Ebola in Africa does not seem to be under control

It is highly recommended that you be aware of the WHO report on the current situation.  For more info as of 6th October 2014.... 

This Bulletin was last issued on Thursday, 02 October 2014.  

The outbreak of Ebola Virus Disease (EVD) centred in Guinea, Liberia and Sierra Leone continues to worsen and has led to over 3000 deaths. Initial cases with localised transmission have also occurred in Nigeria and Senegal, but have largely been contained,. The outbreak in west Africa is the most serious outbreak of EVD in recorded history.
An unrelated outbreak of a separate lineage of EVD in the Democratic Republic of the Congo (DRC) has led to a number of deaths.
First issued in April 2014, this bulletin is updated regularly. We strongly recommend that Australians residing or travelling in Africa, as well as Australian businesses with commercial interests in the region, subscribe to this bulletin and relevant travel advisory updates to receive an email notification each time these are updated.
We currently advise Australians to reconsider their need to travel to Guinea, Sierra Leone and Liberia. Australians in these three affected countries should leave while limited commercial options remain available. If you choose to travel to, or remain in these countries, we strongly recommend that you register your travel and contact details with us, so that we can keep you informed.

About Ebola Virus Disease (EVD)

The Zaire strain of the Ebola virus causes EVD in humans, with a case fatality rate of up to 90%. The fatality rate in the current outbreak, however, is closer to 50%. The symptoms of EVD are severe and can include high fever, muscle pain and weakness, headache and sore throat, followed by vomiting, diarrhoea and in some cases, internal and external bleeding. There is currently no vaccine to prevent Ebola and no proven safe and effective specific treatment for EVD. Care is largely supportive.
The virus is transmitted from infected animals to humans. Human to human transmission then occurs through direct contact with bodily fluids, including blood, faeces and sweat. Transmission can also occur through direct contact with the body of a deceased EVD patient.
On 8 August 2014, the World Health Organization (WHO) announced that the current outbreak of EVD in west Africa is a Public Health Emergency of International Concern. The WHO has released an ‘Ebola Response Roadmap’ intended to guide and coordinate the international response to the EVD outbreak in west Africa. The Roadmap is available on the WHO web portal.

Travel advice

The Australian Government advises Australians to reconsider their need to travel to Guinea, Sierra Leone and Liberia, where there is widespread, intense transmission of EVD. This reflects the seriousness of the outbreak, the challenges in containing it, the limited emergency care options, the potential for a deterioration in the security situation and the increasing travel restrictions which have significantly reduced freedom of movement in the region. We advise you to leave these three countries while limited commercial flights continue to operate.
Sporadic demonstrations and local disturbances have been reported across Guinea, Liberia and Sierra Leone related to the EVD outbreak – be aware that these can turn violent. A team of eight health workers and journalists have been killed in a village in south east Guinea while on an outreach visit to raise awareness of EVD. The United Nations Security Council has declared that the EVD outbreak is a threat to international peace and security.
Australians in EVD affected countries will find it increasingly difficult and costly to leave Africa. Departure options from Guinea, Liberia and Sierra Leone are extremely limited. Only a small number of commercial airlines continue to operate out of these countries and many land borders are closed. Additionally, many countries in Africa, including the major travel hubs of Kenya and South Africa, have now banned entry to travellers who have been in EVD affected countries.
Should you decide to travel to these countries despite our advice, we strongly recommend that you register your travel plans with us, and subscribe to free bulletin and travel advice updates so we can keep you informed. Areas in these three countries that are affected by the Ebola virus are mentioned in relevant country travel advisories. See also this map to easily identify affected areas.
EVD is not highly contagious to the general population, as transmission requires direct contact with the bodily fluids of an infected person or animal. However, the high rate of infection among frontline healthcare workers in the current outbreak is of significant concern.
You should closely monitor the advice provided by local health authorities and the WHO. Maintain strict standards of hygiene and avoid all direct contact with patients with EVD or unknown illnesses. Avoid contact with any objects that could have been contaminated with bodily fluids. Avoid contact with wild animals and do not eat or handle raw or undercooked animal products, such as blood and meat. Know the symptoms of EVD and see a healthcare provider immediately if you feel unwell, or if any EVD symptoms develop. If you are unwell following travel, be sure to tell your healthcare provider and Australian border officials that you have been in an EVD affected country.
The standards of local emergency health care in affected countries are well below Australian standards. The current outbreak of EVD has overwhelmed many local health facilities and options for obtaining routine or emergency medical care may be severely limited. You should also be aware that non-EVD related medical evacuations from EVD affected countries will be substantially more complicated than usual due to the restrictions on travel from EVD affected countries.
If you choose to remain in the region for work, you should ensure that your employer has contingency plans for treatment or evacuation should you show symptoms of the disease. If, despite our advice, you are considering undertaking independent travel, you should ensure that your travel insurance will cover healthcare and/or medical evacuation for EVD.
Limits to consular assistance: The Australian Government will have very limited capacity to provide consular assistance in these circumstances. Medical evacuations for any potential EVD patient – and particularly symptomatic EVD patients - will be extremely difficult, if not impossible, to conduct. Australia does not have a diplomatic or consular mission in Guinea, Sierra Leone or Liberia and the Australian High Commission in Accra, Ghana has consular responsibility for these countries. Australian High Commission personnel have deferred all travel to Guinea, Liberia and Sierra Leone as a result of the EVD outbreak.
Australian embassies and high commissions elsewhere in Africa, including in Nigeria, continue to operate as normal.

