Ebola in Sierra Leone

Health Alert

LEVEL 3 - AVOID NONESSENTIAL TRAVEL

Updated September 9, 2015

CDC urges all US residents to avoid nonessential travel to Sierra Leone and Guinea(http://wwwnc.cdc.gov/travel/notices/warning/ebola-guinea) because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick, because of the possibility they may be sick with Ebola.

CDC no longer recommends US residents practice enhanced precautions when traveling to Liberia(http://wwwnc.cdc.gov/travel/notices/warning/ebola-liberia).

At a Glance

Total Cases (Suspected, Probable, and Confirmed): 13683
Laboratory-Confirmed Cases: 8699
Total Deaths: 3953

What is the current situation?

For more than one year, Liberia, Guinea, and Sierra Leone have been experiencing the largest and most complex outbreaks of Ebola in history. Outbreaks are continuing in Guinea(http://wwwnc.cdc.gov/travel/notices/warning/ebola-guinea) and Sierra Leone(http://wwwnc.cdc.gov/travel/notices/warning/ebola-sierra-leone). However, the World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia on May 9, 2015. Civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health infrastructure in Sierra Leone is being severely strained as the outbreak grows. CDC is closely monitoring the situation and will update information and advice for travelers as needed.

CDC recommends that US residents avoid nonessential travel to Sierra Leone. If you must travel, such as for humanitarian aid work in response to the outbreak, protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are sick with Ebola.

The recommendation to avoid nonessential travel is intended to help control the outbreak and prevent continued spread in two ways: to protect US residents who may be planning travel to the affected areas, and to enable the government of Sierra Leone to respond most effectively to contain this outbreak. CDC is committed to the multinational effort to help Sierra Leone control the outbreak and is scaling up its response activities by, among other things, deploying additional staff to the affected countries. Substantial international humanitarian assistance is required, and CDC encourages airlines to continue flights to and from the region to facilitate transport of teams and supplies essential to control the outbreak. Healthcare and management experts who have specialized skills and experience working in this kind of environment are needed to help in countries with Ebola. All aid workers should be affiliated with a recognized humanitarian aid organization.

For more information, visit 2014 Ebola Outbreak in West Africa on the CDC Ebola website.

What is Ebola?

Ebola is a rare and deadly disease. The disease is caused by infection with one of the Ebola virus species (Zaire, Sudan, Bundibugyo, or Tai Forest virus). Ebola is spread by direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth)

with the blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with or has died from Ebola;
with objects (like needles and syringes) contaminated with body fluids of a person who is sick with or has died from Ebola;
with infected fruit bats and primates (apes and monkeys); and
possibly with semen from a man who has recovered from Ebola (for example, contact during oral, vaginal, or anal sex).

Signs of Ebola include fever and symptoms such as severe headache, fatigue (feeling very tired), muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.

Who is at risk?

How can I be exposed to Ebola?

You can be exposed to the Ebola virus if you have contact with blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person sick with Ebola without wearing the right protective clothing and equipment. For healthcare workers, this includes wearing a face shield or goggles, a medical mask, double gloves, a waterproof gown or coveralls, an apron, and waterproof boots.

This kind of exposure can happen if you —

Are stuck with a needle or splashed in the eye, nose, or mouth with blood or body fluids of someone sick with Ebola.
Handle blood or body fluids of a sick Ebola patient.
Touch a person who is sick with Ebola.
Touch the body of someone who died from Ebola.
Care for or live with a person who is sick with Ebola.
Spend a long amount of time within 3 feet (1 meter) of a person who is sick with Ebola.

Travelers could be infected if they come into contact with blood or body fluids from someone who is sick or has died from Ebola. Healthcare workers and the family and friends in close contact with Ebola patients are at risk of getting sick because they may come in contact with infected blood or body fluids.

People also can become sick with Ebola if they come into contact with infected wildlife or raw or undercooked bushmeat (wild animals hunted for food) from an infected animal.

