Questions and Answers on Ebola

General

How do I protect myself against Ebola?

If you must travel to an area affected by the 2014 Ebola outbreak, protect yourself by doing the following:

• Wash hands frequently or use an alcohol-based hand sanitizer.
• Avoid contact with blood and body fluids of any person, particularly someone who is sick.
• Do not handle items that may have come in contact with an infected person’s blood or body fluids.
• Do not touch the body of someone who has died from Ebola.
• Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.
• Avoid facilities in West Africa where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.
• Seek medical care immediately if you develop fever, headache, muscle pain, fatigue, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
  • Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

CDC has issued a Warning, Level 3 travel notice for U.S. citizens to avoid nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has also issued an Alert, Level 2 travel notice for the Democratic Republic of the Congo (DRC). A small number of Ebola cases have been reported in the DRC, though current information indicates that this outbreak is not related to the ongoing Ebola outbreak in West Africa. For travel notices and other information for travelers, visit the Travelers’ Health Ebola web page.

Has the first patient to become sick in this outbreak, know as “patient zero” been identified?

Reports in the medical literature and elsewhere have attempted to identify the patient who might have been the initial person infected in the West Africa Ebola outbreak. It’s important for CDC to learn as much as it can about the source and initial spread of any outbreak.

With regard to the West Africa Ebola outbreak, tracing the lineage of how Ebola has spread thus far can help CDC apply that knowledge toward better prevention and care techniques. The knowledge gained in this work might entail details about specific patients. CDC generally refrains, however, from identifying particular patients in any aspect of an outbreak.

I am a U.S. resident experiencing some flu-like symptoms (e.g. fever, headache, muscle aches). How do I know if I have seasonal influenza or Ebola?

Seasonal influenza and Ebola virus infection can cause some similar symptoms. However, of these viruses, your symptoms are most likely caused by seasonal influenza. Influenza is very common. Millions of people are infected, hundreds of thousands are hospitalized and thousands die from flu each year. In the United States, fall and winter is the time for flu. While the exact timing and duration of flu seasons vary, outbreaks often begin in October and can last as late as May. Most of the time flu activity peaks between December and February. Information about current levels of U.S. flu activity is available in CDC's weekly FluView report.

In the United States, there have been two travel-associated cases and two locally acquired cases among healthcare workers. There is widespread transmission of Ebola virus disease in West Africa.

It is usually not possible to determine whether a patient has seasonal influenza or Ebola infection based on symptoms alone. However, there are tests to detect seasonal influenza and Ebola infection. Your doctor will determine if you should be tested for these illnesses based on your symptoms, clinical presentation and recent travel or exposure history. (For information regarding the signs and symptoms of Ebola, and whether you may need to be tested, please review the Ebola case definitions.)

What is CDC doing in the U.S. about the outbreak in West Africa?

CDC has activated its Emergency Operations Center (EOC) to help coordinate technical assistance and control activities with partners. CDC has deployed several teams of public health experts to the West Africa region and plans to send additional public health experts to the affected countries to expand current response activities.

If an ill traveler arrives in the U.S., CDC has protocols in place to protect against further spread of disease. These protocols include having airline crew notify CDC of ill travelers on a plane before arrival, evaluation of ill travelers, and isolation and transport to a medical facility if needed. CDC, along with Customs & Border Patrol, has also provided guidance to airlines for managing ill passengers and crew and for disinfecting aircraft. CDC has issued a Health Alert Notice reminding U.S. healthcare workers about the importance of taking steps to prevent the spread of this virus, how to test and isolate patients with suspected cases, and how to protect themselves from infection.

Travelers

What is being done to prevent ill travelers in West Africa from getting on a plane?

In West Africa

CDC’s Division of Global Migration and Quarantine (DGMQ) is working with airlines, airports, and ministries of health to provide technical assistance for the development of exit screening and travel restrictions in the affected areas. This includes:

• Assessing the ability of Ebola-affected countries and airports to conduct exit screening,
• Assisting with development of exit screening protocols,
• Training staff on exit screening protocols and appropriate PPE use, and
• Training in-country staff to provide future trainings.

During Travel

CDC works with international public health organizations, other federal agencies, and the travel industry to identify sick travelers arriving in the United States and take public health actions to prevent the spread of communicable diseases. Airlines are required to report any deaths onboard or ill travelers meeting certain criteria to CDC before arriving into the United States, and CDC and its partners determine whether any public health action is needed. If a traveler is infectious or exhibiting symptoms during or after a flight, CDC will conduct an investigation of exposed travelers and work with the airline, federal partners, and state and local health departments to notify them and take any necessary public health action. When CDC receives a report of an ill traveler on a cruise or cargo ship, CDC officials work with the shipping line to make an assessment of public health risk and to coordinate any necessary response.

In the United States

CDC has staff working 24/7 at 20 Border Health field offices located in international airports and land borders. On October 27, CDC’s public health authorities began active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea. These travelers are now arriving to the United States at one of five airports where entry screening is being conducted by Customs and Border Protection and CDC.  Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. CDC staff are ready 24/7 to investigate cases of ill travelers on planes and ships entering the United States.

CDC works with partners at all ports of entry into the United States to help prevent infectious diseases from being introduced and spread in the United States. CDC works with Customs and Border Protection, U.S. Department of Agriculture, U.S. Coast Guard, U.S. Fish and Wildlife Services, state and local health departments, and local Emergency Medical Services staff.

Relatively few of the approximately 350 million travelers who enter the United States each year come from these countries. Most people who become infected with Ebola are those who live with or care for people who have already caught the disease and are showing symptoms.

What do I do if I’m returning to the U.S. from the area where the outbreak is occurring?

