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1 Intro Epidemic evolution Available healthcare and cases per country Restrictions on crossing borders and at airports Travel recommendations What is Ebola? Definitions Precautions Q&A Contact & sources While the outbreak is still not contained and expected to last for the next six months, an increasing number of neighbouring countries have closed their borders with the affected countries during the week. This week-end, Democratic Republic of Congo has reported several confirmed cases of Ebola in the remote Northern Equateur province. This outbreak is not considered in any way related with the ongoing outbreak in West Africa . Quarantine measures in a radius of 100 km around the location have been announced by the Ministry of Health and no travel advisories for Congo Have been issued. Health workers are paying a heavy toll to the disease with 240 of them infected and 120 fatalities. This is creating a lack of medical staff in health facilities which are already overwhelmed. WHO is calling for international support from the healthcare professionals. An experimental treatment (ZMAPP) which had thus far never been tested in humans has raised hopes after the recovery of two US aid workers who were discharged from hospital after being given the treatment. It has not been confirmed that the treatment was the reason for the cure. A Japanese company has announced introduction of an antiviral medication that may help counteract the Ebola virus, but it is in very early stages and untested on animals or humans. Therefore it is important to keep in mind that Ebola remains a disease without available specific treatment. Locally the risk remains low for (non- healthcare workers) expatriates or travellers who follow strict hygiene rules by avoiding close contact with the patients or contaminated materials in high risk environments. However, expect a heightened state of alert related to the outbreak, resulting in more restrictions on travel. Additionally, expect that transportation entities and government authorities will act very cautiously to enable evacuation of any ill or injured foreigners in Ebola affected areas. For all above reasons, AXA Assistance’s recommendation remains to avoid or interrupt any travel to the countries of Guinea, Sierra Leone, Liberia for non- essential personnel. Dr Cai Glushak International Chief Medical Officer Legend Update of information August 27,2014

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Page 1: ebola outbreak  axa assistance health update

1

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

While the outbreak is still not contained and expected to last for the next six

months, an increasing number of neighbouring countries have closed their

borders with the affected countries during the week.

This week-end, Democratic Republic of Congo has reported several

confirmed cases of Ebola in the remote Northern Equateur province. This

outbreak is not considered in any way related with the ongoing outbreak in

West Africa . Quarantine measures in a radius of 100 km around the location

have been announced by the Ministry of Health and no travel advisories for

Congo Have been issued.

Health workers are paying a heavy toll to the disease with 240 of them

infected and 120 fatalities. This is creating a lack of medical staff in health

facilities which are already overwhelmed. WHO is calling for international

support from the healthcare professionals.

An experimental treatment (ZMAPP) which had thus far never been tested in

humans has raised hopes after the recovery of two US aid workers who were

discharged from hospital after being given the treatment. It has not been

confirmed that the treatment was the reason for the cure. A Japanese

company has announced introduction of an antiviral medication that may

help counteract the Ebola virus, but it is in very early stages and untested on

animals or humans. Therefore it is important to keep in mind that Ebola

remains a disease without available specific treatment.

Locally the risk remains low for (non- healthcare workers) expatriates or

travellers who follow strict hygiene rules by avoiding close contact with the

patients or contaminated materials in high risk environments. However,

expect a heightened state of alert related to the outbreak, resulting in more

restrictions on travel. Additionally, expect that transportation entities and

government authorities will act very cautiously to enable evacuation of any

ill or injured foreigners in Ebola affected areas.

For all above reasons, AXA Assistance’s recommendation remains to avoid

or interrupt any travel to the countries of Guinea, Sierra Leone, Liberia for

non- essential personnel.

Dr Cai Glushak

International Chief Medical Officer

Legend

Update of information

August 27,2014

Page 2: ebola outbreak  axa assistance health update

2

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

This outbreak started in March 2014 in Guinéa and rapidly spread

to Sierra Leone and Liberia, and then to Nigeria.

Disease activity has been most concentrated in the primary

epicenter, Gueckedou, located in the Forestiere region along the

Guinea-Sierra Leone border. However, significant foci have also

appeared in coastal Guinea near Conakry, coastal Sierra Leone

near Freetown, and coastal Liberia near Monrovia.

