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Advice for Humanitarian Aid Workers Traveling to Guinea, Liberia, or Sierra Leone during the Ebola Outbreak

Current Situation

An outbreak of Ebola has been ongoing in West Africa since March 2014. This outbreak is affecting Guinea, Liberia, and Sierra Leone and is the largest outbreak of Ebola in history. The situation in West Africa is changing rapidly, and other countries might experience imported cases or outbreaks. Instances of civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health systems in the affected countries are being severely strained as the outbreak grows.

CDC is recommending that US residents avoid nonessential travel to Guinea, Liberia, and Sierra Leone because of widespread outbreaks. CDC is closely monitoring the situation in West Africa and will update travel recommendations as needed.

Since it is important that humanitarian aid work continue in the region, protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of people who are sick with Ebola. For more information, visit 2014 Ebola Outbreak in West Africa on the CDC Ebola website.

Recommendations for Humanitarian Aid Workers

If you are traveling to areas where outbreaks of Ebola are occurring, CDC recommends that you take precautions to protect your health and safety.

Before You Leave

  • Learn about Ebola. For information, see CDC's Ebola website.
  • Schedule a visit with a travel medicine provider, ideally 4–6 weeks before you leave, to discuss recommendations for you based on your health history and your travel plans. Even if you are leaving sooner, a visit to a travel medicine doctor is still helpful. Your provider should ensure that you are up-to-date on routine vaccines, as well as provide any other vaccines, medicines, and information you may need for your destination.
  • Pack needed medical supplies and basic first aid items.
  • Check your health insurance plan and any insurance benefits offered by your organization to ensure you are covered for healthcare abroad in the event of illness. Ask your organization about their medical evacuation plans. CDC recommends you purchase travel health insurance and medical evacuation insurance if you are not fully covered by your personal health insurance or organization-issued plans.
    • Information about medical evacuation services can be found on the US Department of State’s Air Ambulance/MedEvac/Medical Escort Providers page.
      • Some insurance providers are excluding medical evacuation coverage for people who have Ebola. Check with providers to ensure you have the coverage you need.
      • Be sure to check the coverage limits for evacuation insurance. Also check to see if the policy covers evacuation to the United States or to the nearest location where adequate medical care is offered.
  • Work with your organization to ensure a plan is in place to bring you back to the United States if you are exposed to Ebola but do not have symptoms.
    • Because we are facing the biggest and most complex Ebola outbreak in history, travel restrictions have been established that may affect you. See Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure to learn more about traveling if you have been exposed to Ebola.
    • Due to the expense of charter flights, your organization might want to coordinate with other aid organizations to provide charter flights for employees and volunteers who cannot travel on commercial flights.
  • Healthcare resources in affected countries may be limited or not available. Before you leave, identify places you can get health care during your trip. The US embassy in the country you are going to can help you locate medical services.
  • Register with the US embassy in your destination country through the US Department of State’s Smart Traveler Enrollment Program (STEP).

During Your Trip

TRAVELING: General Travel Health Recommendations

Protect your health and safety during your trip by following CDC’s recommended health behaviors. Learn more by going to the “Stay Healthy and Safe” section of the Destination page for the country where you are traveling and the Humanitarian Aid Workers page.

General Recommendations for Preventing Ebola

Ebola is spread through direct, unprotected contact with the blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of an infected symptomatic person, contact with the body of someone who has died from Ebola, and exposure to objects (such as needles) that have been contaminated with infected blood or other body fluids and tissues.

How can I be exposed to Ebola?

You can be exposed to the Ebola virus if you have contact with blood or body fluids (such as urine, saliva, sweat, feces, vomit, and semen) of a person sick with Ebola without wearing the right protective clothing. This includes wearing a mask over your mouth and nose, waterproof gloves, a gown (to protect clothing), and eye protection (goggles or a face shield – corrective eye glasses are not enough).

This kind of exposure can happen if you —

  • Are stuck with a needle or splashed in the eye, nose, or mouth with blood or body fluids of someone sick with Ebola.
  • Handle blood or body fluids of a sick Ebola patient.
  • Touch a person who is sick with Ebola.
  • Touch the body of someone who died in a country where Ebola outbreaks are occurring.
  • Care for or live with a person who is sick with Ebola.
  • Spend a long amount of time within three feet (one meter) of a person who is sick with Ebola.

There is no vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.