After you return, pay attention to your health.

• Monitor your health for 21 days if you were in an area with an Ebola outbreak, especially if you were in contact with blood or body fluids, items that have come in contact with blood or body fluids, animals or raw meat, or facilities where Ebola patients are being treated or participated in burial rituals.
• Seek medical care immediately if you develop fever, headache, muscle pain, fatigue, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
• Tell your doctor about your recent travel and your symptoms before you go to the office or emergency room. Advance notice will help your doctor care for you and protect other people who may be in the office.

What do I do if I am traveling to an area where the outbreak is occurring?

If you are traveling to an area where the Ebola outbreak is occurring, protect yourself by doing the following:

• Wash your hands frequently or use an alcohol-based hand sanitizer.
• Avoid contact with blood and body fluids of any person, particularly someone who is sick.
• Do not handle items that may have come in contact with an infected person’s blood or body fluids.
• Do not touch the body of someone who has died from Ebola.
• Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.
• Avoid facilities in West Africa where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on facilities.
• Seek medical care immediately if you develop fever,  headache, muscle pain, fatigue, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
  • Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

Should people traveling to Africa be worried about the outbreak?

Ebola has been reported in multiple countries in West Africa (see Affected Countries). CDC has issued a Warning, Level 3 travel notice for United States citizens to avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has also issued an Alert, Level 2 travel notice for the Democratic Republic of the Congo (DRC). A small number of Ebola cases have been reported in the DRC, though current information indicates that this outbreak is not related to the ongoing Ebola outbreak in West Africa. You can find more information on these travel notices at http://wwwnc.cdc.gov/travel/notices.

CDC currently does not recommend that travelers avoid visiting other African countries. Although spread to other countries is possible, CDC is working with the governments of affected countries to control the outbreak. Ebola is a very low risk for most travelers – it is spread through direct contact with the blood or other body fluids of a sick person, so travelers can protect themselves by avoiding sick people and facilities in West Africa where patients with Ebola are being treated.

What does CDC’s Travel Alert Level 3 mean to U.S. travelers?

CDC recommends that U.S. residents avoid nonessential travel to Guinea, Liberia, and Sierra Leone. If you must travel (for example, to do 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 ill with Ebola. For more information about the travel alerts, see Travelers’ Health Ebola web page.

Travel notices are designed to inform travelers and clinicians about current health issues related to specific destinations. These issues may arise from disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect travelers’ health. A level 3 alert means that there is a high risk to travelers and that CDC advises that travelers avoid nonessential travel.

In the United States

Are there any other cases of people in the U.S. getting Ebola?

Two imported cases, including one death, and two locally acquired cases in healthcare workers have been reported in the United States. On September 30, 2014, CDC confirmed the first travel-associated case of Ebola (the index case) to be diagnosed in the United States in a man who had traveled from West Africa to Dallas, Texas, and later sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. That patient passed away of Ebola on October 8.

Two healthcare workers who had cared for the index patient at Texas Health Presbyterian tested positive for Ebola on October 10 and 15, respectively. Both of these healthcare workers have recovered and were discharged from the hospital.

On October 23, a medical aid worker who volunteered in Guinea, one of the three West African nations experiencing an Ebola epidemic, was hospitalized in New York City with Ebola. The diagnosis was confirmed by CDC on October 24. The patient is in isolation in a New York City hospital, and public health officials are investigating and conducting contact tracing.

CDC and public health officials in Texas, New York, and Ohio are working to identify people who have had close personal contact with these patients, and healthcare professionals have been reminded to use meticulous infection control at all times.

Is there a danger of Ebola spreading in the U.S.?

Ebola is not spread through casual contact; therefore, the risk of an outbreak in the U.S. is very low. We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

Why don't we restrict travel to the United States?

CDC does not recommend stopping travel from countries with Ebola outbreaks. Travel restrictions balance the public health risk to others, the rights of individuals, and the impact of the recommendations on the welfare of the countries with Ebola outbreaks. They are based on the least restrictive means necessary to protect the public's health. The key to controlling this epidemic is to focus on stopping the spread at its source, and international humanitarian assistance must continue.

Every day, CDC works closely with partners at U.S. international airports and other ports of entry to look for sick travelers with possible infectious diseases. CDC and Customs and Border Protection (CBP) are now conducting enhanced entry screening of travelers who have traveled from or through Guinea, Liberia, and Sierra Leone. By doing enhanced entry screening at five U.S. airports, over 94% of travelers from the affected countries will be evaluated.

Active post-arrival monitoring began on October 27 in six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed. Active post-arrival monitoring means that health officials maintain daily contact with all travelers from Guinea, Liberia and Sierra Leone for 21 days following their last date of exposure to Ebola. Post-arrival monitoring is an added safeguard that complements existing exit screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever.

On October 27, CDC released Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure to protect Americans from Ebola. This updated guidance focuses on strengthening monitoring of people potentially exposed to Ebola and for evaluating their intended travel, including the application of movement restrictions when indicated. This interim guidance has been updated by establishing a "low (but not zero) risk" category; adding a "no identifiable risk" category; modifying the recommended public health actions in the high, some, and low (but not zero) risk categories; and adding recommendations for specific groups and settings.

Through these changes, CDC and state and local health departments seek to support people who may have been exposed to Ebola, while also continuing to stop Ebola at its source in West Africa through the valor of our healthcare workers who serve. These changes will help ensure any symptoms they might develop are monitored and a system is in place to quickly recognize when they need to be routed to care. These actions will better protect potentially exposed individuals and the American public as a whole.

A fact sheet about the new interim guidance is available at: http://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html