think I may have been exposed to Ebola? NEW
- Currently, there are no countries with widespread Ebola transmission.
- If you think you may have been exposed to Ebola, call your local health department or your doctor even if you do not have symptoms. Your doctor can evaluate your exposure and any symptoms and consult with public health officials to determine if more actions are needed.
- You should check for signs and symptoms of Ebola for 21 days following your last exposure to the area affected by an Ebola outbreak or last close contact with a person sick with Ebola.
- Take your temperature every morning and evening
- Watch for other symptoms like severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
Can my local hospital care for a patient with Ebola? NEW
What kinds of personal protective equipment (PPE) are recommended to be worn by healthcare workers caring for patients with Ebola?
- CDC has published detailed, comprehensive guidance on the PPE to be used by health care workers when caring for Persons Under Investigation (PUI) or confirmed Ebola patients. These detailed guidance documents can be found here: http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/index.html
Why is the treatment for Ebola unavailable?
- There is no specific treatment for Ebola; instead, the symptoms are treated as they appear. Treatment may include providing hydration, blood pressure control, oxygen support, pain control, nutritional support, and treating any secondary bacterial infections or other co-existing health conditions.
- Some patients have been treated with experimental medicines. For example, there was a limited supply of ZMapp, but because the product is still in an experimental stage, it is too early to know whether it is effective. The manufacturer has been planning for phase 1 clinical trials and does not have the capacity to manufacture large quantities of the treatment. The manufacturer of the experimental treatment continues to research and evaluate the product's safety and effectiveness.
- Other anti-viral treatments have been used, and recently there has been increased use of blood and blood products from patients who already recovered from Ebola.
When will an Ebola vaccine be available?
- Experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness. Some of the vaccine trials are described below:
- In August of 2014, National Institutes of Health (NIH) announced that initial human testing of an investigational vaccine to prevent Ebola virus disease was underway. NIH is collaborating with other agencies and other nations in parallel to expedite vaccine development.
- The World Health Organization announced that they began a trial in October of 2014 for an experimental Ebola vaccine.
- The Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), the Sierra Leone Ministry of Health and Sanitation (MoHS), and the CDC are working together on a candidate Ebola vaccine trial in Sierra Leone, which launched in April 2015.
- Further details about the various vaccine trials can be found here: http://www.who.int/medicines/emp_ebola_q_as/en/
If a person catches Ebola and then is cured, are they now immune to it or is it possible to catch it again?
- Available evidence shows that people who recover from Ebola infection develop antibodies that last for at least 10 years, and possibly longer. It isn’t known if people who recover are immune for life or if they can become infected with a different species of Ebola.
- Most experts agree that survivors are protected from becoming ill from the same strain of Ebola for an undefined period of time.
Isolation and Quarantine
What are isolation and quarantine? Are they different?
- Isolationseparates sick people with a contagious disease from people who are not sick. For example, those who are infected with Ebola are placed in isolation in the hospital.
- Quarantine separates and restricts the movement of people who have been exposed to a contagious disease, but are not sick. People are usually quarantined for the duration of the incubation period and are then released from quarantine. If they become sick while in quarantine they will be evaluated, and if they have the same disease, they will be isolated until they are no longer infectious.
What happens in isolation and quarantine?
- A person can be isolated or quarantined in their home, another residence, an institution, or other place.
- The site must have adequate food, clothing, health care, and have their other essential needs met.
- The person being isolated or quarantined will be monitored for illness by the local health department.
How are isolation and quarantined enforced?
- Isolation and/or quarantine may be in the form of recommendations to the person, who agrees to comply, or they may be required to protect others. A required period of isolation or quarantine could be ordered by public health authorities, if the communicable disease is extremely dangerous, or when a person fails to adequately follow disease control recommendations voluntarily.
- If the person disregards recommendations from health care professionals and the local health department, the State Health Commissioner can issue an Order of Isolation or Order of Quarantine to reduce the risk to the public.
- If someone violates the Commissioner’s order, additional measures, may be taken to assure compliance.
Information about air travel and active monitoring of travelers
Am I at risk if I am on a flight with a person who has Ebola?
- Remember that a person with Ebola only poses a risk to others if he or she is showing signs of illness.
- If a person is experiencing symptoms of Ebola while on a flight, health officials will conduct an investigation to identify people who sat close to the ill person or had other close contact with the ill person.
Is Ebola guidance available for airline staff?
- The CDC quarantine website has information for airlines about stopping ill travelers from boarding, managing and reporting onboard sick travelers, protecting crew and passengers from infection, and cleaning the plane and disinfecting contaminated areas.
- This website includes a video on what airline crew and staff need to know about Ebola.