On August 24, the Democratic Republic of Congo's health minister

said two Ebola deaths have been confirmed in the Equateur

province in the north-west of the country. These cases of Ebola

have not been confirmed by the WHO. According to the Minister,

the outbreak in this country has "nothing to do with the one in

West Africa".

At the present stage, the Ebola outbreak is considered as an

epidemic by the WHO. Friday 8th August, The World Health

Organization says the Ebola epidemic constitutes a "Public Health

Emergency of International Concern (PHEIC)".

This outbreak started in March 2014 in Guinéa and rapidly spread

Disease activity has been most concentrated in the primary

epicenter, Gueckedou, located in the Forestiere region along the

ne border. However, significant foci have also

appeared in coastal Guinea near Conakry, coastal Sierra Leone

near Freetown, and coastal Liberia near Monrovia.

On August 24, the Democratic Republic of Congo's health minister

confirmed in the Equateur

west of the country. These cases of Ebola

have not been confirmed by the WHO. According to the Minister,

the outbreak in this country has "nothing to do with the one in

e Ebola outbreak is considered as an

epidemic by the WHO. Friday 8th August, The World Health

Organization says the Ebola epidemic constitutes a "Public Health

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3

Guinea : suspected and confirmed case count : 607

Suspected case deaths: 406

Laboratory confirmed cases: 443

Sierra Leone : suspected and confirmed case count : 910

Suspected case deaths: 392

Laboratory confirmed cases: 804

Liberia : suspected and confirmed case count : 1082

Suspected case deaths: 624

Laboratory confirmed cases: 269

Nigeria : suspected and confirmed case count : 16

Suspected case deaths: 5

Laboratory confirmed cases: 12

In Guinea, Sierra Leone and Liberia: the healthcare system is very limited with

lack of medical facilities and hospital equipment.

Reliable medical facilities, able to provide minimum level of care, are to be found

in the capital cities only. Some private medical facilities offer a better range of

treatment options than public facilities but are still well below global standards.

There are no ambulance or emergency rescue services and trauma care is

extremely limited.

Hospitals and medical facilities are very poorly equipped and are barely able to

provide basic care. Emergency services similar to those existing in western

countries are non-existent, and the blood supply is unreliable and unsafe for

transfusion. Medicines are scarce, often beyond expiration dates, and generally

unavailable in most areas. Sterilization of equipment should not be assumed.

Treatment is frequently unreliable.

The level of sanitation throughout urban areas is very poor, which increases the

potential for disease transmission. Upper respiratory infections and diarrhea are

common, as well as more serious diseases like, cholera typhoid and malaria.

In Nigeria: the level of health care is poor in the whole country; the only few

good quality medical facilities are located in Lagos and Abuja

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

Page 4: ebola outbreak  axa assistance health update

4

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

Curfew

Liberia

The government of Liberia has imposed a nationwide 2100-0600 curfew.

Movement into or out of West Point (due north of Roberts International

Airport (ROB)) in Monrovia and Dolo's Town in Margibi County is prohibited

due to government quarantines.

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5

International airports

Guinea

Liberia

Payne Airport (MLW)

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

Sierra Leone

Freetown

Nigeria

Abuja

Lagos

Port

All passengers departing from all major international

airports must fill out a health form and have their

temperature taken.

At this level of the

been enforced by the authorities. Travelers should check restrictions before

travelling.

International airports

Guinea: Conakry - Gbessia International Airport (CKY)

• Remains open.

• The only entry point by air in Guinea / chartered aircraft are able to

leave Guinea from any open airport.

• Medical teams from the Pasteur Institute of Paris and various French

NGOs are positioned on site for specific assistance to Guinean sanitary

authorities.

• All passengers departing from the capital city’s airport must fill out a

health form and have their temperature taken.

Liberia: Monrovia - Roberts International Airport (ROB) & Monrovia

Payne Airport (MLW)

• Remain open.

• The only entry points by air in Liberia.

• All passengers departing from the capital city’s airport must fill out a

health form and have their temperature taken.

Sierra Leone:

Freetown - Lungi International Airport (FNA)

• Remains open.

• The only entry point by air in Sierra Leone.

• From Freetown city, only reachable by boat, ferry,

overcraft or helicopter (30 mn)

All passengers departing from the capital city’s airport

must fill out a health form and have their temperature

taken.