  • Practice careful hygiene. For example, wash your hands with soap and water or use an alcohol-based hand sanitizer.
  • Avoid contact with blood and body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of people who have Ebola.
  • Do not handle items that may have come in contact with an infected person’s blood or body fluids.
  • Avoid direct contact with the body of someone who has died from Ebola, including participating in funeral and burial rituals.
  • Avoid contact with animals (such as monkeys or bats) or with raw or undercooked meat.
  • Do not eat or handle bushmeat (wild animals hunted for food).
  • Avoid hospitals in West Africa where Ebola patients are being treated.
  • Report any potential unprotected Ebola exposure or illness promptly following your organization's reporting procedures.
Special Health Care Worker Recommendations for Preventing Ebola

If you will be working in healthcare settings, you should be prepared to care for patients in a region where resources are scarce and the healthcare system is strained. Refer to the World Health Organization's (WHO) Infection Prevention and Control Guidance for Care of Patients in Health Care Settings, with Focus on Ebola, even if you do not plan to work directly with Ebola patients.

Although not a full list of precautions, humanitarian aid workers traveling to West Africa to work in a healthcare setting may be exposed to people with Ebola and should be sure to follow these steps:

  • Wear the right personal protective equipment, including but not limited to masks, gloves, gowns, and eye protection, when entering patient care areas.
  • Use proper infection prevention and control measures.
    • Follow cleaning and disinfection recommendations of reusable medical equipment, proper disposal of needles and other disposable equipment, and proper disposal of patient excretions.
    • Wash your hands often, using soap and water (or use alcohol-based hand sanitizers when soap and water are not available) to remove potentially infectious materials from your skin and help prevent disease transmission.
    • Do not reuse gloves; instead dispose of them according to recommended infection control precautions. After disposing of the gloves, wash your hands.
  • Learn the signs and symptoms of Ebola and develop a triage system so Ebola patients can be identified and properly handled.
  • Avoid direct, unprotected contact with the bodies of people who have died from Ebola.
  • Immediately notify your organization and the US embassy or consulate in the country if you think you have been exposed to Ebola.
Recommendations If You Become Sick During Your Trip
  • Notify your organization that you have become ill.
  • Seek medical care immediately if you develop fever (100.4°F / 38°C or higher) or symptoms such as severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
  • Tell the doctor about your symptoms before going to the doctor’s office or hospital. Advance notice will help the doctor care for you and protect other people who may be in the doctor’s office or hospital.
  • The US embassy or consulate is often able to provide advice on where you can get health care. (You are encouraged to identify these resources in advance.)
  • Limit your contact with other people when you travel to the doctor; avoid public transportation.
  • Do not travel anywhere except to the doctor’s office or hospital.

Returning Home

Travelers in outbreak-affected countries are being screened at the airports to look for signs of Ebola and to find out if people have been exposed to Ebola, even if they are not sick. Those who have been exposed to Ebola or are sick with symptoms of Ebola will not be allowed to travel on commercial flights to the United States and potentially to other countries.

  • Screening at the airport may look different in each country, but 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.

After the screening, authorities will decide if and when you can continue your trip.

  • If you have symptoms of Ebola or have been exposed to Ebola —even if you are not sick— you will not be allowed to travel on commercial planes, buses, trains, or ships.
  • If you have symptoms of Ebola, you may need to be medically evacuated to receive needed care.
  • If you have been exposed to Ebola but are not sick, you will either have to arrange a charter flight home or stay in West Africa for at least 21 days until authorities ensure it is safe for you to travel.

See Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure to learn more about traveling if you have been exposed to Ebola.

After Your Return to the United States

If you were exposed to Ebola during your trip, call your doctor even if you do not have symptoms. Your doctor should evaluate your exposure level and symptoms if you have them and consult with public health authorities to determine whether actions, such as medical evaluation and testing for Ebola, monitoring, or travel restrictions are needed.

Pay attention to your health after you return, even if you were not exposed to Ebola during your trip.

  • Monitor your health for 21 days if you were in an area with an Ebola outbreak.
    • Take your temperature every morning and evening.
    • Watch for other Ebola symptoms: severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
    • If your temperature is 100.4°F (38°C) or higher or you have any other Ebola symptoms, seek medical care immediately.
      • Tell the doctor about your recent travel and your symptoms before you go to the doctor’s office or hospital. Advance notice will help the doctor care for you and protect other people who may be in the doctor’s office or hospital.
      • Limit your contact with other people when you travel to the doctor; avoid public transportation.
      • Do not travel anywhere except to the doctor’s office or hospital.
  • During the time that you are monitoring your health, you can continue your normal activities, including work. If you get symptoms of Ebola, it is important to stay apart from other people and to call your doctor right away.

More Information

 

 
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