What is happening at airports in the United States to prevent Ebola? NEW
- Since October 22, 2014, all passengers arriving in the United States whose travel originated in a country with widespread Ebola transmission were required to fly into one of the five airports that have the enhanced screening and additional resources in place (New York’s JFK, Newark, Dulles, Atlanta and Chicago). Currently, only Guinea is still affected by this process.
- As of December 22, 2015, enhanced entry screening was discontinued for travelers coming to the United States from Sierra Leone. These travelers will no longer be funneled through one of the U.S. airports conducting enhanced entry screening.
- As of September 21, 2015, enhanced entry screening was discontinued for travelers coming to the U.S. from Liberia. These travelers will no longer be funneled through the U.S. airports that are conducting enhanced entry screening.
- Travelers coming from Guinea will still undergo exit screening before leaving the country.
- Upon entry to the United States, travelers coming from Guinea will answer questions about travel history and possible exposures to Ebola. They will also provide contact information so that the health department at their destination can connect with them, if needed. Travelers from Guinea will receive a modified CARE (Check and Report Ebola) Kit including information about Ebola, a thermometer, and contact information for state and local health departments
What is active post-arrival monitoring and how does it affect travelers into the U.S. from Ebola affected nations in West Africa? NEW
- As of December 29, 2015, active post-arrival monitoring has been discontinued and there are no longer any countries with widespread Ebola transmission.
- Active post-arrival monitoring was implemented on October 27, 2014 to allow public health authorities to add another layer of protection against transmission of EVD. Casting a wider net enabled public health experts to be aware of all persons who traveled to Ebola-affected nations within the previous 21 days.
- This provided another way for public health personnel to identify any person who developed symptoms of Ebola virus disease as quickly as possible.
- Further details about active monitoring can be found here: http://www.vdh.virginia.gov/epidemiology/ebola/BasicAirportProtocol.htm
- CDC recommends that travelers from Guinea, Liberia, or Sierra Leone watch their health for fever or other symptoms of Ebola for 21 days after they leave any of those countries. They should contact their state or local health department or seek health care if symptoms develop during this time.
Are new Ebola protocols being instituted for travelers arriving from Guinea? NEW
- Yes, as of December 29, 2015, the CDC and VDH discontinued active monitoring of persons who traveled to Guinea.
- As of November 10, 2015, the CDC and VDH discontinued active monitoring of persons who traveled only to Sierra Leone.
- As of June 17, 2015, CDC and VDH recommended that active monitoring of persons who traveled only to Liberia be discontinued.
- Travelers from Guinea are still being screened at their arrival airport in the U.S. and will be advised to watch their health for 21 days after leaving Guinea. VDH will continue to respond to any inquiries from travelers regarding their health, but will not conduct daily, active monitoring of this extremely low risk population. In general, if needed we will encourage these travelers to seek health care as appropriate for their illness, which may include outpatient or urgent care settings.
What countries/areas have been affected by the Ebola outbreak in West Africa? NEW
- Currently, there are no countries with widespreadtransmission of Ebola.
- Guinea, Liberia, and Sierra Leone are now considered countries with former widespread transmission and current, established control measures.
- The World Health Organization (WHO) declared the end of the Ebola outbreak in Guinea on December 29, 2015, in Sierra Leone on November 7, 2015, and in Liberia on May 9, 2015, meaning that 42 days (two incubation periods) had passed since the last Ebola patient was buried or survived and tested laboratory-negative twice.
- Other countries have also been affected by the outbreak in West Africa, and up-to-date information about travel notices can be found at this website: http://wwwnc.cdc.gov/travel/diseases/ebola.
Summary of updated procedures for travelers from Guinea: NEW
- Travelers leaving Guinea will still undergo exit screening before leaving Guinea.
- Travelers from Guinea entering the United States will continue to be funneled through one of five U.S. airports conducting enhanced entry screening (New York JFK, Washington-Dulles, Newark International, Chicago O’Hare, and Atlanta Hartsfield-Jackson). Travelers from Guinea will continue to answer questions about travel history and possible exposures to Ebola. Travelers will also provide their contact information so that the health department at their destination can connect with them, if needed.
- Under the modified entry screening, travelers from Guinea will receive a version of the CARE kit that includes information about Ebola, a thermometer, and contact information for state and local health departments. Travelers will be encouraged to watch their health for 21 days after leaving Guinea and to contact their local health departments if they develop symptoms consistent with Ebola.
- Travelers from Guinea will no longer need to be actively monitored by or be in daily contact with their health departments.
- Travelers from Guinea no longer need to be managed routinely as having suspected EVD if they present with a febrile illness. Evaluation at any healthcare facility (including outpatient or urgent care setting) may be considered if appropriate for the clinical presentation.
- Travelers from Guinea no longer routinely require enhanced Ebola-specific infection control precautions. Healthcare facilities should implement their facility’s routine precautions that are appropriate for the patient’s clinical presentation.