Nigeria:

Abuja - Nnamdi Azikiwe Intl. Airport (ABV),

Lagos - Murtala Muhammed Intl. Airport (LOS),

Port-Harcourt - Omagwa Intl. Airport (PHC)

All passengers departing from all major international

airports must fill out a health form and have their

temperature taken.

At this level of the outbreak, a number of travel restrictions have already

been enforced by the authorities. Travelers should check restrictions before

travelling.

Gbessia International Airport (CKY)

by air in Guinea / chartered aircraft are able to

edical teams from the Pasteur Institute of Paris and various French

NGOs are positioned on site for specific assistance to Guinean sanitary

departing from the capital city’s airport must fill out a

health form and have their temperature taken.

Roberts International Airport (ROB) & Monrovia - Spriggs

All passengers departing from the capital city’s airport must fill out a

health form and have their temperature taken.

rom Freetown city, only reachable by boat, ferry,

All passengers departing from the capital city’s airport

must fill out a health form and have their temperature

All passengers departing from all major international

outbreak, a number of travel restrictions have already

been enforced by the authorities. Travelers should check restrictions before

Page 6: ebola outbreak  axa assistance health update

6

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

Flight suspension

Sched

to the Ebola outbreak (alphabetical order: name [IATA code + hub]):

AFRICAN AIRCARRIERS

- Air Côte d'Ivoire [HF / Abidjan]

- Arik Air [W3 / Lagos + Abuja]

- Asky [KP / Lomé]

- Ca

- Douniah Airlines [DH / Bamako]

- Eagle Atlantic Airlines [E2 / Accra]

- Gambia Bird Airlines [3G / Banjul]

- Kenya Airways [KQ / Nairobi]

- Mauritania Airlines International [L6 / Nouakchott]

- Senegal Airlines [DN / Dakar]

OTHER

- British Airways [BA / Londres]

- Emirates [EK / Dubaï]

Flight operations to any areas affected by or suspected of being affected by

Ebola could be suspended anytime with little notice by governments or air

Borders (air+land)

Guinea

Senegal closed its

Ivory Coast closed its borders with Guinea on Aug 23.

Sierra Leone

However, the border is porous.

regions since 06/08/2014.

Liberia

Ivory Coast closed its borders with Liberia on Aug 23.

State of emerg

However, the border is porous.

Nigeria

Highway 7 (TAH7) bet

State of emergency declared since 09/08/2014.

On August 18th, Cameroon has c

and suspended all flights to and from Nigeria.

Flight suspension

Scheduled Airlines having suspended their flights to the concerned countries due

to the Ebola outbreak (alphabetical order: name [IATA code + hub]):

AFRICAN AIRCARRIERS

Air Côte d'Ivoire [HF / Abidjan]

Arik Air [W3 / Lagos + Abuja]

Asky [KP / Lomé]

Camair-Co [QC / Douala]

Douniah Airlines [DH / Bamako]

Eagle Atlantic Airlines [E2 / Accra]

Gambia Bird Airlines [3G / Banjul]

Kenya Airways [KQ / Nairobi]

Mauritania Airlines International [L6 / Nouakchott]

Senegal Airlines [DN / Dakar]

OTHER AIRCARRIERS

British Airways [BA / Londres]

Emirates [EK / Dubaï]

Flight operations to any areas affected by or suspected of being affected by

Ebola could be suspended anytime with little notice by governments or air

Borders (air+land)

Guinea closed its borders with Sierra Leone and Liberia on 09/08/2014.

Senegal closed its borders with Guinea on Aug 21.

Ivory Coast closed its borders with Guinea on Aug 23.

Sierra Leone: land borders closed since 31/07/2014 + state of emergency declared

However, the border is porous. Total sanitory blocade on Kénéma and Kailahun

regions since 06/08/2014.

Liberia: land borders officially closed since 27/07/2014.

Ivory Coast closed its borders with Liberia on Aug 23.

State of emergency declared since 06/08/2014.

However, the border is porous.

Nigeria: land border remain open, especially at the border post on the Trans African

Highway 7 (TAH7) between Lagos and Cotonou (Benin).

State of emergency declared since 09/08/2014.

On August 18th, Cameroon has closed its borders (land, sea and air) with Nigeria

and suspended all flights to and from Nigeria.

uled Airlines having suspended their flights to the concerned countries due

to the Ebola outbreak (alphabetical order: name [IATA code + hub]):

Mauritania Airlines International [L6 / Nouakchott]

Flight operations to any areas affected by or suspected of being affected by

Ebola could be suspended anytime with little notice by governments or air

eone and Liberia on 09/08/2014.

