July 31, 2014                                

The Situation

Ebola Outbreak - Impact on Travel

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The Disease
The outbreak - the largest in history - has spread across Guinea, Liberia, Nigeria and Sierra Leone and killed at least 672 people, according to the World Health Organization. The disease has no vaccine and no specific treatment.

According to WHO, Ebola first appeared in 1976 in two simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Ebola is a rare but deadly infection that causes bleeding inside and outside the body. Although popular movies and books describe major outbreaks of ebola-like disease in the U.S., they're just works of fiction. Ebola strikes mainly in remote villages of Central and West Africa, but it has spread to some African cities, too.

The disease, also known as Ebola hemorrhagic fever or Ebola virus disease kills up to 90% of people who are infected.

For the most part, early symptoms are similar to diseases like malaria and cholera, as well as the flu, which can mean the disease can be difficult to detect.

Many of the early symptoms of Ebola look like the flu or other mild illnesses. They include:

• Fever
• Headache
• Muscle aches
• Sore throat
• Weakness
• Diarrhea

As the disease gets worse, people who are infected may develop:

• Bleeding inside and outside of the body
• Rash
• Trouble breathing

WHO says the risk of travelers contracting Ebola is considered low because it requires direct contact with bodily fluids or secretions such as urine, blood, sweat or saliva. Ebola cannot be spread like flu through casual contact or breathing in the same air.

Patients are contagious only once the disease has progressed to the point they show symptoms, according to the WHO. And the most vulnerable are health care workers and relatives who come in much closer contact with the sick.

Since February, the West African countries of Guinea, Liberia, and Sierra Leone have struggled with the region's first known Ebola outbreak. Despite significant improvements during April - when disease activity was contained in Liberia and transmission declined dramatically in Guinea - persistent activity in rural southeast Guinea renewed during May, leading to the first sustained transmission in Sierra Leone and a second outbreak in Liberia. Disease activity appears to be declining once again in Guinea, but transmission continues in Liberia and remains high in Sierra Leone, which has now surpassed Guinea in both the rate of new Ebola cases and the total number of Ebola cases. Although the risk of actually contracting Ebola remains extremely low for most travelers and expatriates, serious ancillary risks have created significant travel and business disruptions in both the three Ebola-affected countries and other concerned African countries.

Summary
As of July 27, international authorities have reported a total of 1,201 Ebola Virus Disease (EVD) cases and 672 EVD deaths in West Africa. These include 427 EVD cases and 319 deaths in Guinea, including 311 confirmed cases and 208 confirmed deaths; 249 EVD cases and 129 EVD deaths in Liberia, including 84 confirmed cases and 60 confirmed deaths; and 525 EVD cases and 224 EVD deaths in Sierra Leone, including 419 confirmed cases and 188 confirmed deaths. As these figures demonstrate, the focus of Ebola activity has shifted to Sierra Leone following its introduction there in May.

Disease activity has been most concentrated in the primary epicenter, Gueckedou in the Forestiere region along the Guinea-Sierra Leone-Liberia border: i.e., Gueckedou Prefecture in Guinea, Kailahun District and Kenema District in Sierra Leone, and Lofa County in Liberia. However, significant foci have also appeared in coastal Guinea near Conakry, coastal Sierra Leone near Freetown, and coastal Liberia near Monrovia. Authorities have further confirmed one travel-related Ebola infection: an infected man who traveled from Liberia to Lagos, Nigeria July 20. Many countries - especially in or near West Africa - have increased health screenings at border checkpoints and at international airports. Furthermore, media have reported significant numbers of healthcare workers abandoning their posts due to Ebola concerns.