- Travelers from Guinea with a febrile illness should be evaluated without delay for other causes of travel-related illness, including malaria (primarily Plasmodium falciparum), acute diarrhea and viral respiratory infections. Those with these particular symptoms of concern (fever WITH vomiting, diarrhea, and/or unexplained bleeding) should be placed in a private room until further diagnostic assessments are complete.
Key points of clinical guidance regarding persons whose travel was to Guinea, Liberia, or Sierra Leone are: NEW
- VDH will continue to respond to any inquiries from travelers regarding their health, but will not conduct daily, active monitoring of this extremely low risk population.
- In general, if needed we will encourage these travelers to seek health care as appropriate for their illness, which may include outpatient or urgent care settings.
If I have to travel to an area affected by an Ebola outbreak, how do I protect myself while I am there? NEW
- Follow CDC travel advisories (http://wwwnc.cdc.gov/travel/notices). Current recommendations are to practice usual precautions if travelling to Guinea, Liberia, or Sierra Leone (Watch Level 1).
- Wash hands frequently or use an alcohol-based hand sanitizer.
- 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 nonhuman primates or their blood and fluids, and do not touch or eat raw meat prepared from these animals.
- Avoid hospitals in West Africa where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.
* Check the CDC website for an up-to-date list of Ebola-affected countries since the onset of this epidemic: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html#areas
Why did the US send troops to Liberia?
- As per Dr. Tom Frieden, the Director of the CDC, “We can’t get to zero risk in the U.S. until we stop the Ebola epidemic at its source in West Africa.”
- Thousands of Americans have gone overseas to Africa and some American troops were involved in a mission called “Operation United Assistance.” The mission to combat Ebola was stationed in Liberia and was mainly made up of U.S. troops but also includes doctors, nurses, scientists, aviators, engineers, mechanics, and technicians, most of whom were volunteers from the U.S. Public Health Service.
- The main goals of the mission were to set up a joint force command headquarters in Liberia to support military activities and help coordinate aid from other agencies, appoint a General Officer in Monrovia, provide engineers to build Ebola Treatment Units, and establish a training site for health care providers to direct care to Ebola patients.
- In Liberia, where the epidemic raged for months, CDC, the U.S. Military, NGOs, and the international community helped to build and operate as many as 26 treatment units, which provided more than 3,100 beds for Ebola patients. This was to remove Ebola victims from their home, where they can easily spread the virus, and treat them at the ETUs where the risk of spread is limited.
- Though this mission the U.S. military deployed primarily to Liberia, while other American civilian operations have taken place in Guinea, Sierra Leone, and other West African nations.
- Hundreds of American civilians have been in West Africa for months fighting the deadly virus.
- Read more: http://www.dailymail.co.uk/news/article-2808562/New-U-S-operation-flys-thousands-U-S-soldiers-civilians-Liberia-fight-Ebola-outbreak-difficult-mission-not-enough.html
Ebola in the US
Is it safe for Ebola patients to use the bathroom?
- Yes. Sanitary sewers may be used for the safe disposal of patient waste.Additionally, sewage handling processes in the United States are designed to inactivate infectious agents.
How are hospitals managing the waste products of persons with Ebola?
- The Ebola virus is a classified as a Category A infectious substance by and regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products.
- Ebola-associated waste that has been appropriately incinerated, autoclaved, or otherwise inactivated is not infectious, does not pose a health risk, and is not considered to be regulated medical waste or a hazardous material under Federal law.
- The following websites provide further details about waste management of persons with Ebola:
Ebola Preparedness in Virginia
Should I be concerned about Ebola coming to Virginia?
- Ebola poses no substantial risk to the U.S. general population, but the Virginia Department of Health and partner agencies such as the Centers for Disease Control and Prevention (CDC) realize that Ebola causes a lot of public worry and concern.
- If someone with Ebola came to Virginia, it is very unlikely it would spread widely like the outbreak did in West Africa. That is because Virginia and other states in the United States have a strong healthcare infrastructure. Modern hospitals use procedures to prevent the disease from spreading, and public health officials would work to identify those at risk of infection to prevent them from spreading it to other people.
- The Virginia Department of Health has a plan in place to work with its partners in the event a suspected case of Ebola is reported in the state.
What has been done in Virginia to prevent the spread of Ebola? NEW
- Since mid-October 2014, passengers arriving on flights originating from countries with widespread Ebola transmission were screened at the airport for signs and symptoms of Ebola and asked about potential exposures that would put them at risk for having Ebola. These travelers were actively monitored by local health departments for fever and other symptoms of Ebola for 21 days, and were given instructions on how to get medical care if necessary.
- If a case of Ebola is identified in Virginia, the Virginia Department of Health will take the following steps:
- Coordinate with healthcare providers to collect information about the patient, including travel and exposure history, illness symptoms, and dates and types of interactions the patient has had with other people since becoming symptomatic.