Travel restrictions and preventative measures

The WHO announcement marking the EVD outbreak as a Public Health Emergency of International Concern has led to new travel restrictions in many African countries. Authorities in several countries have implemented flight bans and an increasing number of carriers have indefinitely suspended flights into Guinea, Sierra Leone and Liberia. Many land borders have been closed.
Health screening is being undertaken at many international airports that have direct flights into the region or that are major air travel hubs. Travellers with fever or EVD-like symptoms may be subject to quarantine or denied entry or exit from certain countries. If you are unwell, you should consider the possible implications of this health screening should you choose to travel to west Africa.
A summary of restrictions is detailed below, based on the latest confirmed advice from foreign governments. This list is not exhaustive. If you are planning travel, you should be aware that further restrictions may be put in place with little or no notice. Monitor the media closely and before you travel, confirm that borders remain open and/or check with your carrier for the most up to date information on flight schedules.

Countries with widespread and intense transmission of EVD

Guinea: Land borders with Senegal, Sierra Leone and Liberia have been closed. Health screenings have been introduced at border crossings. Travellers with fever or EVD-like symptoms are subject to quarantine or denied entry or exit from the country. Only a small number of carriers are continuing to operate commercial flights.
Sierra Leone: A 60-90 day state of emergency has been imposed, which enables the military to enforce quarantine zones, restrict public movements and limit public gatherings. The government of Sierra Leone has imposed restrictions on internal movement and further travel restrictions are in place in areas bordering Guinea and Liberia. Health screenings have been introduced at border crossings. Travellers with fever or EVD-like symptoms are being subject to quarantine or denied entry or exit from the country. Only a small number of carriers are continuing to operate commercial flights.
Liberia: Liberian authorities have implemented a state of public emergency in response to the EVD outbreak. They have put in place a range of measures to combat the spread of the disease including closing the majority of Liberia’s borders and imposing restrictions on travel within the country. A nationwide curfew is in place between 11 pm and 6 am. Local emergency measures may change without warning. Travellers with fever or EVD-like symptoms are being subject to quarantine or being denied entry or exit from the country. Only a small number of carriers are continuing to operate commercial flights.

Countries with localised or contained outbreaks of EVD

Nigeria: A small number of cases of EVD, including eight deaths, were confirmed in Nigeria. The virus has now largely been contained. To prevent further imported cases, health screening measures for passengers arriving and departing are in place at all airports in Nigeria.
Senegal: On 29 August, Senegal confirmed its first case of the disease. The virus has now been contained. In an effort prevent further imported cases, authorities banned the entry of any travellers who have been in Guinea, Liberia and Sierra Leone in the previous 40 days. The land border with Guinea is closed. Sea and air borders are also closed to vessels and aircraft from Guinea, Liberia and Sierra Leone, with the exception of a designated humanitarian air corridor.
Democratic Republic of the Congo (DRC): An EVD outbreak has been confirmed in Equateur Province in northern DRC. This is a separate lineage of EVD from the west Africa outbreak. Travellers should carefully consider the likely impact on their travel plans of any restrictions on movement that may be imposed in the future.