Ebola virus has been found in the semen of some men who have recovered from Ebola. It is possible that Ebola could be spread through sex. The risk of getting Ebola from semen is considered to be very low, and likely decreases over time. CDC and other public health partners are continuing to study how Ebola is spread, and will share what is known as it becomes available.

What can travelers do to prevent Ebola?

There is no approved vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.

Avoid nonessential travel to Guinea and Sierra Leone.
If you must travel, please make sure to do the following:
- Before your trip, check your health insurance plan to learn what is covered in the event that you become sick. CDC recommends that anyone traveling to Sierra Leone have full coverage, including coverage for emergency medical evacuation.
  - Information about medical evacuation services can be found on the US Department of State’s website on the Air Ambulance/MedEvac/Medical Escort Providers page.
  - Some insurance providers are excluding medical evacuation coverage for people who have Ebola. Check with providers to ensure you have the coverage you need.
  - Be sure to check the coverage limits for evacuation insurance. Also check to see if the policy covers evacuation to the United States or to the nearest location where adequate medical care is offered.
- Practice careful hygiene. For example, wash your hands frequently with soap and water or use an alcohol-based hand sanitizer.
- Avoid contact with blood and body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen).
- Do not handle items that may have come in contact with an infected person’s blood or body fluids.
- Avoid contact with dead bodies, including participating in funeral or burial rituals.
- Until more information is known about sexual transmission, avoid contact with the semen of a man who has recovered from Ebola (for example, during oral, vaginal, or anal sex). If you do have sex, use a condom the right way every time. Consider bringing your own supply of condoms.
- Avoid contact with animals (such as bats or monkeys) or with raw or undercooked meat.
- Do not eat or handle bushmeat (wild animals hunted for food).
- Avoid hospitals in West Africa where Ebola patients are being treated. The US Embassy or consulate is often able to provide advice on facilities that are suitable for your needs. The US Embassy in Freetown can be reached at +(232) 76-515-000.
- Seek medical care immediately if you develop fever (100.4°F / 38°C or above) or other symptoms such as severe headache, fatigue (feeling very tired), muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
  - Limit your contact with other people when you travel to the doctor. Do not travel anywhere else.

Special Recommendations for Travelers Who Will Be Working in Healthcare Settings

If you will be working in a healthcare setting while in Sierra Leone, you should be prepared to care for patients in a region where resources are limited and the healthcare system is strained.

Healthcare workers who may be exposed to people with Ebola should be sure to follow these steps:

Wear the recommended personal protective equipment (PPE).
Use proper infection control and decontamination measures.
Isolate patients with suspected, probable, or confirmed Ebola from other patients.
Avoid direct contact with dead bodies without wearing recommended PPE.
Immediately notify your organization, health officials, and the US embassy or consulate in Sierra Leone if you think you have been exposed to someone with Ebola but were not wearing recommended PPE.

See CDC’s resources on the Ebola: Non-US Healthcare Settings page and the CDC Safety Training Course for Healthcare Workers Going to West Africa in Response to the 2014 Ebola Outbreak. The World Health Organization also has advice in their Infection prevention and control guidance for care of patients in health-care settings, with focus on Ebola document.

Returning to the United States

See CDC’s Screening and Monitoring Travelers to Prevent the Spread of Ebola fact sheet for information about exit screening in West African countries with Ebola outbreaks and entry screening in other countries, including the United States.

You can also learn more about how you will be connected with a health department after you arrive in the United States to monitor your health for Ebola symptoms.

Traveling to Other Countries or on Cruises

Let your health department know about your travel plans, especially if you are going to another state, leaving the country, or taking a cruise. If you are allowed to travel, there may be special steps you need to follow.

If you plan to travel to another country, let your health department know and call the country’s embassy to find out if they have any travel bans or quarantines for people who have recently been in a country with an Ebola outbreak.
If you plan to take a cruise, call the cruise line to learn about restrictions that may apply to you. Some cruise lines may not allow passengers to board ships if they have recently been in or traveled through certain countries.

The Travel Health and Vaccine Specialists

JEMA : Your Health Promotion Experts

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