What is Ebola virus disease?

1. What is Ebola virus disease?
Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a
death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and
chimpanzees). Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola
River in the Democratic Republic of Congo, and the other in a remote area of Sudan.The origin of the virus
is unknown but fruit bats (Pteropodidae) are considered the likely host of the Ebola virus, based on
available evidence.

The Ebola outbreak which was first notified to WHO on 21 March 2014 by the Ministry of Health of Guinea
has spread to the neighboring countries of Liberia and Sierra Leone and as of 25 July 2014, 1201 cases
with 672 deaths were reported to WHO.

2. How do people become infected with the virus?
Ebola is introduced into the human population through close contact with the blood, secretions, organs
or other bodily fluids of infected animals. 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.
Ebola then spreads in the community through human‐to‐human transmission, with infection resulting
from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or
other bodily fluids of infected people or secretions (stool, urine, saliva, semen), and indirect contact with
environments contaminated with such fluids. Infection can also occur if broken skin or mucous
membranes of a healthy person come into contact with environments that have become contaminated
with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles. Burial
ceremonies in which mourners have direct contact with the body of the deceased person can also play a
role in the transmission of Ebola.

3. What are typical signs and symptoms of infection?
EVD is a severe acute viral illness. Early symptoms include sudden onset of fever, chills, intense
weakness, muscle pain, and headache. Around the fifth day, a skin rash can occur. This is followed by
vomiting, sore throat, abdominal pain and diarrhea. , Symptoms become increasingly severe and may
include jaundice (yellow skin) severe weight loss, mental confusion, impaired kidney and liver function,
and in some cases, both internal and external bleeding, shock, and multi‐organ failure.
The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days
(most commonly 8‐10 days). The patients become contagious once they begin to show symptoms. They
are not contagious during the incubation period.

4. When should someone seek medical care?
If a person has been in an area known to have Ebola virus disease or in contact with a person known or
suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately.
Any cases of persons who are suspected to have the disease should be reported to the nearest health
unit without delay. Prompt medical care is essential to improving the rate of survival from the disease. It
is also important to control spread of the disease and infection control procedures need to be started
immediately.

5. What is the treatment?
Severely ill patients require intensive supportive care. They are frequently dehydrated and need
intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no
specific treatment to cure the disease. Some patients will recover with the appropriate medical care.

To help control further spread of the virus, people that are suspected or confirmed to have the disease
should be isolated from other patients and treated by health workers using strict infection control
precautions.

6. What can I do? Can Ebola be prevented?
In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for
Ebola infection and taking protective measures are the only way to reduce human infection and death.

7. Focus areas those who travel to EVD countries
Tourists and businessmen/women returning from affected areas in a country
The risk of a tourist or businessman/woman becoming infected with Ebola 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. 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. Tourists are in any event advised to avoid all such contacts.

Visiting families and relatives
The risk for travelers visiting friends and relatives in affected countries is similarly low, unless the
traveler has direct physical contact with a sick or dead person or animal infected with Ebola virus. In
such a case, contact tracing should confirm the exposure and prevent further spread of the disease
through monitoring the exposed traveler.

Patients travelling with symptoms and fellow travelers
There is a possibility that a person who had been exposed to Ebola virus and developed symptoms may
board a commercial flight, or other mode of transport, without informing the transport company of his
status. It is highly likely that such patients would seek immediate medical attention upon arrival,
especially if well informed, and then should be isolated to prevent further transmission. Although the

risk to fellow travelers in such a situation is very low, contact tracing is recommended in such
circumstances.

Raise the awareness and knowledge of travelers
• Travelers leaving for or arriving in an area where EVD is occurring should be provided at points of entry
(e.g. in airports or ports on boarding or arrival areas or at ground crossing points) with information on
the potential risk of EVD.
• Information should also be spread among communities that may include cross‐border travelers and
near all relevant international borders.
The information provided should emphasize that travelers or residents in the affected areas of countries
can minimize any risk of getting infected if they avoid:
• Contact with blood or bodily fluids of a person or corpse infected with the Ebola virus.
• Having sexual intercourse with a sick person or a person recovering from EVD for at least 7 weeks.
• Having contact with any object, such as needles, that has been contaminated with blood or bodily
fluids.
• Travelers should be informed where to obtain medical assistance at the destination and who to inform
(e.g. through hotline telephone numbers).
• Returning visitors from the affected areas should be alerted that if they develop infectious disease
symptoms (such as fever, weakness, muscle pain, headache, sore throat, vomiting, diarrhoea, rash, or
bleeding) within three weeks after return or if they suspect that they have been exposed to Ebola virus
(e.g. volunteers who worked in healthcare settings) in the affected areas, they should seek rapid medical
attention and mention their recent travel to the attending physician.