Ivory Coast closed its borders with Guinea on Aug 23.

: land borders closed since 31/07/2014 + state of emergency declared.

Total sanitory blocade on Kénéma and Kailahun

cially closed since 27/07/2014.

Ivory Coast closed its borders with Liberia on Aug 23.

land border remain open, especially at the border post on the Trans African

ween Lagos and Cotonou (Benin).

losed its borders (land, sea and air) with Nigeria

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7

A number of authorities have started to issue travel advisories. In the wake of the United States Centers for

Disease Control and Prevention (CDC) statement of July 31st

, US nationals should defer non essential travel to

the Ebola Virus Disease (EVD)-affected countries of Sierra Leone, Guinea, and Liberia. Several other countries

have issued similar travel recommendations. These include:

Australia: www.smartraveller.gov.au/zw-cgi/view/TravelBulletins/Ebola

Canada: http://travel.gc.ca/travelling/health-safety/travel-health-notices/ebola

France (French): www.diplomatie.gouv.fr/fr/conseils-aux-voyageurs/infos-pratiques-20973/article/virus-ebola-

guinee-forestiere

Germany (German)

Guinea: www.auswaertiges-amt.de/DE/Laenderinformationen/00-SiHi/GuineaSicherheit.html

Liberia: http://www.auswaertiges-amt.de/DE/Laenderinformationen/00-SiHi/LiberiaSicherheit.html

Sierra Leone: www.auswaertiges-amt.de/DE/Laenderinformationen/00-SiHi/SierraLeoneSicherheit.html

The WHO has not yet recommended travel or trade restrictions for Ebola-

affected countries. However, the organization is reviewing terms with air

authorities and other global travel officials to devise communication. The

WHO likely remains reluctant to issue restrictions because of the many

economic and political ramifications that may befall a nation when facing a

global suspension of travel. Since it is up to national health officials to

determine the risk threshold for the nation it represents, many countries have

issued their own travel recommendations urging travelers to defer

nonessential travel to Sierra Leone, Guinea, and/or Liberia. Furthermore,

many countries - especially in or near West Africa - have increased health

screenings at border checkpoints and at international airports. Several airlines

have suspended service to Sierra Leone and Liberia due to Ebola concerns, and

authorities in Sierra Leone and Liberia have implemented a number of

response actions in an attempt to contain the spread of disease.

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

AXA Assistance strongly recommends to avoid all travel to the affected

countries and that non essential personnel leave the area.

Additionally, refer to the recommendations and advice by Governmental

authorities in your country.

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8

What is Ebola Hemorrhagic Fever (EHF)?

Ebola hemorrhagic fever is a severe, often-fatal viral disease in humans and

nonhuman primates (monkeys, gorillas and chimpanzees), caused by infection

with the Ebola virus. Health officials believe the virus originates in the animal

population in parts of Africa and then spreads to humans. Subsequently the

virus is spread from person to person through human contact. The current

strain affecting West Africa has a mortality (death) rate of greater than 80%

and as high as 90%. EHF causes a syndrome that starts like a general non-

specific viral syndrome (like the flu), but which then causes failure of multiple

organ systems and is noted for the development of bleeding from various body

sites.

There is no known cure for the illness nor any known preventative vaccine or

medication.

How is Ebola spread?

Ebola is primarily spread by human-to-human contact or contact with body

fluids. This can occur by direct contact with infected individuals, contact with

items and surfaces contaminated with body fluid, and contact with the bodies

of patient who have died of EVH. One of the major sources of spread is

thought to be through the traditional handling of the remains of deceased EVH

patients by family members and other contacts.

It is also thought that transmission from animal sources occurs through

handling and consumption of bush meat (usually monkeys).

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola? (1/3)

Definitions

Precautions

Q&A

Contact & sources

Page 9: ebola outbreak  axa assistance health update

9

What are the signs and symptoms of EHF?

