Questions and Answers: 2014 Ebola Outbreak

General

How do I protect myself against Ebola?

If you must travel to an area affected by the 2014 Ebola outbreak:

• Avoid contact with the blood and body fluids (such as urine, feces, saliva, sweat, urine, vomit, breast milk, semen, and vaginal 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 have contact with the semen from a man who has recovered from Ebola (for example, avoid having oral, vaginal, or anal sex).
• Do not touch bats and nonhuman primates (apes and monkeys) 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 healthcare facilities that are suitable for your medical needs.

CDC has issued a Warning, Level 3 travel notice for U.S. residents to avoid nonessential travel to Guinea and Sierra Leone. CDC no longer recommends U.S. residents practice enhanced precautions when traveling to Liberia and has downgraded its travel notice to a Watch, Level 1 notice.  Although there is believed to be no risk of Ebola to travelers, travelers should, as usual, avoid contact with sick people, dead bodies, or blood and body fluids. For these travel notices and other information for travelers, visit the Travelers’ Health Ebola web page.

Has the first patient to become sick in this outbreak, known 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.

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.

Before the Ebola outbreak in West Africa, CDC had protocols in place to protect against spread of disease in the event that an ill traveler arrived in the United States. These protocols include having airline crew notify CDC of sick travelers on a plane before arrival, evaluation of sick travelers, and isolation and transport to a medical facility if needed. CDC, along with Customs and Border Protection, has also provided guidance to airlines for managing sick 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. In response to the Ebola outbreak in West Africa, CDC and Customs and Border Protection are working together to conduct enhanced entry screening at five U.S. airports. See the Screening and Monitoring Travelers to Prevent the Spread of Ebola fact sheet for more information.

Travelers

What is being done to prevent sick travelers from arriving in the United States?

In West Africa

CDC is working with airlines, airports, and ministries of health to provide technical assistance for the development and implementation of exit screening and travel restrictions in countries with widespread Ebola transmission and countries that previously had an Ebola outbreak. This includes:

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

Exit screening efforts in West Africa help identify travelers who are sick with Ebola or who have been exposed to Ebola, to prevent them from leaving a country until it is confirmed that they are not sick with Ebola and are therefore not at risk of spreading Ebola.

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 to 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.

What is being done for travelers arriving in the United States from Guinea and Sierra Leone?

Responding to Ill Travelers

CDC has staff working 24/7 at 18 Border Health field offices located in international airports and at land borders. These CDC staff are ready 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 (CBP), 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.

Enhanced Entry Screening

All air travelers arriving in the United States from Guinea and Sierra Leone are required to arrive to the United States at one of the airports where entry screening and risk assessments are being conducted by CBP and CDC (New York’s JFK International, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta).

For travelers arriving from Guinea and Sierra Leone, entry screening has three main objectives:

• To assess travelers’ potential exposure to Ebola and connect them to the state health department at their destination for appropriate monitoring for 21 days after leaving the country. This also helps protect the health of all Americans should a traveler develop Ebola after entering the country.
• To educate travelers and provide tools to help them monitor themselves for symptoms, and report to their health department for active monitoring or if they develop symptoms.
• To identify travelers who are ill upon arrival in the United States to assess whether they may be sick with Ebola, necessitating further medical evaluation before continuing their travel.

For travelers arriving from Liberia, CDC does not recommend enhanced entry screening and monitoring because of the very low risk of Ebola transmission and the very low risk of importation into the United States. Travelers arriving in the United States from Liberia are no longer being funneled through one of the U.S. airports that are conducting enhanced entry screening.

Post-Arrival Monitoring

CDC’s public health authorities are also conducting active post-arrival monitoring of travelers who have been in Guinea or Sierra Leone. Active post-arrival monitoring means that travelers from these countries will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. Additional public health actions may be recommended depending on travelers’ possible exposures to Ebola while in one of the two countries. Post-arrival monitoring helps to make sure a system is in place to quickly recognize when people who develop symptoms may need to be routed to medical care.

For more information, see the Screening and Monitoring Travelers to Prevent the Spread of Ebola fact sheet, CDC’s Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure, and related Questions and Answers.

CDC recommends that travelers from Liberia watch their health for fever or other symptoms of Ebola for 21 days after they leave Liberia. They should contact their state or local health department or seek healthcare if symptoms develop.  

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:

• Wash your hands frequently or use an alcohol-based hand sanitizer.
• Avoid contact with the blood and body fluids (such as urine, feces, saliva, sweat, urine, vomit, breast milk, semen, and vaginal 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 have contact with the semen from a man who has recovered from Ebola (for example, avoid having oral, vaginal, or anal sex).
• Do not touch bats and nonhuman primates (apes and monkeys) or their blood and fluids and do not touch or eat raw meat prepared from these animals.
• Do not eat or handle bushmeat (wild animals hunted for food).
• Avoid facilities in West Africa where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on healthcare facilities that are suitable for your medical needs.
• Report any potential unprotected Ebola exposure or illness promptly.
• Seek medical care immediately if you develop fever, fatigue, headache, muscle pain, 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 residents to avoid all nonessential travel to Guinea and Sierra Leone. CDC no longer recommends U.S. residents practice enhanced precautions when traveling to Liberia. Although there is believed to be no risk of Ebola to travelers, travelers should, as usual, avoid contact with sick people, dead bodies, or blood and body fluids. You can find more information on 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 infected blood or other body fluids, so travelers can protect themselves by avoiding sick people, body fluids, and facilities in West Africa where patients with Ebola are being treated.

What do CDC’s Travel Health Notices mean to U.S. travelers?

CDC recommends that U.S. residents avoid nonessential travel to Guinea and Sierra Leone. If you must travel (for example, for humanitarian aid work in response to the outbreak) protect yourself by following CDC’s advice for avoiding contact with blood and other body fluids. CDC no longer recommends U.S. residents practice enhanced precautions when traveling to Liberia, but does advise travelers to practice usual precautions such as avoiding contact with sick people, dead bodies, or blood and body fluids.

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 warning means that there is a high risk to travelers and that CDC advises that travelers avoid nonessential travel. A Level 1 watch means that travelers should follow usual precautions while in the country.

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 were previously 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 from 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 was hospitalized in New York City with Ebola. The diagnosis was confirmed by CDC on October 24. The patient has recovered and was discharged from Bellevue Hospital Center on November 11.

CDC and public health officials have worked to identify people who had close personal contact with these patients, and healthcare professionals have been reminded to use meticulous infection control at all times. To date, all contacts of the Ebola patients in the United States have completed the 21-day monitoring period.

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 or former 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.

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 conducting entry screening of travelers who have traveled from or through Guinea, Liberia, and Sierra Leone.

All states are conducting some form of active monitoring for travelers returning from Guinea and Sierra Leone, the two countries that still have Ebola outbreaks. Active post-arrival monitoring means that health officials maintain daily contact with all travelers from Guinea and Sierra Leone for 21 days following their last date of possible 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.

CDC has published Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure to protect Americans from Ebola. This 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.

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. Active post-arrival monitoring helps 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 are intended to protect potentially exposed individuals and the American public as a whole.

For more information, see CDC’s Q&As on the monitoring and movement guidance.