8. Guidance for Airline Crews
Management of possible exposure to Ebola virus

Crew members on a flight with a passenger who is ill with a fever, jaundice, and/or bleeding and who is
traveling from an area in which Ebola cases have been reported should follow these precautions:
• Keep the sick person separated from close contact* with others as much as possible.
• Provide the sick passenger with a surgical mask (if the passenger can tolerate wearing one) to reduce
the number of droplets expelled into the air by talking, sneezing, or coughing.
• Tissues can be given to those who cannot tolerate a mask.
• Personnel should wear disposable gloves for direct contact with blood or other body fluids.
The ill passenger should be reported before arrival or as soon as the illness is noted. Designated
personnel will help arrange for medical assistance to be available when the airplane lands and will work
with the airline to assist with medical transportation of the patient upon arrival, disease control and
containment measures, passenger and crew notification, surveillance activities, and airline disinfection
procedures.

If exposure occurs

Personnel who think they have been exposed to Ebola virus and who develop symptoms during travel
should take the following actions:

• Notify your employer for help in locating a health ‐care provider. Inform the employer about the
possible exposure to Ebola virus, and ask about health‐care options.
• Before visiting a doctor’s office, alert the health‐care provider, clinic, or emergency room in advance
about the possible exposure to Ebola virus so that arrangements can be made to prevent transmission
to others in the health‐care setting.
• When traveling to a health‐care provider, limit your contact with others. All other travel should be
avoided.

9. Travellers
Stopping ill travelers from boarding aircraft

People who have been exposed to Ebola virus disease should not travel on commercial airplanes until
there is a period of monitoring for symptoms of illness lasting 21 days after exposure. Sick travelers
should delay travel until cleared to travel by a doctor or public health authority.
Airlines should consider using their own authority to deny boarding of sick travelers if Ebola is
suspected.

Management of ill people on aircraft if Ebola virus is suspected

Crew members on a flight with a passenger or other crew member who is ill with a fever, jaundice, or
bleeding and who is traveling from or has recently been in a risk area should follow these precautions:
• Keep the sick person separated from others as much as possible.
• Provide the sick person with a surgical mask (if the sick person can tolerate wearing one) to reduce the
number of droplets expelled into the air by talking, sneezing, or coughing.
• Give tissues to a sick person who cannot tolerate a mask. Provide a plastic bag for disposing of used
tissues.
• Wear impermeable disposable gloves for direct contact with blood or other body fluids.

Universal Precaution Kits:

Airplanes traveling to countries affected with Ebola should carry Universal Precaution Kits, as
recommended by the International Civil Aviation Organization (ICAO), for managing ill onboard
passengers.

   10. Actions
    What to do if you think you have been exposed

    Any person who thinks he or she has been exposed to Ebola virus either through travel, assisting an ill
    traveler, handling a contaminated object, or cleaning a contaminated aircraft should take the
    following precautions:
    • Notify your employer immediately.

• Monitor your health for 21 days. Watch for fever (temperature of 101°F/38.3°C or higher), chills,
    muscle aches, severe diarrhea, vomiting, rash, and other symptoms consistent with Ebola.

         When to see a health care provider
• If you develop sudden fever, chills, muscle aches, severe diarrhea, vomiting, rash, or other symptoms
consistent with Ebola, you should seek immediate medical attention.

      Before visiting a health care provider, alert the clinic or emergency room in advance about your
       possible exposure to Ebola virus so that arrangements can be made to prevent spreading it to
       others.
      When traveling to a health care provider, limit contact with other people. Avoid all other travel.

• If you are located abroad, contact your employer for help with locating a health care provider.