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FREQUENTLY ASKED QUESTIONS ON EBOLA VIRUS DISEASE

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WHAT IS EBOLA
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.
HOW DO PEOPLE
BECOME INFECTED WITH THE VIRUS?
In the current
outbreak in West Africa, the majority of cases in humans have occurred as a
result of human-to-human transmission.
Infection occurs
from direct contact through broken skin or mucous membranes with the blood, or
other bodily fluids or secretions (stool, urine, saliva, semen) of infected
people. 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.
More than 100
health-care workers have been exposed to the virus while caring for Ebola patients.
This happens because they may not have been wearing personal protection
equipment or were not properly applying infection prevention and control
measures when caring for the patients. Health-care providers at all levels of
the health system – hospitals, clinics, and health posts – should be briefed on
the nature of the disease and how it is transmitted, and strictly follow
recommended infection control precautions.
WHO does not advise
families or communities to care for individuals who may present with symptoms
of Ebola virus disease in their homes. Rather, seek treatment in a hospital or
treatment centre staffed by doctors and nurses qualified and equipped to treat
Ebola virus victims. If you do choose to care for your loved one at home, WHO
strongly advises you to notify your local public health authority and receive
appropriate training, equipment (gloves and personal protective equipment
[PPE]) for treatment, instructions on proper removal and disposal of PPE, and
information on how to prevent further infection and transmission of the disease
to yourself, other family members, or the community.
Additional
transmission has occurred in communities during funerals and burial rituals.
Burial ceremonies in which mourners have direct contact with the body of the
deceased person have played a role in the transmission of Ebola. Persons who
have died of Ebola must be handled using strong protective clothing and gloves
and must be buried immediately. WHO advises that the deceased be handled and
buried by trained case management professionals, who are equipped to properly
bury the dead.
People are
infectious as long as their blood and secretions contain the virus. For this
reason, infected patients receive close monitoring from medical professionals
and receive laboratory tests to ensure the virus is no longer circulating in
their systems before they return home. When the medical professionals determine
it is okay for the patient to return home, they are no longer infectious and
cannot infect anyone else in their communities. Men who have recovered from the
illness can still spread the virus to their partner through their semen for up
to 7 weeks after recovery. For this reason, it is important for men to avoid
sexual intercourse for at least 7 weeks after recovery or to wear condoms if
having sexual intercourse during 7 weeks after recovery.
 Generally, a person
must come into contact with an animal that has Ebola and it can then spread
within the community from human to human.
WHO IS MOST AT RISK?
During an outbreak,
those at higher risk of infection are:
health workers;
family members or
others in close contact with infected people;
mourners who have
direct contact with the bodies of the deceased as part of burial ceremonies.
More research is
needed to understand if some groups, such as immuno-compromised people or those
with other underlying health conditions, are more susceptible than others to
contracting the virus.
 Exposure to the
virus can be controlled through the use of protective measures in clinics and
hospitals, at community gatherings, or at home.
WHAT ARE TYPICAL
SIGNS AND SYMPTOMS OF INFECTION?
Sudden onset of
fever, intense weakness, muscle pain, headache and sore throat are typical
signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired
kidney and liver function, and in some cases, both internal and external
bleeding.
Laboratory findings
include low white blood cell and platelet counts, and elevated liver enzymes.
The incubation
period, or the time interval from infection to onset of symptoms, is from 2 to
21 days. The patients become contagious once they begin to show symptoms. They
are not contagious during the incubation period.
Ebola virus disease
infections can only be confirmed through laboratory testing.
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.

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.
WHAT CAN I DO? CAN
IT BE PREVENTED? IS THERE A VACCINE?
Currently, there is
no licensed medicine or vaccine for Ebola virus disease, but several products
are under development.
WAYS TO PREVENT
INFECTION AND TRANSMISSION
While initial cases
of Ebola virus disease are contracted by handling infected animals or
carcasses, secondary cases occur by direct contact with the bodily fluids of an
ill person, either through unsafe case management or unsafe burial practices.
During this outbreak, most of the disease has spread through human-to-human
transmission. Several steps can be taken to help in preventing infection and
limiting or stopping transmission.
Understand the
nature of the disease, how it is transmitted, and how to prevent it from
spreading further. (For additional information, please see the previous
questions about Ebola virus disease in this FAQ.)
Listen to and
follow directives issued by your country’s respective Ministry of Health.
