Health Vigilance Urged For China’s Spring Festival

Credit CDC

 

# 9626

 

In China, it is often called Chunyun, Chinese New Year, or simply, The Spring Festival.  In Korea it is called Seollal. While in Vietnam it is celebrated as Tết Nguyên Đán ; the Feast of the First Morning.  Tết for short.

 

By whatever name, the Lunar New Year is undoubtedly the most important holiday in all of Asia

 

Each year it inspires the largest migration of humans on the planet as hundreds of millions flee the big cities and return to their home towns for a few days to attend a reunion dinner with their families - preferably on the eve of the lunar New Year.

 

The entire Spring festival travel season begins about 2 weeks before the Lunar New Year, and runs for about 6 weeks. With the New Year falling on February 19th this year, we are 10 days from the start of an event which could see more than 3 billion passenger journeys – mostly by crowded train –  across Asia over the next 60 days.

 

Ducks, geese, and chickens figure prominently at many of these family dinners, and the live markets do tremendous business during this time of year.  Many cities are therefore reluctant to halt the trade in live birds until after the New Year.

 

As all of this occurs during the height of the regular flu season, and concurrent with China’s winter spike in avian flu cases, public health agencies are understandably alert to the possibility of seeing a post-holiday surge in illnesses, including influenza, measles, malaria, tuberculosis and food poisoning. 

 

In 2010, in The Impact Of Mass Gatherings & Travel On Flu Epidemics , we looked at a study  published in BMC Public Health, that looked at and attempted to quantify the impacts of mass gatherings and holiday travel on the spread of an influenza epidemic.

 

And in 2011, in Viruses With A Ticket To Ride, we looked at research that appeared in BMC Infectious Diseases, that looked at the incidence of ARI (Acute Respiratory Infection) presenting within 5 days of train or tram travel in the UK. They found that recent  bus  or  tram  use  within  five  days  of  symptom  onset  was  associated  with  an  almost  six-fold  increased  risk  of  consulting  for  ARI.

While seemingly a strong finding, this observational study was limited by its small size, the fact that it was only conducted in a single location (Nottingham, UK), and that it was conducted during a normal flu season, not a pandemic.

The good news is, that while mass gatherings may provide greater opportunities for disease outbreaks, history has shown that major epidemic outbreaks have been a rarity (for a notable exception, see The Impact Of Mass Gatherings & Travel On Flu Epidemics).

 

While the risks of seeing a major disease outbreak in any given year are small, public health authorities must anticipate and prepare for the worst.  A few days ago Taiwan’s CDC issued the following advisory for those intending to travel to mainland China.

 

Press Releases

As H7N9 outbreak escalates in China, Taiwan CDC reminds travelers visiting China to heighten vigilance for avian flu

( 2015-01-22 )

As the ongoing H7N9 outbreak in China escalates and the winter break and the Chinese New Year Holiday are fast approaching, the Taiwan Centers for Disease Control (Taiwan CDC) reminds travelers visiting China to heighten their vigilance for avian influenza and practice good personal hygiene and avoid contact with poultry and birds and consume only thoroughly cooked poultry and eggs in order to ward off infection.

In light of a significant increase in the number of H7N9 cases (29), which were confirmed in mostly Fujian Province and Guangdong Province, China, last week, Taiwan CDC has issued a travel notice of Level 2: Alert for avian influenza to Xinjiang Uyghur Autonomous Region, Jiangsu Province, Zhejiang Province, Guangdong Province, Fujian Province, Shanghai City, and Jiangxi Province, and a travel notice of Level 1: Watch for avian influenza to the other provinces and cities in China, excluding Hong Kong and Macau.

<SNIP>

Taiwan CDC once again urges travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask when coughing and take preventive measures such as avoiding direct contact with poultry and birds or their droppings/dead bodies, and consuming only thoroughly cooked poultry and eggs. If influenza-like illness symptoms develop upon arriving in Taiwan, please voluntarily notify the airline crew and the quarantine officer at the quarantine station in the airport. If symptoms such as fever and cough develop after returning to Taiwan, please put on a surgical mask and seek immediate medical attention.  Moreover, please inform the physician of the recent travel and exposure history to facilitate diagnosis and treatment. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).

 

And for some health and safety tips from America’s CDC, we have following from the CDC Travelers Health Website.

 

Lunar New Year 

Released: January 13, 2015

The Year of the Goat begins on February 19, 2015, and many travelers will visit Asia to celebrate the Lunar New Year. If you are traveling to Asia, plan ahead for a safe and healthy trip.

Every destination has unique health issues of which travelers need to be aware. To find specific information about the places you are traveling, visit our destination pages. In addition to being up-to-date on routine vaccines, you will find vaccine and medicine recommendations, along with many other tips for safe and healthy travel.

What can travelers do to protect themselves?

Before your trip:

• Schedule an appointment with your healthcare provider at least 4–6 weeks before you depart. Talk to your doctor or nurse about vaccines and medicines recommended for your destination. Travelers who want to reduce their risk of seasonal flu should receive the flu vaccine at least 2 weeks before departure. See the Travel Clinics webpage for help in finding a travel medicine clinic near you.
• Consider travel health and medical evacuation insurance.
• Pack a travel health kit.

