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Advice for Humanitarian Aid Workers

This content is also available in French.

Purpose

These CDC recommendations help prepare humanitarian aid workers to safely work in a country with Ebola outbreaks. Recommendations support before traveling, while working overseas, and returning to the United States.

Key points

Before you leave

  • Learn about Ebola, including how to prevent Ebola exposures.
  • See a travel medicine provider to discuss health recommendations based on your medical history and travel plans.
  • Make a plan with your organization about where you will get any needed medical care and what to do if you have an unprotected exposure to Ebola or any other illness.
  • If you will be working in healthcare settings, make sure you are trained to work in non-US healthcare settings, are trained on proper use of personal protective equipment (PPE), and bring with you an adequate supply of PPE.
  • Stay informed about the outbreak. Check CDC's Ebola Outbreak in West Africa page regularly for the most current outbreak information.

During your travel

  • Follow recommendations for preventing Ebola exposures.
  • Use PPE if working in healthcare settings.
  • Seek medical care immediately if you develop fever or other possible Ebola symptoms.

Returning to the United States

  • Be prepared to go through exit and entry screening.
  • When arriving in the United States, tell Customs and Border Protection officers you were in a country with Ebola.

Recommendations for humanitarian aid workers

Humanitarian aid workers play an essential role in controlling Ebola at its source. All aid workers should be affiliated with a recognized humanitarian aid organization. CDC appreciates your work and wants to support your health and safety

Before you leave

Be well informed and prepared
See a travel medicine provider

Schedule a visit with a travel medicine provider, ideally 4 to 6 weeks before you leave, for a pre-travel health screening. Even if you are leaving sooner, a visit to a travel medicine doctor is still helpful to

  • Discuss specific health recommendations based on your health history and travel plans.
  • Discuss working in challenging settings and its impact on your physical and mental health.
  • Check if you are up-to-date on routine vaccines, as well as any other vaccines, and medicine (such as anti-malaria pills), and provide specific health information for your destination.
Packing tips
  • Travel health kit: Put together a travel health kit with items such as over-the-counter medications, a thermometer, alcohol-based hand sanitizer, anti-malaria pills, and basic first aid items.
  • Personal Protective Equipment (PPE): If you will be working in a healthcare setting or in situations where you will have close contact with people who are sick with Ebola, ensure that your organization provides you with PPE such as face shields or goggles, medical masks, gloves, gowns, aprons, and waterproof boots. If your organization does not provide PPE, it is important to pack these items and bring them with you. PPE is in short supply in countries with Ebola outbreaks.
Check in-country medical resources and medical evacuation plans
  • In-country medical services: Healthcare resources in countries with Ebola may be limited or not available. Before you leave, identify places you can get healthcare during your trip. The US embassy in the country where you are going can help you locate medical services.
  • Medical care and evacuation: Check your health insurance plan and any insurance benefits offered by your organization to ensure you are covered for healthcare abroad if you get sick (both with Ebola or another illness) or injured. Ask your organization about their medical evacuation plans. CDC recommends purchasing 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.
  • Emergency exposure plan: Work with your organization to ensure a plan is in place to bring you back to the United States if you have a high risk of exposure to Ebola.
    • As part of exit screening in countries with Ebola outbreaks, travel restrictions have been established that may affect whether you are allowed to travel on commercial flights if you have been exposed to Ebola—even if you are not sick.
    • If you had a high risk of exposure to Ebola, you may not be allowed to travel on commercial flights to the United States and potentially to other countries. You will either have to arrange a charter flight home or stay in the country until 21 days after your last exposure and authorities ensure it is safe for you to travel.

How can I be exposed to Ebola?

You can be exposed to the Ebola virus if you have contact with infected blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person sick with Ebola without wearing the right protective clothing and equipment.

For healthcare workers, this includes wearing a face shield or goggles, a medical mask, double gloves, a waterproof gown or coveralls, an apron, and waterproof boots.

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 from Ebola.
  • Care for or live with a person who is sick with Ebola.
  • Spend a long amount of time within 3 feet (1 meter) of a person who is sick with Ebola.

During your trip

Become familiar with Ebola symptoms, prevention recommendations, and what to do if you become sick.

Ebola symptoms

Fever (100.4°F / 38°C or above) or other symptoms such as

  • severe headache
  • fatigue (feeling very tired)
  • muscle pain
  • vomiting
  • diarrhea
  • stomach pain
  • unexplained bleeding or bruising

Ebola is a serious disease that causes death. There is no approved vaccine or specific treatment for Ebola, so prevention is important.