EHF starts as a non-specific febrile (fever) illness with symptoms typical of a viral

illness like flu. Because EVH symptoms are non-specific at the onset, it is impossible

in the early stage to distinguish it from many other less serious conditions. The

following are the symptoms patients will experience and a patient may have all or

only some of the symptoms:

- Fever

- Headache

- Joint and muscle aches

- Sore throat

- Diarrhea and vomiting

- Rash

- External/internal bleeding

External bleeding is a later manifestation and indicates breakdown of the

coagulation system. Liver abnormalities, shown on certain blood tests, are a

hallmark of the disease. The patient will likely show signs of confusion as the

neurological system is affected and he/she succumbs to malfunction of other

organs.

How long does it take for a patient to develop symptoms of EHF?

The incubation period of EHF is 2 to 21 days, meaning this is the period of time that

it may take between exposure to Ebola virus and development of symptoms.

Persons who are being traced and observed for the development of Ebola are not

considered to have EVH and pose no risk for illness or spread of the virus if they

have not developed symptoms after 21 days.

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola? (2/3)

Definitions

Precautions

Q&A

Contact & sources

Page 10: ebola outbreak  axa assistance health update

10

What tests are done to determine if a patient has Ebola?

The specific test for EHF does not turn positive immediately, so the patient is likely

to be seriously ill before a positive test result will be available. However, there are

several abnormalities that are consistent with EHF infection. If negative, the

patient is considered not to have EHF. As well, since patient in this area are

vulnerable to a multitude of other illness (like malaria or gastroenteritis), a positive

test for another illness helps rule out EHF. The key tests that will be done are:

- Complete blood count with platelet

- General chemistry

- Liver function tests

- Blood, urine and stool cultures

- Serological tests for the Ebola virus

- Other tests as indicated by specific complications.

What is the prevention and treatment for Ebola?

There is no vaccine or medication that will prevent EHF or decrease the severity of

the illness. The only prevention is avoidance through proper hygiene practices and

avoidance of certain practices (see below).

There is no cure or effective treatment for EHF. Patients are typically placed in

strict isolation to prevent spread to others and given fluids, antipyretics (anti-

fever)) and pain medications until they expire or recover on their own (which a

small percentage do).

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola? (3/3)

Definitions

Precautions

Q&A

Contact & sources

Page 11: ebola outbreak  axa assistance health update

11

* Source : World Health Organization

Please find here below the definitions of the different stages of a contagious

disease as described by the WHO.

The outbreak so far is defined by the WHO as an epidemic has been declared

“an International Public Health Emergency”.

SPORADIC

Disease occurring occasionally, singly, or in scattered instances

ENDEMIC

Disease restricted to a locality or region

EPIDEMIC

Disease affecting or tending to affect an atypically large number of individuals

within a population, community, or region at the same time

PANDEMIC

Epidemic occurring on a scale which crosses international boundaries, usually

affecting a large number of people

*Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions *

Precautions

Q&A

Contact & sources

Page 12: ebola outbreak  axa assistance health update

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The World Health Organization (WHO) reiterated its position that the risk of

transmission of Ebola virus disease during air travel remains low.

“Unlike infections such as influenza or tuberculosis, Ebola is not airborne,” says Dr

Isabelle Nuttall, Director of WHO Global Capacity Alert and Response.

“It can only be transmitted by direct contact with the body fluids of a person who

is sick with the disease.”

On the small chance that someone on the plane is sick with Ebola, the likelihood of

other passengers and crew having contact with their body fluids is even smaller.

Usually when someone is sick with Ebola, they are so unwell that they cannot

travel. WHO is therefore advising against travel bans to and from affected

countries.

“Because the risk of Ebola transmission on airplanes is so low, WHO does not

consider air transport hubs at high risk for further spread of Ebola,” says Dr Nuttall.

The guidance recommended no ban on international travel or trade.

However, WHO recommends extreme caution in these countries: measures already

described in the previous weeks and they do not change.

What preventive measures should be taken?

Observe strict health precautions, including frequent hand washing with soap and

water or with hand sanitizer.

Where possible, limit exposure to crowds, including markets and other areas where

large numbers of people congregate.

Stay away from any locations where bush meat is collected, butchered, or sold.

Avoid places and areas of dense population.

Avoid contact with animals and items that may have come in contact with an

infected person's blood or bodily fluids.

Avoid funeral and burial ceremonies – especially in traditional local settings.

What should I do if I become ill or have a fever?

If you feel ill or develop a fever, immediately report to a healthcare practitioner.

Avoid close contact with colleagues and family if you have fever or other viral

symptoms as described.