During your trip:

• Choose safe transportation: Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries. Read about ways to prevent transportation injuries by visiting the Road Safety page.
• Reduce your exposure to germs: Wash your hands often, and avoid contact with people who are sick. Read more about reducing your exposure to germs in the “Stay Healthy and Safe” section of the destination page.
• Prevent mosquito bites: Diseases spread by mosquitoes, such as malaria, dengue, chikungunya, and Japanese encephalitis, are common throughout Asia. Read more about ways to prevent bug bites by visiting the Avoid Bug Bites page. You may also need to take prescription medicine to protect against malaria or get a vaccine against Japanese encephalitis. Talk to your doctor or nurse about prevention steps that are right for you and your destination.
• Follow food and water safety guidelines: Eating contaminated food and drinking contaminated water can cause illnesses such as hepatitis A, typhoid fever, and travelers’ diarrhea. Read about how to prevent these diseases by visiting the Safe Food and Water page on the Travelers’ Health website.
• Do not touch birds, pigs, or other animals, and avoid farms and poultry markets: Bird flu strains, such as H7N9 and H5N1, are flu viruses that have been seen in China.

• If you feel sick during your trip:
• Talk to a doctor or nurse if you feel seriously ill, especially if you have a fever.
• For more information about medical care abroad, see Getting Health Care Abroad.
• Avoid contact with other people while you are sick.

After your trip:

• If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic. Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.
• If your doctor prescribed antimalarial medicine for your trip, keep taking the rest of your pills after you return home. If you stop taking your medicine too soon, you could still get sick.
• Malaria is always a serious disease and may be deadly. If you become ill with a fever either while traveling in a malaria risk area or for up to 1 year after you return home, you should seek immediate medical attention and should tell the doctor about your travel history.
• For more information, see Getting Sick after Travel. 

 

While each year public health agencies gear up for the Hajj, The Lunar New Year, the Super Bowl, and other mass gathering events - and rarely does anything really bad happen - the old adage is true.

 

`When public health works, nothing happens’.

CDC Updates Ebola Travel Warnings

Credit http://wwwnc.cdc.gov/travel

 

# 9335

 

Although the number of Ebola cases in Mali remains small, unlike with their first introduction of the virus last month - local transmission has occurred and may still be occurring (see WHO Statement On 2nd Introduction Of Ebola Into Mali)- prompting the CDC to issue an updated travel Alert.

Level 3 Warnings remain in effect for Sierra Leone, Liberia, and Guinea, while a Level 2 Alert has been issued for Mali.    

I’ve only posted some excerpts from the Mali update. Follow the link to read it in its entirety. 

 

Ebola in Mali

 Alert - Level 2, Practice Enhanced Precautions

 Updated: November 16, 2014

The purpose of this alert is to notify travelers that a few Ebola cases have been reported in Bamako, Mali, and to inform travelers of actions they can take to reduce their risk of getting the disease.

CDC recommends that travelers to Mali protect themselves by avoiding contact with the blood and body fluids of people who are sick, because of the possibility they may be sick with Ebola. Although the current cluster of cases has been reported only in Bamako, travelers to all parts of Mali should be alert for reports of possible further spread within the country.

At a Glance

• Total Cases: 4
• Laboratory-Confirmed Cases: 3
• Total Deaths: 3

More

What is the current situation?

As of November 12, 2014, the World Health Organization reported a cluster of Ebola cases in Bamako, Mali (see box for case counts). The cluster in Bamako is linked to a man who had been in a clinic in Bamako after becoming sick in Guinea. Since that time, a small number of Ebola cases linked to this patient have been reported in Bamako. (An unrelated death from Ebola occurred in Kayes, Mali on October 24, 2014 and no additional cases related to that person have been reported.) The Malian government has taken actions to contain further spread of Ebola. CDC recommends that travelers to Mali avoid contact with the blood and body fluids of people who are sick and follow the other recommendations listed below, in order to protect themselves from Ebola.

The cases of Ebola in Bamako, Mali, are related to an ongoing Ebola outbreak that has been occurring since March 2014 in Guinea, Liberia, and Sierra Leone and is the largest outbreak of Ebola in history.

For more information about the ongoing outbreak in West Africa, visit 2014 Ebola Outbreak in West Africa on the CDC Ebola website.

<SNIP>

Returning to the United States

Entry Screening

The United States now requires all travelers to the United States whose trip starts in Guinea, Liberia, or Sierra Leone to enter through one of five US airports (JFK in New York, Newark in New Jersey, Dulles in Virginia near Washington D.C., Hartsfield-Jackson in Atlanta, and O’Hare in Chicago). Beginning November 17, 2014, air travelers to the United States whose trip starts in Mali will also be required to enter the United States through one of these five airports. These airports have enhanced entry screening, which helps identify travelers who may be sick with Ebola or may have had an exposure to Ebola and ensure that these travelers are connected with a health department and given medical care, if needed.

If you are traveling from Mali to the United States,

• You should be prepared for screeners to check your temperature and look for signs and symptoms of illness. You will also be asked to answer questions about possible exposures to someone with Ebola.
• You will be given a CARE (Check and Report Ebola) Kit with information about Ebola and tools to help you check your temperature and symptoms each day for 21 days.

Symptom Monitoring and Movement Restrictions

You will be connected to a health department in your final destination. Public health workers will assess your health and Ebola risk level to decide how best to monitor you for symptoms and what other restrictions may be needed.

• All returning travelers will be actively monitored, which means that public health workers are responsible for checking at least once a day to see if you have a fever or other Ebola symptoms. This will continue for 21 days after the last possible exposure (such as 21 days after leaving Mali).
• You will be asked to take your temperature 2 times a day and watch yourself for Ebola symptoms.
• A public health worker will tell you how to report your temperature and any symptoms each day. You might do this by phone, during a daily visit, or online.
• The public health worker will also tell you what to do if you have a fever (temperature of 100.4°F/38°C or above) or other symptoms (severe headache, fatigue [feeling very tired], muscle pain, vomiting, diarrhea, stomach pain, and unexplained bleeding or bruising).
  • If you have a fever or other symptoms, it is very important that you get medical care right away. Follow the directions the public health worker tells you. But if you cannot reach someone right away, you can contact your state health department or call CDC at 1-800-232-4636. If you have a medical emergency, call 911.
• Based on your level of possible exposure to Ebola, your travel and public activities may be limited.