Prevention recommendation
  • Practice careful hygiene. Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
  • Avoid contact with infected blood and body fluids or objects.
  • Avoid contact with dead bodies, including participating in funeral and burial rituals.
  • Avoid contact with animals (such as monkeys or bats) or with raw or undercooked meat.
  • Don’t eat or handle bushmeat (wild animals hunted for food).
  • Avoid hospitals in West Africa where Ebola patients are being treated if you are not working in a healthcare setting.
  • Report any potential unprotected Ebola exposure or illness promptly, following your organization's reporting procedures.
If working in healthcare settings

If you will be working in healthcare settings, be prepared to care for patients in a region where resources are scarce and the healthcare system is strained.

Healthcare workers who may be exposed to people with Ebola should follow these steps:

  • Wear the recommended PPE.
  • Use proper infection control and decontamination measures.
  • Isolate patients with Ebola from other patients.
  • Avoid direct contact with dead bodies without wearing recommended PPE.
  • Immediately notify your organization, local health officials, and the US embassy or consulate if you think you have been exposed to someone with Ebola but were not wearing recommended PPE or your PPE failed.

See CDC’s resources on Ebola: Non-US Healthcare Settings and the CDC Safety Training Course for Healthcare Workers Going to West Africa. WHO also has Infection prevention and control guidance.

If you become sick during your trip
  • Notify your organization and public health authorities.
  • Seek medical care immediately if you develop fever or other possible Ebola symptoms.
  • Avoid exposing others.
  • Avoid public transportation.

Leaving West Africa

Exit screening

Travelers are being screened at the airports before leaving countries with Ebola outbreaks. Exit screenings may vary in each country, but be prepared for screeners to check your temperature and look for symptoms of illness. You will also be asked to answer questions about possible exposures to Ebola.

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

  • If you have Ebola symptoms or have had a high risk of exposure to Ebola, you won’t be allowed to travel on commercial flights to the United States and potentially to other countries.
  • If you have symptoms of Ebola, you won’t be able to travel until your symptoms go away, unless you are being medically evacuated to receive needed care.
  • If you have had a high risk of exposure to Ebola but are not sick, you or your organization will either have to arrange a charter flight home or stay in the country until 21 days after your last exposure and authorities ensure it is safe for you to travel.

Returning to the United States

Entry screening

All air travelers to the United States who were in Guinea, Liberia, Mali, or Sierra Leone must enter through one of 5 US airports (JFK in New York, Newark in New Jersey, Dulles near Washington D.C., Hartsfield-Jackson in Atlanta, and O’Hare in Chicago). These airports conduct enhanced entry screening for these travelers. This screening helps identify travelers who may be sick with Ebola or may have had an exposure to Ebola and connects them with a health department and medical care, if needed.

  • Work with your organization to make sure your return flight to the United States is booked through one of these 5 airports.
  • Tell Customs and Border Protection officers you were in a country with Ebola. This is especially important if you have been to any other country after leaving West Africa and before arriving in the United States so you can go through the screening process.
  • Be prepared for screeners to check your temperature and look for signs and symptoms of illness. You will also need to answer questions about possible exposures to someone with Ebola.
  • You will receive 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.
Monitoring for symptoms

You will be connected to a health department at 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. Active monitoring means 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 the country with Ebola).
    • If you work in a healthcare setting, such as a hospital, your health department may allow you to coordinate this monitoring process with your occupational health program.
  • You will be asked to take your temperature 2 times a day and watch 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 (100.4°F/38°C or above) or other symptoms. (Other common West African illnesses, like malaria, could be considered.)
    • Follow these directions from your public health worker if you develop a fever or any other possible Ebola symptoms. If you cannot reach someone right away, you can contact your state health department or call CDC at 1-800-232-4636. It is very important that you get medical care right away.
  • Based on your level of possible exposure to Ebola, your travel and public activities may be limited.

See CDC’s fact sheet and questions and answers about the Monitoring Symptoms and Controlling Movement Guidelines to learn more.

Going back to work

Public health officials will advise when you can go back to work depending on your level of exposure.

Inform your employer if you need to limit contact to discuss options for teleworking while being monitored. Also discuss how to address stigmatization concerns with your colleagues. Remind them that people

  • who recently traveled to West Africa don’t put others at risk if they don’t show Ebola symptoms.
  • being actively monitored may have had some risk of exposure and are being watched for symptoms. It doesn’t mean they are contagious.
  • who have no symptoms after 21 days don’t have Ebola—so are no risk to others.

Responding to the Ebola outbreak may be physically and emotionally challenging. Many aid workers report depression after returning home. Take time to rest and readjust. If you continue to feel depressed, you may wish to seek counseling.

Resources

From CDC

For West Africa settings
For US settings

From other sources

 
Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC-INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
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