Ebola: The Facts

Last updated: 3rd December 2014

ebola 2Since the first incidence of Ebola was officially reported in March 2014, the disease has spread virulently across parts of West Africa and claimed 5738 lives in the process, leading the World Health Organisation (WHO) to declare an international health emergency. There is currently no approved vaccine or treatment and Ebola can prove fatal in up to 90% of cases. As such, the recent outbreak has caused serious concern and attracted media attention across the world. In this post, which will be regularly updated, we aim to answer the most important questions for businesses affected by, or planning for, the Ebola outbreak and include the current risk assessment for the UK.

In addition, organisations have been reminded yet again of just how fragile their safety margins are from the impacts of infectious diseases and we have created an advice note with suggestions of how organisations should approach and develop their preparedness for disease outbreak please click here.

What is Ebola?

Ebola Virus Disease is a disease caused by one of five different representatives of the Ebolavirus genus; four of which have been proven to cause severe illness in both animals and humans. Discovered in 1976 in the Democratic Republic of Congo, the Ebola virus is a severe infectious disease that can prove fatal in up to 90% of cases. Since its discovery, outbreaks have been sporadic and concentrated in the remote regions of Central and West Africa. It is likely, although not verified, that the virus is zoonotic and that the natural host of the virus is fruit bats. The current survival rate in this outbreak is 47%.

How is Ebola treated?

Ebola can neither be vaccinated against nor cured with a specific course of treatment – the best hope for patients being supportive medical care.

However, due to the severity of the outbreak, the WHO has considered the widespread use of experimental drugs for infected patients in West Africa. The experimental biopharmaceutical drug ZMapp was first tested on humans during the current West African outbreak and the recovery of a number of patients, including British nurse William Pooley, has been attributed to the drug. The manufacturer, Mapp Biopharmaceuticals, announced on the 11th August that the available supply of the drug has now been exhausted having only entered animal trials a few months prior to the outbreak.

An American doctor treated for Ebola in Nebraska received doses of the experimental drug TKM-Ebola, which is manufactured by the Canadian based firm Tekmira, along with the blood of another Ebola survivor and made a full recovery. TKM-Ebola is designed to target strands of the genetic material of Ebola and interrupt its genetic code. Although the drug has not been officially cleared by the FDA, a framework has been agreed for its use in emergencies. Doses of the drug are limited.

The antiviral drug Brincidofovir was used to treat a Liberian man diagnosed with Ebola in America. However, the drug has never been tested before on humans and has not been shown to work on animals who have contracted the disease.

Serum from the blood of recovered patients has also been used to treat patients.  The antibodies in the recovered patients blood cells may help the infected patient’s immune system to fight of the Ebola Virus. However, the recovered patient and the infected patient must share a blood type for this to be a workable treatment.

GlaxoSmithKline have recently announced positive results from an initial trial of Ebola vaccines. Twenty adults were tested and an immune response to Ebola was noted in all subjects, while the vaccine itself was ‘well tolerated’ by each patient. If this vaccine proves to be viable, pending further tests, it could be available as early as the second half of next year to those in high risk areas.

Which countries are currently affected?

Currently Guinea, Liberia, Sierra Leone, Mali and America are currently affected by the outbreak. Following small outbreaks, Nigeria, Senegal, Spain and the Democratic Republic of Congo have been declared free of the Ebola virus after having completed a 42 day incubation period with no further cases.

A British nurse was infected with the disease after working in a treatment centre in Sierra Leone. Will Pooley was flown back to the UK by the RAF at the end of August and treated in the Royal Free Hospital in Hampstead. Mr Pooley received the ZMapp drug and was released from hospital on the 2nd September after being given the all clear.

A Spanish nurse became the first person to contract Ebola outside of West Africa after treating a Spanish Missionary infected with the disease. As of the 21st October, she has produced multiple negative tests for the Ebola virus and has been given the all clear. No further cases have been confirmed.

Thomas Eric Duncan, a Liberian citizen, was diagnosed with Ebola in Dallas, Texas, on the 1st October. He boarded a flight from Monrovia a few days prior, at which time he was exhibiting no symptoms. Duncan sadly died on the 8th October. In the first known case of the disease transmitted in the US, two hospital workers who treated Duncan at the Texas Presbytarian Hospital were since been diagnosed with Ebola.

Infected patients have also been repatriated and treated in isolation in France, Germany, Norway and the UK.

What is the current spread of the disease as of 10th November?

America: 4 cases, 1 death
Guinea: 2134 cases, 1260 deaths
Liberia: 7168 cases, 3016 deaths

Mali: 8 case, 6 death

Sierra Leone: 6599 cases, 1398 deaths

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Democratic Republic of Congo: 68 cases, 49 deaths
Nigeria: 20 cases, 8 deaths
Senegal: 1 case, 0 deaths

Spain: 1 case, 0 deaths

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Total: 16003 cases, 5738 deaths

Which borders are affected by the outbreak?