(Continue . . .)

 

MSF Protocols For Volunteers Returning From Ebola Stricken Nations

MSF health staff in protective clothing constructing perimeter for isolation ward.

Credit CDC Ebola Webpage

 

# 9243

 

Even though we are just beginning to learn the details about New York City’s Ebola case – that of a Médecins Sans Frontières (MSF) volunteer doctor recently returned from Guinea – already the media are attempting to dissect his movements (see WPIX report NYC doctor rode subway before testing positive for Ebola at Bellevue) over the past couple of days.

 

While we can’t assume that every Ebola infected individual sheds virus on exactly the same timetable, the fact that Thomas Duncan’s family was exposed for several days before he was hospitalized – yet none developed the disease - suggests that Ebola cases are likely far less infectious early in their illness.

 

Nevertheless, the City of New York will have a huge job ahead doing contact tracing, monitoring, environmental cleanup, and public relations work as a result of this latest Ebola incident.  Some of these steps will be prudent or medically necessary, while others will be employed to reassure a jittery population.

While MSF volunteers treating Ebola cases are quite deservedly viewed as heroes, the societal and economic impact of dealing with this latest imported case will be substantial, and that will doubtless spark further debate over what restrictions should be in place for travelers arriving from Ebola hot zone countries.

Late yesterday MSF released the following statement regarding the protocols used by their staff during the 21 days after leaving Ebola affected nations.

 

MSF Protocols for Staff Returning from Ebola-Affected Countries

October 23, 2014

Since the beginning of its operations in West Africa in March to combat the Ebola outbreak, Doctors Without Borders/Médecins Sans Frontières (MSF) has put in place stringent protocols to protect its staff from exposure to the Ebola virus and to monitor the health of its returning staff.

MSF has specific guidelines and protocols for staff members returning from Ebola assignments.  These guidelines govern the 21-day incubation period of the virus (it can take up to 21 days to display symptoms of possible Ebola infection). A fever that develops during the 21-day period may also be due to something other than Ebola, such as the flu. A fever that develops after the 21-day-period is not due to Ebola. 

Until today, out of more than 700 expatriate staff deployed so far to West Africa, no MSF staff person has developed confirmed Ebola symptoms after returning to their home country. While some MSF staff members have been exposed in the field, those exposures were detected and the staff members were immediately isolated and treated. Two international staff members have been medically evacuated. They have fully recovered.

MSF pre-identifies health facilities in the United States that can assist and manage the care of our staff members in the event they develop symptoms after their return home. This pre-identification practice is carried out in coordination with the US Centers for Disease Control (CDC) and departments of health at state and local levels.

Upon returning to the United States, each MSF staff member goes through a thorough debriefing process, during which they are informed of our guidelines. 

The guidelines include the following instructions:

1.    Check temperature two times per day
2.    Finish regular course of malaria prophylaxis (malaria symptoms can mimic Ebola symptoms)
3.    Be aware of relevant symptoms, such as fever
4.    Stay within four hours of a hospital with isolation facilities
5.    Immediately contact the MSF-USA office if any relevant symptoms develop

These guidelines are consistent with those provided by the CDC to people returning from one of the Ebola-affected countries in West Africa. MSF is also implementing new federal guidelines outlining reporting requirements for people returning from Ebola affected countries.

Our colleague in New York followed the MSF protocols and guidelines since returning from West Africa. At the immediate detection of fever on the morning of October 23, 2014, he swiftly notified the MSF office in New York.  He did not leave his apartment until paramedics transported him safely to Bellevue Hospital in Manhattan, and he posed no public health threat prior to developing symptoms. 

While MSF is not in a position to comment on his medical condition or the care he is receiving, the organization sincerely wishes for his swift and complete recovery.  

Steps Doctors Without Borders takes to ensure the health and well being of its staff and the community at large:

If returned staff members do not live within four hours of appropriate medical facilities, MSF will ensure they are accommodated appropriately during the 21-day incubation period.

In the unlikely event that a staff person develops Ebola-like symptoms within the 21-day period, he/she is advised to immediately contact MSF and to refrain from traveling on public transportation. Local health authorities are immediately notified.

As long as a returned staff member does not experience any symptoms, normal life can proceed. Family, friends, and neighbors can be assured that a returned staff person who does not present symptoms is not contagious and does not put them at risk. Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.

However, returned staff members are discouraged from returning to work during the 21-day period.  Field assignments are extremely challenging and people need to regain energy.  In addition, people who return to work too quickly could catch a simple bacterial or viral infection (common cold, bronchitis, flu etc.) that may have symptoms similar to Ebola. This can create needless stress and anxiety for the person involved and his/her colleagues. For this reason, MSF continues to provide salaries to returned staff for the 21-day period.

CDC Statement On Post-Arrival Monitoring Of Travelers From Ebola Impacted Countries

 

 

# 9235

 

I wasn’t able to listen into today’s CDC press conference, but we have a short press release describing a new system – scheduled to go into effect next week – to actively monitor arrivals from Ebola affected nations for up to 21 days after they enter this country.

 

CDC Announces Active Post-Arrival Monitoring for Travelers from Impacted Countries

Travelers from Guinea, Liberia, and Sierra Leone will receive a CARE (Check And Report Ebola) kit when they arrive in the United States.

The Centers for Disease Control and Prevention (CDC) announced that public health authorities will begin 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. 

Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, have already taken steps to plan and implement active post-arrival monitoring which will begin on Monday, October 27.  Active post-arrival monitoring will begin in the remaining states in the days following.   CDC is providing assistance with active post-arrival monitoring to state and local health departments, including information on travelers arriving in their states, and upon request, technical support, consultation and funding.