- Ensure that responders and healthcare workers are following the recommended prevention measures.
- Identify and monitor close contacts of the ill individual. This includes, but is not limited to: household or other close contacts, healthcare providers, emergency medical services providers, and laboratory workers. Contacts will be placed under illness surveillance for 21 days and will be provided with instructions on limitations of activity or other measures to protect health and prevent the spread of disease.
- Coordinate public messaging with healthcare facilities and local and state agencies.
- Provide key risk communication messages to the public.
What Personal Protective Equipment should be used by Virginia Law Enforcement employees dealing with a person suspected of having Ebola?
- The use of standard, or universal precautions, is sufficient for most situations when dealing with a person suspected of having the Ebola virus. This means public safety personnel should wear the following PPE provided to each sworn employee and available in the area offices:
- Gloves (disposable nitrile)
- Eye protection (safety glasses or face shield)
- Red Biohazard Bag (for disposal of used PPE)
- Additional PPE might be required in certain situations (e.g. large amounts of blood and body fluids present in the environment), including but not limited to double gloving, disposable shoe covers, and fluid-resistant gowns. The currently issued Tyvek coverall stocked in the State Police Warehouse does not provide a fluid barrier and should not be used as a PPE in these circumstances.
Is Ebola guidance available for emergency responders?
- The CDC has issued interim guidance for Emergency Medical Services (EMS) systems and 911 public safety answering points on the management of patients with known or suspected Ebola virus disease in the US.
- This guidance also applies to law enforcement agencies, fire service agencies, and individual EMS providers (including emergency medical technicians, paramedics, and medical first responders).
Are first responders equipped to handle/transport a suspected Ebola patient to a hospital?
- Yes. Transport ambulances carry personal protective equipment on the ambulances, and personnel are trained in the use of personal protective equipment to allow them to treat and transport patients suspected of having been infected with all types of infectious agents including Ebola.
What kind of personal protective equipment (PPE) do first responders have?
- Ambulances carry masks, gowns, gloves, and eye protection. If additional PPE is recommended by VDH or CDC, the new PPE will be added to the supplies carried in the ambulance, and EMS responders will be trained in their use.
Have first responders been properly trained in using PPE?
- Proper PPE training is part of the basic EMS training that all certified responders receive. Responders are encouraged to review protocols and practice use of PPE regularly.
- If PPE recommendations change, responders will be notified and additional training will be recommended if necessary.
Is first responders’ PPE adequate to handle a suspected Ebola patient?
- PPE carried by EMS meets the current CDC recommendations. All infection prevention recommendations, including use of PPE, meet current CDC recommendations.
- All prevention and control measures are evaluated as we learn more about the Ebola virus. Updated recommendations will be disseminated as new information becomes available.
What if a first responder is exposed to Ebola? What signs and symptom should I look for?
- With proper PPE and management of the patient, risk for exposure to the Ebola virus is low.
- If a responder is concerned that he/she might have been exposed to the Ebola virus while transporting a patient, he/she should contact the supervisor immediately. The supervisor should contact the local health department as soon as possible. The health department will evaluate the risk for exposure, and may recommend monitoring of the responder’s health during the days following the possible exposure.
- Ebola is not communicable until someone begins exhibiting signs and symptom of the illness, i.e., fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and/or unexplained hemorrhaging/bruising.
What are the risks to family members of first responders who handle/transport a suspected Ebola patient?
- Risks are low if the responder uses appropriate PPE and uses all recommended infection prevention measures.
- If Ebola Virus Disease is confirmed, all healthcare providers will be placed under health department surveillance for 21 days.
- If the risk of transmission is high, the responder may be asked to quarantine him/herself to limit opportunities for others to be exposed.
- The disease is not communicable until a patient begins to exhibit signs or symptoms. The likelihood of contracting Ebola is extremely low unless a person has direct unprotected contact with the blood or body fluids (like urine, saliva, feces, vomit, sweat, and semen) of a person who is sick with Ebola or direct handling of bats or nonhuman primates from areas with Ebola outbreaks.
- Family members can help protect themselves by practicing good personal hygiene and following all health department recommendations.
Should a first responder stay away from family members after transporting a suspected Ebola patient? Why or why not?
- EMS is required to report all suspected Ebola cases to Public Health.
- Based on individual circumstances, public health personnel will then work with the EMS agency to determine the risks to their family and the public and to determine if voluntary quarantine or other measures are necessary.
If a suspected Ebola patient is transported to a hospital, what happens to that ambulance/vehicle? Can it be safe to use again?
- The vehicle is decontaminated as is the non-disposable equipment based on CDC guidelines.
- Once decontamination is completed the vehicle can be put back in service at the discretion of the owning agency.