Ebola in Liberia

Health Alert

LEVEL 2 - PRACTICE ENHANCED PRECAUTIONS

Updated June 17, 2015

What is the current situation?

For more than a year, Liberia, Guinea, and Sierra Leone have been experiencing the largest and most complex outbreak of Ebola in history. Cases continue to be reported in Guinea(http://wwwnc.cdc.gov/travel/notices/warning/ebola-guinea) and Sierra Leone(http://wwwnc.cdc.gov/travel/notices/warning/ebola-sierra-leone). The World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia on May 9, 2015, meaning that 42 days (two incubation periods) had passed since the last Ebola patient was buried. The health system in Liberia continues to monitor for new cases and to take precautions to prevent transmission in the country. CDC is also closely monitoring the situation and will update information and advice for travelers as needed.

CDC is no longer recommending that US residents avoid nonessential travel to Liberia. However, CDC recommends that US residents practice enhanced precautions when traveling to Liberia. Although the risk to travelers is extremely low, there is the possibility of reintroduction of Ebola into the country. Travelers should follow CDC’s advice for avoiding contact with blood and body fluids. Travelers should also be aware that getting medical care in Liberia may be difficult because the health infrastructure has been severely strained by the Ebola outbreak. Certain travelers, such as senior citizens, people with underlying illnesses, and people with weakened immune systems, should consider postponing travel.

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 in humans 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 direct 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 with Ebola or who has died from Ebola. Healthcare workers and the family and friends in close contact with Ebola patients are most 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 die who get the disease. If you are traveling to Liberia, please take the following steps to prevent Ebola:

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).
Avoid contact with dead bodies.
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).
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. The US Embassy or consulate is often able to provide advice on facilities that are suitable for your medical needs,The US Embassy Monrovia can be reached at +(231) 77-677-7000.

Preparing to Travel to Liberia

CDC recommends you take steps to protect yourself from other health risks in Liberia. See Health Information for Travelers to Liberia(http://wwwnc.cdc.gov/travel/destinations/traveler/none/liberia?s_cid=ncezid-dgmq-travel-single-001) to learn more about ways to stay healthy and safe on your trip.

Visit a travel medicine provider, ideally 4 to 6 weeks before you leave, to discuss health recommendations based on your medical history and travel plans.
- Because it may be difficult to get medical care in Liberia, certain travelers, such as senior citizens, people with underlying illnesses, and people with weakened immune systems, should talk to their doctor about whether they should consider postponing travel.
Check your health insurance plan to learn what is covered in the event that you become sick. CDC recommends that anyone traveling to Liberia 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.
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.
Some insurance providers are excluding medical evacuation coverage for people who have Ebola. Check with providers to ensure you have the coverage you need.

Returning to the United States

Exit Screening in Liberia

Travelers leaving Liberia are being screened at airports before departure. You should be prepared for airport screeners to check your temperature and look for signs and symptoms of illness when you leave the country. They may also ask you questions about your time in Liberia.

Entry Screening in the United States

The United States requires all air travelers to the United States whose trip starts in Liberia to enter through one of five US airports (JFK in New York, Newark in New Jersey, Dulles in Virginia near Washington D.C., Hartsfield-Jackson in Atlanta, and O’Hare in Chicago). Staff will take your temperature and ask you questions about your time in Liberia. You will be asked to provide your contact information so state or local public health workers can contact you later, if needed. You will also be given some information about watching your health for 21 days after leaving Liberia.

During those 21 days, if you develop a 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, contact your state or local health department. By doing so, you can receive any needed medical care quickly.

Traveling to Other Countries or on Cruises

CDC does not recommend any travel restrictions for people arriving in the United States from Liberia. However, other countries (and some cruise lines) might have policies in place that restrict travel.

If you plan to travel to another country, 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 that previously had an Ebola outbreak.
Some cruise lines may not allow passengers to board ships if they have recently been in or traveled through certain countries. Call the cruise line in advance if you are planning to take a cruise in the near future.

The Travel Health and Vaccine Specialists

JEMA : Your Health Promotion Experts