Active post-arrival monitoring is an approach in which state and local health officials maintain daily contact with all travelers from the three affected countries for the entire 21 days following their last possible date of exposure to Ebola virus. Twenty-one days is the longest time it can take from the time a person is infected with Ebola until that person has symptoms of Ebola. 

Specifically, state and local authorities will require travelers to report the following information daily:  their temperature and the presence or absence of other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding; and their intent to travel in-state or out-of-state. In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.

In addition, travelers will receive a CARE (Check And Report Ebola) kit at the airport that contains a tracking log and pictorial description of symptoms, a thermometer, guidance for how to monitor with thermometer, a wallet card on who to contact if they have symptoms and that they can present to a health care provider, and a health advisory infographic on monitoring health for three weeks.

Active monitoring establishes daily contact between public health officials and travelers from the affected region. In the event a traveler begins to show symptoms, public health officials will implement an isolation and evaluation plan following appropriate protocols to limit exposure, and direct the individual to a local hospital that has been trained to receive potential Ebola patients.

Post arrival monitoring is an added safeguard that complements the existing exit screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever, Ebola symptoms, and contact with Ebola and enhanced screening protocols at the five U.S. airports that will now receive all travelers from the affected countries. All three of these nations have asked for, and continue to receive, CDC assistance implementing exit screening. 

CDC Ebola Travel Messaging: A Signage of The Times

 

# 9046

 

 

Last spring, when MERS-CoV began to spread aggressively across the Middle East, we saw some informational signs go up in International Airports (see MERS Advisories Go Up In Some US Airports) warning travelers about the risks, and what symptoms to watch for, with that emerging coronavirus.

Yesterday, as part of their Communication Resources for Use by International Partners, the CDC unveiled similar signage for the rapidly progressing Ebola epidemic in West Africa.

 

 

Travel Notices

• Warning - Avoid nonessential travel: Ebola in Liberia
• Warning - Avoid nonessential travel: Ebola in Guinea
• Warning - Avoid nonessential travel: Ebola in Sierra Leone
• Alert - Practice enhanced precautions: Ebola in Nigeria

UK Govt. Strongly Advises Against Travel To Sierra Leone, Liberia & Guinea

Source OCHA

 

# 9014

 

 

A change in the advice  by the UK’s Foreign Office today now advises against all but essential travel to the three primary Ebola-stricken nations, and warns that as conditions deteriorate and air service to the region diminishes, it may become increasingly difficult for people to leave.

 

 

Foreign Office Sierra Leone, Guinea and Liberia travel advice update

Published 28 August 2014

The UK has changed its travel advice to Sierra Leone, Guinea and Liberia. Foreign Office advises against all but essential travel to these countries.

The UK advises against all but essential travel to Sierra Leone, Guinea and Liberia due to the ongoing Ebola outbreak and the impact this is having on commercial flights and medical facilities. British Airways have suspended flights to Sierra Leone and Liberia until 31 December due to the deteriorating public health situation and some other airlines have also suspended flights to these countries.

If you are a British national in these countries, you should stay in contact with your employer or host organisation about the support that they can provide to you while you are in the country or should you wish to leave. You should be aware that the narrowing range of commercial flight options and growing restrictions on travel in the region may make it difficult to leave, particularly at short notice, and consider your own plans in this context.

Full travel advice to these countries can be found here.

 

The entry for Liberia reads (in part):

 

Due to the narrowing commercial options for flights and the impact on medical facilities, the FCO advise against all but essential travel to these countries, except for those involved in the direct response to the Ebola outbreak.

 

The CDC has issued strong travel warnings to the region as well, and updated their advice on August 26th.

Updated: August 26, 2014

CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola.

Warning Level 3, Avoid Nonessential Travel

• Updated Ebola in Sierra Leone Updated August 26, 2014 CDC urges all US residents to avoid nonessential travel to Sierra Leone, Guinea, and Liberia because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. Read More >>
• Updated Ebola in Liberia Updated August 26, 2014 CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. Read More >>
• Updated Ebola in Guinea Updated August 26, 2014 CDC urges all US residents to avoid nonessential travel to Guinea, Liberia, and Sierra Leone because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. Read More >>

Senegal Closes Border With Guinea Over Ebola Concerns

 

 

# 8984

 

In the wake of South African Cabinet Issues Ebola Related Travel Restrictions  yesterday, we’ve word overnight that Senegal – Guinea’s neighbor to the north – has closed their shared border and have imposed new controls over commerce and transportation between the two nations.

 

Senegal Shuts Border to Guinea Amid Ebola Spread

 (AFP, AP, dpa)

Senegal has closed its border with Guinea and imposed controls for boats and ships hailing from Ebola-hit countries Guinea, Sierra Leone and Liberia. South Africa has imposed similar measures for travelers.

The Interior Ministry in Dakar announced late on Thursday that it would seek to shut off access to Guinea, which borders the southeast of Senegal.

(Continue . .. )

Despite advice to the contrary from the World Health Organization, the hard hit nations of Guinea, Liberia, and Sierra Leone are increasingly being isolated by their neighbors – and by the international community – as they struggle contain this Ebola epidemic.  

 

Some airlines have either canceled, or announced plans to curb, service to the region making it difficult for relief efforts to get personnel or supplies in and out, and severely impacting the local economies.

This, despite consistent messaging from the WHO that air travel  - even to and from Ebola stricken nations – is considered low risk.

 

The WHO’s most recent statement on the issue of travel restrictions reads:

WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD.

 

Regardless of its scientific or humanitarian merit, this is a message that is having a hard time competing against the daily barrage of horrific images and reporting coming out of the Ebola affected regions.  