Other African countries

Botswana: Authorities have banned entry of all travellers who have been in Guinea, Liberia, Nigeria and Sierra Leone in the previous 30 days.
Cabo Verde: Travel is restricted into the country for non-resident foreigners who in the previous 30 days have been to any of the countries affected by EVD.
Cameroon: Authorities have banned entry for any traveller who has been in an EVD affected country, including Nigeria, in the previous 21 days. All air, sea and land borders with Nigeria have temporarily been closed.
Cote d’Ivoire: Authorities have banned entry for any traveller who has been in an affected country in the previous three months (90 days). Land borders with Guinea and Liberia have also reportedly been closed.
Ethiopia: Authorities have introduced additional health screening and information requirements for travellers arriving by air and land. Travellers who register a high temperature during screening may be quarantined.
Equatorial Guinea: The issuance of visas has been suspended for those travelling from central and west Africa. The national carrier Ceiba Intercontinental has reportedly cancelled all incoming and outgoing flights to/from Sao Tome et Principe, Cameroon, Cote d’Ivoire, Ghana, Republic of Congo, Benin, Togo, Nigeria and Gabon. In addition, permission for vessels travelling to or from west, central or east Africa to berth or depart from Malabo port has been suspended.
Gabon: All incoming flights from or via countries affected by EVD, including Nigeria, have been cancelled.
Guinea-Bissau: Authorities have closed the land border with Guinea, reinforced maritime patrols and airport controls, and suspended flights to and from affected countries.
Kenya: Entry of passengers travelling from or through Guinea, Liberia and Sierra Leone, is suspended, with the exception of health professionals supporting efforts to contain the outbreak and Kenyan citizens.
Malawi: Authorities have introduced health screening at airports and land borders for passengers arriving from west Africa.
Mali: Health screening at airports and land border crossings has been increased.
Mauritius: Authorities have banned the entry of any nationals who have visited Guinea, Liberia, Sierra Leone, Nigeria or the Democratic Republic of the Congo in the previous two months.
Namibia: Authorities have suspended the entry of passengers travelling from EVD affected countries, with the exception of Namibian citizens.
Rwanda: Authorities have banned entry of all travellers who have been in Guinea, Liberia and Sierra Leone in the previous 22 days. Health screening is in place at all border posts. Any non-residents with a fever of 37.5 degrees or above will not be allowed to enter Rwanda.
Seychelles: Citizens of any nationality who have visited Sierra Leone, Guinea, Liberia, Nigeria and the Democratic Republic of the Congo will not be allowed to enter the Seychelles.
South Africa: Foreign citizens arriving from EVD affected countries in west Africa will not be allowed to enter South Africa. South African citizens will be allowed to re-enter, but will be subject to screening.
The Gambia: Authorities have cancelled all incoming flights from Guinea, Sierra Leone, Liberia and Nigeria.
Uganda: Health screening is in place at Entebbe International Airport for all travellers from affected west African countries and from the Democratic Republic of the Congo. An isolation centre has been established at the airport for any suspected EVD cases.
Zambia: The entry of travellers from affected west African countries is banned.
Zimbabwe: Passengers from EVD-affected countries are being identified and interviewed at airports and land borders. Travellers from west Africa are reportedly subject to a 21 day health surveillance

Airline suspensions

We are aware that the following airlines have changed or suspended flights in the west Africa region as a result of the EVD outbreak. Further suspensions may be put in place at short notice. Before travelling by air in Africa, we strongly recommend that you contact your airline for the latest information on service changes that may affect your plans.

• Air France has suspended flights to Liberia and Sierra Leone. Flights to Guinea may be off-schedule, or cancelled at short notice.
• British Airways has suspended flights Liberia and Sierra Leone until 31 March 2015.
• Emirates has suspended flights to Guinea.
• Kenyan Airways has temporarily suspended flights from Liberia and Sierra Leone into Nairobi.
• Asky Airlines has suspended flights to and from Guinea, Sierra Leone and Liberia.
• Arik Air and Gambia Bird have suspended services to Liberia and Sierra Leone.
• Ceiba Intercontinental has suspended flights to west African countries.
• Korean Air has suspended flight to and from Kenya.
• Royal Air Maroc and Brussels Airlines are operating on modified routes and schedules.
• Delta has ceased flying to Monrovia, Liberia for commercial reasons not related to the EVD outbreak.

Mitigating the risk to Australia

The risk to Australia remains very low. The Australian Government has put in place banners and electronic messaging at our international airports to raise awareness of the symptoms of EVD. All passengers whose travel originated in affected countries in Africa are having their health checked. As part of routine procedures, incoming flights to Australia have on-board announcements asking passengers who are feeling unwell with fever, chills or sweats to alert a crew member. Crew members then alert border protection and biosecurity staff for follow-up health procedures. Australia’s border protection procedures are robust and sufficient to deal with any threat and our infection control mechanisms in hospitals are first rate.

Additional resources

WHO links:

• WHO Ebola webpage
• WHO Ebola response roadmap
• WHO travel and transport risk assessment

Supplied by