If you suspect
someone close to you or in your community of having Ebola virus disease,
encourage and support them in seeking appropriate medical treatment in a
health-care facility.
If you choose to
care for an ill person in your home, notify public health officials of your
intentions so they can train you and provide appropriate gloves and personal
protective equipment (PPE) (gloves, impermeable gown, boots/closed shoes with
overshoes, mask and eye protection for splashes), as well as instructions as a
reminder on how to properly care for the patient, protect yourself and your
family, and properly dispose of the PPE after use. N.B. WHO does not recommend
home care and strongly advises individuals and their family members to seek
professional care in a treatment centre.
When visiting
patients in the hospital or caring for someone at home, hand washing with soap
and water is recommended after touching a patient, being in contact with their
bodily fluids, or touching his/her surroundings.
People who have
died from Ebola should only be handled using appropriate protective equipment
and should be buried immediately by public health professionals who are trained
in safe burial procedures.
Additionally,
individuals should reduce contact with high-risk infected animals (i.e. fruit
bats, monkeys or apes) in the affected rainforest areas. If you suspect an
animal is infected, do not handle it. Animal products (blood and meat) should
be thoroughly cooked before eating.
WHAT ABOUT HEALTH
WORKERS? HOW SHOULD THEY PROTECT THEMSELVES WHILE CARING FOR PATIENTS?
Health workers
treating patients with suspected or confirmed illness are at higher risk of
infection than other groups. During an outbreak a number of important actions
will reduce or stop the spread of the virus and protect health workers and
others in the health-care setting. These actions are called “standard and other
additional precautions” and are evidence-based recommendations known to prevent
the spread of infections. The following questions and answers describe the precautions
in detail.
SHOULD PATIENTS
WITH SUSPECTED OR CONFIRMED EBOLA VIRUS BE SEPERATED FROM OTHER PATIENTS?
Isolating patients
with suspected or confirmed Ebola virus disease in single isolation rooms is
recommended. Where isolation rooms are not available, it is important to assign
designated areas, separate from other patients, for suspected and confirmed
cases. In these designated areas, suspect and confirmed cases should also be
separate. Access to these areas should be restricted, needed equipment should
be dedicated strictly to suspected and confirmed EVD treatment areas, and
clinical and non-clinical personnel should be exclusively assigned to isolation
rooms and dedicated areas.
ARE VISITORS
ALLOWED IN AREAS WHERE PATIENTS SUSPECTED OR CONFIRMED EBOLA VIRUS DISEASE ARE
ADMITTED?
Stopping visitor
access to patients infected with EVD is preferred. If this is not possible,
access should be given only to those individuals who are necessary for the
patient’s well-being and care, such as a child’s parent.
IS PROTECTIVE
EQUIPMENT REQUIRED WHEN CARING FOR THESE PATIENTS?
In addition to
standard health-care precautions, health-care workers should strictly apply
recommended infection control measures to avoid exposure to infected blood,
fluids, or contaminated environments or objects – such as a patient’s soiled
linen or used needles.
All visitors and
health-care workers should rigorously use what is known as personal protective
equipment (PPE). PPE should include at least: gloves, an impermeable gown,
boots/closed shoes with overshoes, a mask, and eye protection for splashes
(goggles or face shields).
IS HAND HYGIENE
IMPORTANT?
Hand hygiene is
essential and should be performed:
Before donning
gloves and wearing PPE on entry to the isolation room/area;
Before any clean or
aseptic procedures is being performed on a patient;
After any exposure
risk or actual exposure with a patient’s blood or body fluids;
After touching
(even potentially) contaminated surfaces, items, or equipment in the patient’s
surroundings; and
After removal of
PPE, upon leaving the isolation area.
It is important to
note that neglecting to perform hand hygiene after removing PPE will reduce or
negate any benefits of the PPE.
 Either an
alcohol-based hand rub or soap and running water can be used for hand hygiene,
applying the correct technique recommended by WHO. It is important to always
perform hand hygiene with soap and running water when hands are visibly soiled.
Alcohol-based hand rubs should be made available at every point of care (at the
entrance and within the isolation rooms and areas); running water, soap, and
single use towels should also be always available.
WHAT OTHER
PRECAUTIONS ARE NECESSARY IN THE HEALTH- CARE SETTING?
Other key
precautions are safe injection and phlebotomy procedures, including safe
management of sharps, regular and rigorous environmental cleaning,
decontamination of surfaces and equipment, and management of soiled linen and
of waste.