WHO Update – Travel & Transport In Relation To Ebola Outbreak

# 8966

 

Last week the World Health Organization –  after seeing a number of air carriers refusing to service African nations – began to push back against the idea that air travel to Ebola-affected countries presented a high risk of infection to passengers and crew (see WHO: Ebola Poses `Low-Risk’ To Air Travelers).

 

The WHO has also consistently argued against the need for, or effectiveness of, of border closings or travel restrictions to affected countries.

 

Today the WHO revisits the issue in a press release that also announces the formation of a Travel and Transport Task Force which will `monitor the situation and provide timely information to the travel and tourism sector as well as to travellers’.

 

Even though it is based on the best available scientific evidence - given the fearsome reputation of Ebola, and the constant hyping of the threat by the media – this is not going to be an easy message to get across.

 

The problem is, cancellation of flights and/or shipping and trade in and out of Africa not only severely impacts both African and the global economies, it can seriously hamper relief efforts as well.  

 

This statement was emailed to journalists, but a live link will likely be posted on this page  shortly.

 

WHO Ebola News
18 August 2014

Travel and Transport in Relation to Ebola Virus Disease (EVD) Outbreak

The current Ebola Virus Disease (EVD) outbreak is believed to have begun in Guinea in December 2013. This outbreak now involves community transmission in Guinea, Liberia and Sierra Leone and recently an ill traveller from Liberia infected a small number of people in Nigeria with whom he had direct contact.

On 8 August 2014, the World Health Organization (WHO) declared the Ebola virus disease outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) in accordance with the International Health Regulations (2005).

In order to support the global efforts to contain the spread of the disease and provide a coordinated international response for the travel and tourism sector, the heads of the World Health Organization (WHO), the International Civil Aviation Organization (ICAO), the World Tourism Organization (UNWTO), Airports Council International (ACI), International Air Transport Association (IATA) and the World Travel and Tourism Council (WTTC) decided to activate a Travel and Transport Task Force which will monitor the situation and provide timely information to the travel and tourism sector as well as to travellers.

The risk of transmission of Ebola virus disease during air travel is low. Unlike infections such as influenza or tuberculosis, Ebola is not spread by breathing air (and the airborne particles it contains) from an infected person. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animals, all unlikely exposures for the average traveller. Travellers are, in any event, advised to avoid all such contacts and routinely practice careful hygiene, like hand washing.

The risk of getting infected on an aircraft is also small as sick persons usually feel so unwell that they cannot travel and infection requires direct contact with the body fluids of the infected person.

Most infections in Liberia, Guinea and Sierra Leone, are taking place in the community when family members or friends take care of someone who is ill or when funeral preparation and burial ceremonies do not follow strict infection prevention and control measures.

A second important place where transmission can occur is in clinics and other health care settings, when health care workers, patients, and other persons have unprotected contact with a person who is infected. In Nigeria, cases are related only to persons who had direct contact with a single traveller who was hospitalized upon arrival in Lagos.

It is important to note that a person who is infected is only able to spread the virus to others after the infected person has started to have symptoms. A person usually has no symptoms for two to 21 days (the “incubation period”). Symptoms include fever, weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, and in some cases, bleeding.

The risk of a traveller becoming infected with the Ebola virus during a visit to the affected countries and developing disease after returning is very low, even if the visit includes travel to areas in which cases have been reported.

If a person, including a traveller, stayed in the areas where Ebola cases have been recently reported, he/she should seek medical attention at the first sign of illness (fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, red eyes, and in some cases, bleeding). Early treatment can improve prognosis.

Strengthened international cooperation is needed, and should support action to contain the virus, stop transmission to other countries and mitigate the effects in those affected.

Affected countries are requested to conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. Any person with an illness consistent with EVD should not be allowed to travel unless the travel is part of an appropriate medical evacuation. There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation.

Non-affected countries need to strengthen the capacity to detect and immediately contain new cases, while avoiding measures that will create unnecessary interference with international travel or trade.

The World Health Organization (WHO) does not recommend any ban on international travel or trade, in accordance with advice from the WHO Ebola Emergency Committee.

Travel restrictions and active screening of passengers on arrival at sea ports, airports or ground crossings in non-affected countries that do not share borders with affected countries are not currently recommended by WHO.

Worldwide, countries should provide their citizens traveling to Ebola-affected countries with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.

More information on Ebola outbreak in Western Africa:
http://www.who.int/csr/disease/ebola/en/

WHO media contacts:
Gregory Härtl
Telephone: +41 22 791 4458; Mobile: +41 79 203 6715; Email: hartlg@who.int
Fadéla Chaib
Telephone: + 41 22 791 3228;Mobile:+ 41 79 475 55 56; Email: chaibf@who.int

Nigerian MOH Reports 7 Cases Of Ebola, 2nd Death – CDC issues Travel Alert

 

 

# 8919

 

Based on multiple media reports (see here and here) the Nigerian government announced today the second death, and the treating of as many as 7 cases of Ebola in Lagos.  The first fatality was the index case – the Liberian who flew into Lagos on July 20th, falling ill on the flight.

 

The second fatality is reportedly a Nigerian nurse who treated him.

Yesterday is was reported that the second confirmed case in Nigeria was a doctor who attended the index case (see Nigeria Ebola doctor contracts the virus), and that eight people were in `quarantine’  while another 70 were being monitored.

 

Today, Health Minister Onyebuchi Chukwu is reported to have told reporters  - “Nigeria has now recorded 7 confirmed cases of Ebola Virus Disease (EVB)” – although I’ve not seen the words `lab confirmed’ used anywhere. 

 

So whether all of these are lab confirmed, probable, or merely suspected is still in doubt.

 

Of the roughly 1,600 cases reported to date in Guinea, Liberia, and Sierra Leone – it is worth noting that only just over 1,000 are lab confirmed – while another 600 are considered either probable or suspected. Testing, particularly in the early stages of the disease, isn’t always reliable.