As of July 30, two air carriers have suspended activities due to increased concerns over Ebola: ASKY Airlines (KP), which suspended all flight service to Liberia's Roberts International Airport (ROB) and Sierra Leone's Lungi International Airport (FNA), and Arik Air (W3), which indefinitely suspended all service to Liberia and Sierra Leone. However, additional airlines may take similar actions in the coming weeks. Furthermore, in an attempt to contain Ebola activity in Liberia, the Liberian president ordered the indefinite closure of all border crossings except Foya Crossing in Lofa County, Bo-Waterside Crossing in Grand Cape Mount County, and Ganta Crossing in Nimba County. Normal flight operations will continue at Roberts International Airport (ROB) in Harbel and James Spriggs Payne Airport (MLW) in Monrovia. However international travelers should expect enhanced health screenings at operating entry and exit points. Neighboring countries may similarly restrict border crossings in the near future.

Advice
The WHO and the US CDC do not currently recommend against travel to any Ebola-affected country, because the low risk of Ebola exposure for travelers is far outweighed by the economic and humanitarian damage such restrictions would cause for affected countries. However, ongoing Ebola activity has seriously taxed healthcare providers in Guinea, Liberia, and Sierra Leone and has created challenges for assistance providers attempting to medically evacuate even non-Ebola patients from these countries.

Individuals operating in or near Ebola-affected areas should practice diligent personal health precautions, keeping in mind the following Ebola-specific information:

· Although Ebola is considered "highly contagious," it is not highly transmissible. The risk of transmission among people not involved in healthcare or funeral settings is small.

   o Healthcare workers currently operating in the area are most at risk, since Ebola is passed through blood, organs, tissues, bodily fluids, and close personal contact with infected individuals.

   o NGO workers and volunteers intent on assisting healthcare workers in the affected areas should consider deferring their travel until the outbreak is over.

· Since many local hospitals in the affected areas may be at overcapacity, personnel operating in the area and requiring non-emergency care may consider soliciting provider care at a hotel in lieu of a clinic. Many times, intravenous fluids, respiratory therapy, and other types of care can be administered by healthcare professionals in quality hotels.

   o Occupations with personnel at risk of trauma need to consider their proximity to appropriate care facilities and the possibility of exposure to Ebola or other diseases while being treated.

· Managers charged with site safety and health should be able to recognize the signs of Ebola and other hemorrhagic fevers: headache behind the eyes, flu-like symptoms, high fevers, diarrhea, and petechiae - a red or purple "rash" that may appear under areas with pressure.

   o Bleeding may be a late symptom.

· Frequent and thorough hand washing with soap and water may reduce the incidence of disease. If soap and water is unavailable, use of a hand sanitizer with at least 60-percent alcohol is an adequate substitution.

   o Social distancing and avoidance of crowded venues may reduce risk of disease transmission, but the likelihood of community spread outside of healthcare or funeral settings is low.

   o Do not consume "bushmeat" or the meat from any primate.

· Be aware of increasing travel disruptions related to this outbreak

   o Plan ahead for increased processing times at borders and international airports as countries implement health screenings of travelers from affected areas

   o Do not attempt to travel internationally while experiencing fever, diarrhea, or other symptoms because authorities may elect to isolate and test such individuals for Ebola and other infectious diseases

   o Consider deferring non-essential travel to Guinea, Liberia, and Sierra Leone due to difficulties evacuating non-Ebola patients from these countries

According to Dr. Thomas Shaffrey, M.D., Assist America's Clinical Director, "individuals with chronic medical conditions or immunocompromised status should consider deferring nonessential travel to Guin┼Że, Liberia, and Sierra Leone due to difficulties accessing timely medical care or medically evacuating patients from these countries.  With outbreaks such as this, International Health Regulations, and national laws regarding the movement of ill patients during outbreaks of international significance, will limit movement of infected individuals or those suspected of being infected in order to limit the spread of the disease."


Sources: USA Today, CBS News, WedMD, iJET, World Health Organization (WHO)

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The content of this edition of AssistAlert is for informational purposes only and is not intended to replace further investigation or personal observations. If you are planning travel, or are traveling in or proximate to the locations identified in this newsletter, you are encouraged to contact SecurAssist for additional information.

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