Monday, March 24, 2014

Ebola In Guinea: ECDC Rapid Risk Assessment




# 8398



In short order the ECDC has published a 7-page Rapid Risk Assessment on the Ebola outbreak in the west African nation of Guinea, that provides background information on Ebola in Africa, an update on this current outbreak,  and provides an assessment of the risks to the EU, and to various groups residing in or traveling to or from Guinea.


The bottom line is, while it is conceivable that an international visitor to Guinea might be exposed and infected, those risks are considered pretty low.



I’ve excerpted a few sections, but follow the link to read it in its entirety.


Rapid risk assessment: Outbreak of Ebola haemorrhagic fever in Guinea

Main conclusions and recommendations

An outbreak of Ebola haemorrhagic fever is currently ongoing in Guinea. Eighty cases were reported, including 59 deaths. This is the first such outbreak in Guinea.

As of 23 March 2014, the situation in Sierra Leone is also under investigation, as there are concerns about the disease’s spread in the districts which border affected prefectures in Guinea.

As the incubation period can be up to three weeks, it is likely that the Guinean health authorities will identify  additional cases in the coming week. Additional cases could be identified in neighbouring regions. However, control measures, such as isolation of cases and active monitoring of contacts, currently implemented in Guinea with the support of international partners, should be able to control this outbreak and prevent further spread of the disease.

It is unlikely, but not impossible, that travellers infected in Guinea could arrive in the EU while incubating the disease and develop symptoms while in the EU. These cases should immediately seek and receive medical  attention and be isolated to prevent further transmission. Returning visitors from tropical countries that develop infectious disease symptoms such as fever, headache, diarrhoea or general malaise within three weeks after  return should always seek rapid medical attention and mention their recent travel to the attending physician.

EU citizens in Guinea are not at risk of becoming infected unless they are in direct contact with body fluids of  dead or living infected persons or animals. Avoiding such contact would effectively mitigate this risk. The risk related to seeking medical care in Guinea depends on the implementation of precautionary measures in those settings.


ECDC threat assessment for the EU  

Risk for the EU

The EU’s capacity to detect and confirm an infection with Ebola viruses is sufficient. The risk of patients developing symptoms of Ebola haemorrhagic fever in the EU can be assessed as follows.

WHO does not recommend that any travel or trade restrictions be applied to Guinea.

Tourists returning from Guinea

Non-stop international destinations from Conakry International Airport to the EU are Paris and Brussels. However, other EU destinations can be accessed through a Royal Air Maroc hub in Casablanca, which offers connections to Paris, Nice, Lyon, Marseille, Toulouse, Barcelona, and Milan. Other non-stop destinations from Conakry include Senegal, Côte d’Ivoire, Mali, The Gambia, Mauritania, and Guinea-Bissau [29].

The risk of tourists becoming infected after a stay in Guinea and developing symptoms while in the EU is extremely low, even if they visited affected prefectures, because transmission can only occur in the context of direct contact with blood, secretions, organs or other body fluids of dead or living infected persons or animals. 

Visiting families and friends

The risk for travellers visiting friends and relatives in Guinea is similarly low, unless the travellers have been in close physical contact with sick or dead persons or animals. In such a case, active contact tracing would identify the exposure and prevent further spread of the disease through active contact monitoring.

Exposed persons seeking medical attention in the EU

There is the possibility that persons suspecting exposure might seek medical attention in the EU while potentially incubating the disease, for example EU volunteers who worked in healthcare settings in the affected districts.

These persons are likely to seek immediate medical attention and should be taken care of immediately if they develop any symptoms in order to prevent any further spread of the disease.

Patients presenting with symptoms and seeking medical attention in the EU There is a remote possibility that persons who were exposed to Ebolavirus and developed symptoms would board a commercial flight to seek medical attention in the EU. It is highly likely that such patients would seek immediate medical attention upon arrival in the EU and then be isolated to prevent further transmission. In a guidance document, ECDC pointed out the very low risk to co-passengers on the same flight [30].

Laboratory samples shipped to EU laboratories

There is a theoretical risk that an improperly labelled biological sample is sent to an EU laboratory for further testing, without proper indication of a possible connection to an Ebolavirus infection. However, compliance with sample shipment regulations and universal precautions in the receiving laboratory should mitigate this risk [31].

Aircraft passengers exposed to an Ebola case during a flight

Guidelines for tracing contacts of Ebola or Marburg haemorrhagic fever cases on airplanes have been developed by ECDC [9]. As transmission can only occur in the context of direct contact with blood, secretions, organs or other body fluids of dead or living infected persons or animals, most airplane contacts pose a low to moderate risk of exposure. However, due to the high pathogenicity of Ebola and an expected high susceptibility in airplane passengers, contact tracing should be considered when a potentially infectious, laboratory-confirmed index case of Ebola fever was on board a flight within the last 26 days (longest incubation period 21 days plus five days due to possible non-specific symptoms during the first five days).

Contact tracing should always be initiated if an index case has been symptomatic on board or was flying within four days before the onset of symptoms. Contact tracing should be considered for the entire cabin and crew.

Risk for EU residents in Guinea

The risk for EU residents in Guinea can be considered as very low, unless they are directly exposed to body fluids of dead or living infected persons or animals. Avoiding such contact is an appropriate precautionary measure in this context. The risk of acquiring the disease through exposure to contaminated fluids or equipment in healthcare settings in Guinea depends on the implementation of precautionary measures in those settings, e.g. isolation of cases, universal infection control measures. 

There is a specific risk for healthcare workers and volunteers, especially if involved in caring for Ebola haemorrhagic fever patients. However, the level of precaution taken in such settings should effectively prevent the transmission of the disease.

There is a risk of transmission through unprotected sexual contact with a patient that has recently recovered from the disease. 



For more background on this outbreak, see my earlier blogs WHO Twitter Messaging On Ebola & A Brief History Of Ebola for background), and for continually updated news coverage check in with FluTrackers and Crofsblog often.