 

Meanwhile, the CDC issued an  Alert - Level 2, Practice Enhanced Precautions yesterday, based on 1 confirmed and 3 suspected cases in that country.

British Airways Suspends Flights To Two Ebola Stricken Nations

Credit CDC Ebola Website

 

# 8917

 

In addition to the immense public health ramifications, the Ebola outbreak in Western Africa also carries with it serious economic, and logistical impacts as well. 

 

Today, British Airlines announced the suspension of all flights to and from Liberia and Sierra Leone are canceled for the remainder of August.

 

This announcement was posted a short time ago on the BA website.

 

Flights to/from Liberia and Sierra Leone suspended

Answer Id 5072   |    Updated 05/08/2014 05.08 PM (UK time)

Summary

British Airways has temporarily suspended flights to and from Liberia and Sierra Leone until 31 August 2014 due to the deteriorating public health situation in both countries.

More information

The safety of our customers, crew and ground teams is always our top priority and we will keep the routes under constant review in the coming weeks.

What to do if your flight has been cancelled

If your flight has been cancelled, please do not travel to the airport.

We have a policy in place outlining the options available to you and how to make changes to your booking.

> Re-booking options if your flight has been cancelled

In addition we have made the following options available to you up to the 31 August 2014:

A rebooking to a later date on a British Airways flight to/from Liberia or Sierra Leone from 1 September 2014.

A rebooking with British Airways on its flights in August between London and Abuja, Lagos, Accra or Nairobi. The journey between Liberia or Sierra Leone to/from these four African cities will be at the customer's own expense.

We are also speaking with other carriers to discuss other options which may be available for customers.

(Continue. . . )

 

CDC: U.S. Issues Travel Warning To West African Nations With Ebola

 

# 8899

 

Although the CDC updated their Ebola travel advisories (Alert Level 2, Practice Enhanced Precautions) to Guinea, Sierra Leone and Liberia on Monday – today CDC Director Thomas Frieden announced an escalation to a Warning Level 3, Avoid Nonessential Travel – during a press conference.

 

While exposure to Ebola is a concern in these countries, the degradation of overall medical services in the region due to the Ebola outbreak was also cited as a reason for the decision to raise the alert level.

 

As of this posting, this travel warning has not been posted on the CDC’s Travel Health Notices website.

UPDATED 1415 hrs:

 

In describing the situation, Director Frieden stated that Ebola is worsening in Western Africa, and there are no quick or easy solutions, given the challenges in the region.  This outbreak is likely to continue for months to come, and the CDC is preparing to send 50 EIS (Epidemic Intelligence Service) officers to the region in the next month.

While the CDC is preparing for the possibility that an infected individual might arrive in this country via air travel (see CDC Teleconference & HAN Notice On Ebola), they also reassure that any significant spread in this country is unlikely due to its limited transmissibility, and our public health infrastructure.

 

Dr Frieden ended by stressing three key points (paraphrased).

 

• Ebola is worsening in West Africa.  It is the largest and most complex outbreak known to date. 
• CDC is surging their response in West Africa, and while it won’t be quick ot easy, they know what it takes to stop Ebola.  It will nr a marathon, not a sprint, and it will take 3 to 6 months . . . assuming things go right.
• We have strong systems in place to detect, isolate, and treat Ebola cases should they show up in the United States.

 

The CDC will likely have a transcript, and audio recording, from today’s teleconference posted on this website later today. 

CDC Updated Traveler’s Advisory On MERS

Credit CDC

 

# 8652

 

Eight days ago, in MERS Advisories Go Up In Some US Airports, we looked at a traveler’s awareness campaign for those going to, or returning from, the Arabian peninsula on the dangers of MERS. At the time, I mentioned my surprise that there was no mention of avoiding camels, or camel products, in the CDC’s Traveler’s Advisory or in this newly released airport signage. 

 

Although the exact mode of transmission to humans remains uncertain, many Arabian camels have been found to carry the MERS Coronavirus (see here, here, & here) and camel exposure has been linked to at least some human infections. 

Consequently, many health agencies (including Hong Kong’s CHP, Canada’s PHAC, and the World Health Organization) have issued warning’s advising people to avoid contact with camels, and camel products in the Middle East.

This week the CDC has updated their MERS travel advisory, and it now includes information on camels, and the potential (but unquantified) risks from camel exposure.

 

 

MERS in the Arabian Peninsula

Alert - Level 2, Practice Enhanced Precautions

Updated: May 21, 2014

What is the Current Situation?

Cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula.* There have also been cases in several other countries in travelers who have been to the Arabian Peninsula and, in some instances, their close contacts. Two cases have been confirmed in two health care workers living in Saudi Arabia who were visiting the United States. For more information, see CDC’s MERS website.

CDC does not recommend that travelers change their plans because of MERS. Most instances of person-to-person spread have occurred in health care workers and other close contacts (such as family members and caregivers) of people sick with MERS. If you are concerned about MERS, you should discuss your travel plans with your doctor.

<SNIP>

Exposure to camels

The MERS virus has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with the virus—many people with MERS have had close contact with a person sick with MERS.

The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products. For more information, see http://www.who.int/csr/disease/coronavirus_infections/faq/en/.

The World Health Organization considers certain groups to be at high risk for severe MERS; these groups include people with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems. The World Health Organization recommends that these groups take additional precautions:

• Avoid contact with camels.
• Do not drink raw camel milk or raw camel urine.
• Do not eat undercooked meat, particularly camel meat.

For more information, see http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_09_May_2014.pdf (recommendations begin on page 8).

(Continue . . . .)

 

MERS Advisories Go Up In Some US Airports

Credit CDC – WFAA TV News

 

 

# 8619

 

With the second imported case of MERS in two weeks making headlines, it isn’t surprising that the CDC has recently upgraded their Traveler’s Alert level for the Middle East to countries in or near the Arabian Peninsula (see map below) and have posted notices in more than 20 major airports around the country.

