TOTALLY GEEKED!

The outbreak of Ebola Virus Disease (EVD) centred in Guinea, Liberia and Sierra Leone continues to worsen and has led to more than 4800 deaths. The outbreak in west Africa is the most serious outbreak of EVD in recorded history.

Initial cases or localised transmission have also occurred in Mali, the United States and Spain. A small number of cases were identified in Senegal and Nigeria in mid-2014, however the WHO has now declared that these outbreaks have ended. 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 to broken skin or mucous membranes with bodily fluids, including blood, faeces and sweat. Transmission can also occur through direct contact with the body of a deceased EVD patient.

While EVD is a very serious disease, it is not highly contagious to the general population. However, frontline healthcare workers face a higher risk of infection.

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 continue to 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. There have been violent incidents specifically targeting healthcare workers. 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.

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 feeling 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 and any other illnesses.

Limits to consular assistance: The Australian Government has 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 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

Travel restrictions are in place in many African countries as a result of the EVD outbreak. Authorities in a number of 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: 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. While Guinea has not closed its borders, a number of neighbouring countries have closed their borders to people leaving Guinea (see below). Only a small number of carriers are continuing to operate commercial flights.

Sierra Leone: A 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. While Sierra Leone has not closed its borders, a number of neighbouring countries have closed their borders to people leaving Sierra Leone (see below). 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 initial cases, localised transmission or contained outbreaks of EVD

Mali: On 23 October 2014, Mali confirmed its first case of the disease in Kayes, Western Mali. Health screening at airports and land border crossings has been increased.

Spain: On 6 October, Spain confirmed that a nurse responsible for caring for two patients with imported cases of EVD tested positive for the disease. Thorough contact tracing is underway.

United States of America: On 30 September, the US confirmed its first imported case of EVD, from a patient who had recently travelled from west Africa. Two healthcare workers caring for this patient and a third healthcare worker, recently returned from west Africa, have also tested positive for EVD. Thorough contact tracing is underway and health screening has been put in place at five major US airports for travellers arriving from Guinea, Sierra Leone and Liberia.

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.

Nigeria: A small number of cases of EVD, including eight deaths, were confirmed in Nigeria. The WHO has now declared that the outbreak in Nigeria is over. To prevent further imported cases, health screening measures for passengers arriving and departing are in place at all airports in Nigeria.

Senegal: One imported case of EVD was confirmed in Senegal in August 2014, however the WHO has now declared that the outbreak in Senegal is over. In an effort prevent further imported cases, authorities have 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.

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.

Chad: Chad has cancelled all incoming flights from or via countries affected by EVD, and from Nigeria and Ghana, as a precaution against the spread of the disease.

Cote d’Ivoire: Authorities have banned entry for any traveller who has been in an affected country in the previous three months (90 days).

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.

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

A number of 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.

Returning to Australia from Africa

The likelihood of an outbreak in 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.

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 will then alert border protection and biosecurity staff for follow-up health procedures.

Border agencies have been provided guidance by the Department of Health to identify any passengers presenting EVD symptoms in flights or at airports. Border officers can also provide information and advice to passengers who are feeling ill.

There are no additional compulsory screening or quarantine measures in place for travellers who have been in parts of Africa not affected by EVD.

Travellers who have been in EVD affected parts of west Africa and the DRC will have their health checked at Australian borders. Those identified as having been to an affected country are asked a series of questions by an Agriculture Biosecurity Officer to assess their risk of exposure to EVD.

If you have returned from an EVD affected country and you become ill while back in the community, you should go to the emergency department and let them know that you have been in west Africa, particularly if you know you have been in contact with someone with EVD.

Even if you feel well on your return to Australia from an affected country, you should still see your doctor to discuss whether it might be necessary for you to monitor your health, particularly if you may have had direct contact with someone with suspected or confirmed EVD.

You may also wish to check with the relevant health authorities in your state if any state-based restrictions apply.

For more information, visit the Department of Health website.

http://www.smartraveller.gov.au/zw-cgi/view/travelbulletins/Ebola