Africa:

  • Botswana: All non-citizens travelling from Guinea, Liberia, Sierra Leone, Nigeria and the Congo are currently banned from entering Botswana
  • Cameroon: All travel is banned from Guinea, Liberia and Sierra Leone. Earlier bans on Nigeria and Senegal have been lifted.
  • Cape Verde: Entry will be denied to all non-residents who are travelling from Sierra Leone, Guinea and Liberia, or who have travelled in those countries in the past 30 days.
  • Chad: The land border with Nigeria has been closed while entry of travellers from Guinea, Sierra Leone, Liberia and Nigeria is banned.
  • Equatorial Guinea: No entry to travellers whose journeys originated in countries affected by Ebola.
  • Gabon: Entry visas to travellers from Liberia, Guinea, Sierra Leone and Nigeria are being issued on a case-by-case basis.
  • Kenya: The Suam border crossinghas been closed and entry is suspended of passengers travelling from Guinea, Liberia and Sierra Leone.
  • Mauritania: The Mauritanian border with Mali has been closed.
  • Mauritius: All travellers who have visited Nigeria, Sierra Leone, Guinea, Liberia, Senegal or the Congo in the last two months are banned.
  • Namibia: All foreign travellers who are travelling from Ebola affected regions are prohibited from entering the country.
  • Rwanda: All travellers who have visited Guinea, Liberia or Sierra Leone in the previous 22 days are banned.
  • Senegal: The land border with Guinea is closed.
  • South Sudan: a ban remains on travellers coming from Guinea, Sierra Leone, Liberia or Congo.

Other:

  • USA: travellers from Guinea, Liberia, Mali or Sierra Leon will only be able to enter the country through JFK International Airport, Newark International Airport, Dulles International Airport, Hartsfield-Jackson International Airport or Chicago O’Hare International Airport. All travellers from these regions will be actively monitored for a following 21 days.
  • Australia: The issuance of visas to travellers from Guinea, Liberia and Sierra Leone has been suspended.
  • North Korea: All foreign tourists have been banned, all other tourists will be required to undergo a 21 day quarantine before entering the country.
  • Singapore: Nationals of Guinea, Liberia and Sierra Leone will require visas to enter the country.

Which airlines are not flying to the affected regions?

Although the WHO has advised that no bans are imposed on international trade and travel, the following airlines have halted flights to and from the regions:

➢ Kenyan Airways has halted flights to Liberia and Sierra Leone
➢ British Airways, Emirates, Arik Air, Gambia Bird, Kenya Airways and ASKY Airlines have suspended flights to Sierra Leone, Guinea and Liberia. The British Airways suspension is in place until the 31st March 2015.
➢ Officials in Cameroon have announced they will suspend all flights from the Ebola affected countries.
➢ Korean Air has temporarily halted services to and from Kenya
➢ Air France has suspended flights from Sierra Leone and requires passengers boarding from Guinea and Liberia to have their temperature measured before boarding and will only be given their boarding pass if no symptoms are present. Other airlines are beginning to adopt similar procedures.

Current Risk Assessment:

Currently, the Foreign and Commonwealth Office class the risk to UK Nationals and risk of importation as low. An outbreak of the virus in a non-endemic country is exceptionally rare and has never happened within Europe. However, the Foreign Office has noted that if the current situation continues we should expect a handful of cases in the coming weeks (a maximum of three cases in the next three months). Further transmission of these possible cases is considered very low given the robust measures the UK government have put in place.

While the risk for UK humanitarian workers may be slightly higher, tourists, visitors and expatriate residents of affected areas face a low risk of infection as long as basic precautionary measures are demonstrated.

Following a COBR meeting on the 8th October, the UK’s Chief Medical Officer has announced that enhanced screening processes will be implemented at London’s Gatwick and Heathrow airports and Eurostar terminals. These screenings will involve the assessment of the passengers’ travel history, who they have come into contact with and provision of details of the passengers onward travel arrangements. These assessments will be conducted by trained medical personnel and not border staff.

What are the best sources for up-to-date information?

WHO: http://www.who.int/csr/disease/ebola/en/

Foreign and Commonwealth Office: https://www.gov.uk/government/publications/ebola-virus-disease-risk-assessment-of-outbreak-in-west-africa

Centre for Disease Control and Prevention: http://www.cdc.gov/

Public Health England: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Ebola/

NHS: http://www.nhs.uk/conditions/ebola-virus/Pages/Ebola-virus.aspx

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