 

Credit CDC

 

 

Curiously, there is no mention of avoiding camels, or camel products, in the CDC’s Traveler’s Advisory or in this newly released airport signage. 

 

Although the exact mode of transmission to humans remains uncertain, many Arabian camels have been found to carry the MERS Coronavirus (see here, here, & here) and camel exposure has been linked to at least some human infections.  

 

Canada’s PHAC MERS Middle East Traveler’s advice includes:

• Avoid close contact with all wild or farmed animals, such as bats and camels.

  • If you have chronic medical conditions, your risk may be higher.
  • If you must visit a farm, make sure you practise good hygiene and wash your hands before and after contact with animals.

Hong Kong’s CHP routinely advises traveler’s to the Middle East:

* Avoid going to farms, barns or markets with camels;
* Avoid contact with animals (especially camels), birds, poultry or sick people during travel;

 

Although a bit less restrictive, the  World Health Organization has this to say in their MERS FAQ regarding the risks of camel exposure:

Until more is understood about MERS, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid contact with camels, drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

 

And lastly, the Saudi Ministry of Agriculture – which has long protested any connection between camel exposure and MERS, issued strict precautionary measures last Sunday (see Saudi Ministry Of Agriculture Issues Warnings On Camels), which includes reducing exposure to camels, and the wearing of PPEs (masks, gloves) when in close contact with them.

 

The Agriculture Minister said in the press release posted on a number of health measures that Must be adhered to, Including: NOT to approach direct from camel than it needed with the necessary health precautions and wear protective respiratory masks When dealing with camels, and the need to wash hands with soap Before and after touching the camels, we recommend wearing protective gloves , especially in Cases of Cases of birth and dealing with diseased or dead.

 

All of which makes the absence of any mention of camels in the CDC’s advice a bit surprising.

 

 

CDC Travel Advisory – MERS In The Arabian Peninsula

 

 

# 8563

With the discovery this week of the first imported case of MERS into the United States (see CDC Briefing On MERS In US: Audio & Transcript), the CDC has updated their travel advice to the Middle East, and are advising international travelers to observe and practice enhanced precautions when in the region.

 

An `Alert’ is a second tier notice, above `Watch’ but below `Warning’.   Travel notices are published the CDC’s Traveler’s Health Website.

 

The CDC considers countries in the Arabian Peninsula and surrounding areas to include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

 

 

MERS in the Arabian Peninsula

Updated: May 02, 2014

What is the Current Situation?

Cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula. There have also been cases in several other countries in travelers who have been to the Arabian Peninsula and, in some instances, their close contacts. One case has been confirmed in the United States in a traveler who had recently been to Saudi Arabia. For more information, see CDC’s MERS website.

If you are traveling to countries in or near the Arabian Peninsula,* CDC recommends that you pay attention to your health during and after your trip. You should see a doctor right away if you develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula. Tell the doctor about your recent travel.

CDC does not recommend that travelers change their plans because of MERS. Most instances of person-to-person spread have occurred in health care workers and other close contacts (such as family members and caregivers) of people sick with MERS. If you are concerned about MERS, you should discuss your travel plans with your doctor.

Special advice for people traveling to the Arabian Peninsula to work in health care settings

If you are traveling to provide health care services in the Arabian Peninsula, please review CDC’s recommendations for infection control of confirmed or suspected MERS cases. CDC recommends that you practice these precautions and monitor your health closely.

What is MERS?

MERS is caused by a coronavirus known as MERS-CoV; coronaviruses cause a variety of illnesses, from the common cold to SARS (severe acute respiratory syndrome), which caused a global epidemic in 2003. MERS-CoV is different from any other coronavirus that has been previously found in people. Symptoms of MERS have included fever, cough, and shortness of breath. CDC is working with the World Health Organization and other partners to understand the public health risks from this virus.

What can travelers do to prevent MERS?

People traveling to provide health care services in the Arabian Peninsula should review CDC’s recommendations for infection control of confirmed or suspected MERS cases.

All travelers can take these everyday actions to help prevent the spread of germs and protect against colds, flu, and other illnesses:

• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth. Germs spread this way.
• Avoid close contact with sick people.
• Be sure you are up-to-date with all of your shots, and if possible, see your health care provider at least 4–6 weeks before travel to get any additional shots.
• Visit CDC’s Travelers’ Health website for more information on healthy travel.
• If you are sick:
  • Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash.
  • Avoid contact with other people to keep from infecting them.
  • See a doctor if you develop a fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula.* You should tell the doctor about your recent travel.

(Continue . . . )

This advisory also contains information for clinicians who may encounter patients with respiratory symptoms with a travel history (within 14 days) from the Arabian peninsula, and an assortment of useful links.

CDC Travel Alert: Ebola In Guinea

Photo Credit - CDC

 

 

# 8406

Although the risks to travelers to Guinea are considered to be low, and the World Health Organization does not recommended any travel or trade restrictions to the region, it is still advisable that visitors to Guinea be aware of their Ebola Hemorrhagic Fever outbreak and take basic precautions to avoid infection. 

 

To that end,  the CDC released the following Travel Notice (Alert - Level 2, Practice Enhanced Precautions) yesterday for those planning to visit the affected west African region.

 

Despite its infamous reputation for contagiousness and virulence, Ebola outbreaks over the past 40 years have been generally short-lived and limited geographically. Unfortunately, this week we’ve seen some media attempts to portray Ebola as potentially becoming an `airborne’ virus.

 

First the CDC’s Travel Notice, then I’ll return with a little more on what we know about the transmissibility of the virus.