In addition, it is
important to ensure safe processing of laboratory samples from suspected or
confirmed patients with EDV and safe handling of dead bodies or human remains
for post-mortem examination and burial preparation. Any health-care workers and
other professionals undertaking these tasks in connection with suspected or
confirmed patients with Ebola virus disease should wear appropriate PPE and
follow precautions and procedures recommended by WHO.
WHAT ABOUT RUMOURS
THAT SOME FOODS CAN PREVENT OR TREAT THE INFECTION?
 WHO strongly
recommends that people seek credible health advice about Ebola virus disease
from their public health authority.
 While there is no
specific drug against Ebola, the best treatment is intensive supportive
treatment provided in the hospital by health workers using strict infection
control procedures. The infection can be controlled through recommended
protective measures.
HOW DOES WHO
PROTECT HEALTH DURING OUTBREAKS?
WHO provides
technical advice to countries and communities to prepare for and respond to
Ebola outbreaks.
WHO actions
include:
Disease
surveillance and information-sharing across regions to watch for outbreaks;
Technical
assistance to investigate and contain health threats when they occur – such as
on-site help to identify sick people and track disease patterns;
Advice on
prevention and treatment options;
Deployments of
experts and the distribution of health supplies (such as personal protection
gear for health workers) when they are requested by the country;
Communications to
raise awareness of the nature of the disease and protective health measures to
control transmission of the virus; and
Activation of
regional and global networks of experts to provide assistance, if requested,
and mitigate potential international health effects and disruptions of travel
and trade.
DURING AN OUTBREAK,
NUMBER OF CASES REPORTED BY HEALTH OFFICIALS CAN GO UP AND DOWN. WHY?
During an Ebola
outbreak, the affected country’s public health authority reports its disease
case numbers and deaths. Figures can change daily. Case numbers reflect both
suspected cases and laboratory-confirmed cases of Ebola. Sometimes numbers of
suspected and confirmed cases are reported together. Sometimes they are
reported separately. Thus, numbers can shift between suspected and confirmed
cases.
Analyzing case data
trends, over time, and with additional information, is generally more helpful
to assess the public health situation and determine the appropriate response.
IS IT SAFE TO
TRAVEL DURING AN OUTBREAK? WHAT IS WHO’S TRAVEL ADVICE?
During an outbreak,
WHO reviews the public health situation regularly and recommends any travel or
trade restrictions, if necessary, and may inform national authorities to
implement it. WHO is currently reviewing its recommendations for travel and
expects to issue advice in the coming days.
While travellers
should always be vigilant with regard to their health and those around them,
the risk of infection for travellers is very low since person-to-person
transmission results from direct contact with the body fluids or secretions of
an infected patient.
IS IT SAFE TO
TRAVEL WITH PERSONS WHO HAVE EBOLA?
As with any illness
or disease, it is always possible that a person who has been exposed to Ebola
virus may choose to travel. If the individual has not developed symptoms (see
FAQ #4), they cannot transmit EVD to those around them. If the individual does
have symptoms, they should seek immediate medical attention at the first sign
they are feeling unwell. This may require either notifying the flight crew or
ship crew or, upon arrival at a destination, seeking immediate medical
attention. Travellers who show initial symptoms of EVD should be isolated to
prevent further transmission. Although the risk to fellow travellers in such a
situation is very low, contact tracing is recommended under these
circumstances.
IS IT SAFE TO
TRAVEL TO WEST AFRICA ON BUSINESS OR TO VISIT FAMILY AND FRIENDS?
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 of which are unlikely exposures for the average traveller. In any
event, tourists are advised to avoid all such contacts.
If you are visiting
family or friends in the affected areas, the risk is similarly low, unless you
have direct physical contact with a person who is ill or who has died. If this
is the case, it is important to notify public health authorities and engage in
contact tracing. Contact tracing is used to confirm you have not been exposed
to EVD and to prevent further spread of the disease through monitoring.
WHO’s general
travel advice
 Travelers should
avoid all contact with infected patients.
Health workers
traveling to affected areas should strictly follow WHO-recommended infection
control guidance.
Anyone who has
stayed in areas where cases were recently reported should be aware of the
symptoms of infection and seek medical attention at the first sign of illness.
Clinicians caring
for travelers returning from affected areas with compatible symptoms are
advised to consider the possibility of Ebola virus disease.
For additional
travel advice, please read the Travel and transport risk assessment:
Recommendations for public health authorities and transport sector at  http://who.int/ith/updates/20140421/en/  

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