 

 

Ebola in Guinea

Alert - Level 2, Practice Enhanced Precautions

Released: March 26, 2014

What is the current situation?

According to the Ministry of Health of Guinea, as of March 24, 2014, 6 cases of Ebola have been confirmed in Guékédou Prefecture. Suspected cases of Ebola, including some deaths, have been reported but not yet confirmed in Guékédou, Kissidougou, Macenta, and Nzérékoré prefectures. Suspected cases in border areas of Liberia and Sierra Leone are being investigated.

CDC recommends that travelers to these areas avoid contact with blood and body fluids of infected people to protect themselves.

What is Ebola?

Ebola hemorrhagic fever is a rare and deadly disease. The disease is native to several African countries and is caused by the Ebola virus. It is spread by direct contact with blood or body fluids of a person infected with Ebola virus. It is also spread by contact with contaminated objects or infected animals.

Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

Who is at risk?

Cases of Ebola are seen sporadically throughout Africa. The risk to most travelers is low, but travelers could be infected if they come into contact with an infected person’s blood or body fluids. Health care workers and family and friends of an infected person are at highest risk.

What can travelers do to prevent Ebola?

There is no vaccine for Ebola and no specific treatment. Although travelers are at low risk for the disease, it is important to take steps to prevent Ebola.

• Practice careful hygiene. Avoid contact with blood and body fluids of infected people. Do not handle items that may have come in contact with an infected person’s blood or body fluids.
• Avoid contact with animals. 
• Seek medical care if you develop fever, headache, achiness, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.
• Health care workers who may be exposed to people with the disease should follow these steps:
  • Wear protective clothing, including masks, gloves, gowns, and eye protection.
  • Practice proper infection control and sterilization measures. For more information, see “Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting.”
  • Isolate Ebola patients from unprotected people.
  • Avoid direct contact with the bodies of people who died from Ebola.

Traveler Information

• Ebola Hemorrhagic Fever

Clinician Information

• Ebola Hemorrhagic Fever
• Viral Hemorrhagic Fevers

Information for Airline Personnel

• Interim Guidance about Ebola Virus Infection for Airline Flight Crews, Cargo and Cleaning Personnel, and Personnel Interacting with Arriving Passengers

 

Earlier this week a European media outlet suggested that Ebola and Influenza could somehow `marry’, and create an airborne plague, a notion that Gregory Hartl – spokesperson for the World Health Organization – quickly dispelled.

 

While the idea that influenza and Ebola – viruses from two very different taxonomic families- could reassort (marry) and produce some kind of airborne `Flubola’  lacks scientific credence, it is not beyond the realm of possibility that one of the Ebola viruses could someday mutate into a more transmissible form.

 

Viruses are extremely adaptable, and one learns never to say `never’ when it comes to viruses. But to date, we’ve haven’t seen any evidence of human-to-human airborne transmission of the Ebolavirus.

 

Some of this media speculation may be due to a study that appeared in Scientific Reports in 2012,  which I wrote about at some length in When Viruses Jump Cages.

 

Researchers placed four macaques in a wire cage inside a pig pen where pigs, infected with Ebola-Zaire, were kept. Although sharing common living space, they were separated by the wire cage. Yet, after 2 weeks of shared confinement, all four macaques had contracted the virus.

 

Transmission of Ebola virus from pigs to non-human primates

Hana M. Weingartl,Carissa Embury-Hyatt,Charles Nfon,Anders Leung,Greg Smith& Gary Kobinger

Article number: 811 doi:10.1038/srep00811

Abstract (Excerpt)

Here we show ZEBOV transmission from pigs to cynomolgus macaques without direct contact. Interestingly, transmission between macaques in similar housing conditions was never observed. Piglets inoculated oro-nasally with ZEBOV were transferred to the room housing macaques in an open inaccessible cage system. All macaques became infected. Infectious virus was detected in oro-nasal swabs of piglets, and in blood, swabs, and tissues of macaques. This is the first report of experimental interspecies virus transmission, with the macaques also used as a human surrogate. Our finding may influence prevention and control measures during EBOV outbreaks.

 

While suggestive of a possible airborne transmission of the the Ebola virus (by pigs), it should be noted that infected macaques did not pass the virus on to other macaques in similar experiments. 

 

Additionally, this pig-to-macaque transmission occurred in an artificial laboratory setting, with prolonged-close, but-not-direct-contact, and doesn’t necessarily represent how things happen in the `real world’.

 

The researchers speculated that:

 

. . .  transmission of ZEBOV could have occurred either by inhalation (of aerosol or larger droplets), and/or droplet inoculation of eyes and mucosal surfaces and/or by fomites due to droplets generated during the cleaning of the room. Infection of all four macaques in an environment, preventing direct contact between the two species and between the macaques themselves, supports the concept of airborne transmission.

 

This is, of course, a far cry from demonstrating human-to-human airborne transmission of Ebola, but it ought to give one pause before kissing a pig during an Ebola outbreak.

 

The researchers conclude by stating (reparagraphed for readability):

 

The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting.

Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

The present experimental findings would explain REBOV seropositivity of pig farmers in Philippines that were not involved in slaughtering or had no known contact with contaminated pig tissues.

The results of this study also raise a possibility that wild or domestic pigs may be a natural (non-reservoir) host for EBOV participating in the EBOV transmission to other species in sub-Saharan Africa.

 

The Ebola-Reston virus (REBOV) mentioned above is a cousin to Ebola Zaïre, but this Asian strain has never been shown to cause disease in humans. It can be fatal in simians, however. We first  looked at the discovery of REBOV in pigs, and its possible implications,  back in 2008 in When Viruses Jump Species.

 

All of which is fascinating, but doesn’t alter that fact that for now, the risks of Ebola spreading beyond localized and limited outbreaks in Africa, remains pretty low.