Contact AXA Assistance and your embassy or consulate to get up-to-date referral

advice on providers who will see you.

Expect to be carefully screened for infectious illness by your healthcare provider.

Expect healthcare workers to where protective garments and masks and possibly to

apply masks and other protective cover to you.

Describe the onset and nature of your symptoms accurately. If you have not had

fever, make sure to mention this clearly. Also, if you have not had any exposure

that you feel would put you at risk for contracting EVH, make sure this is well

understood by the provider. Your provider will put great emphasis on your history

and any behavior that will diminish or heighten the possibility you could have

contracted Ebola.

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A

Contact & sources

Page 13: ebola outbreak  axa assistance health update

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1. What is Ebola virus disease?

Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often

fatal illness, with a death rate of up to 90%. The illness affects humans and

nonhuman primates (monkeys, gorillas, and chimpanzees).

Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near

the Ebola River in the Democratic Republic of Congo, and the other in a remote

area of Sudan.

The origin of the virus is unknown but fruit bats (Pteropodidae) are considered the

likely host of the Ebola virus, based on available evidence.

2. How do people become infected with the virus?

Ebola is introduced into the human population through close contact with the

blood, secretions, organs or other bodily fluids of infected animals. In Africa,

infection has occurred through the handling of infected chimpanzees, gorillas, fruit

bats, monkeys, forest antelope and porcupines found ill or dead or in the

rainforest. It is important to reduce contact with high-risk animals (i.e. fruit bats,

monkeys or apes) including not picking up dead animals found lying in the forest or

handling their raw meat.

Once a person comes into contact with an animal that has Ebola, it can spread

within the community from human to human. Infection occurs from direct contact

(through broken skin or mucous membranes) with the blood, or other bodily fluids

or secretions (stool, urine, saliva, semen) of infected people. Infection can also

occur if broken skin or mucous membranes of a healthy person come into contact

with environments that have become contaminated with an Ebola patient’s

infectious fluids such as soiled clothing, bed linen, or used needles.

Health workers have frequently been exposed to the virus when caring for Ebola

patients. This happens because they are not wearing personal protection

equipment, such as gloves, when caring for the patients. Health care providers at all

levels of the health system – hospitals, clinics and health posts – should be briefed

on the nature of the disease and how it is transmitted, and strictly follow

recommended infection control precautions.

Burial ceremonies in which mourners have direct contact with the body of the

deceased person can also play a role in the transmission of Ebola. Persons who

have died of Ebola must be handled using strong protective clothing and gloves,

and be buried immediately.

*Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A* (1/6)

Contact & sources

Page 14: ebola outbreak  axa assistance health update

14

People are infectious as long as their blood and secretions contain the virus. For

this reason, infected patients receive close monitoring from medical professionals

and receive laboratory tests to ensure the virus is no longer circulating in their

systems before they return home. When the medical professionals determine it is

okay for the patient to return home, they are no longer infectious and cannot infect

anyone else in their communities. Men who have recovered from the illness can

still spread the virus to their partner through their semen for up to 7 weeks after

recovery. For this reason, it is important for men to avoid sexual intercourse for at

least 7 weeks after recovery or to wear condoms if having sexual intercourse during

7 weeks after recovery.

3. Who is most at risk?

During an outbreak, those at higher risk of infection are:

health workers, family members or others in close contact with infected people;

mourners who have direct contact with the bodies of the deceased as part of burial

ceremonies; and hunters in the rain forest who come into contact with dead

animals found lying in the forest.

More research is needed to understand if some groups, such as immuno-

compromised people or those with other underlying health conditions, are more

susceptible than others to contracting the virus.

Exposure to the virus can be controlled through the use of protective measures in

clinics and hospitals, at community gatherings, or at home.

*Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A* (2/6)

Contact & sources

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4. What are typical signs and symptoms of infection?

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat

are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash,

impaired kidney and liver function, and in some cases, both internal and external

bleeding.

Laboratory findings include low white blood cell and platelet counts, and elevated

liver enzymes.

The incubation period, or the time interval from infection to onset of symptoms, is

from 2 to 21 days. The patients become contagious once they begin to show

symptoms. They are not contagious during the incubation period.

Ebola virus disease infections can only be confirmed through laboratory testing.

5. When should someone seek medical care?

If a person has been in an area known to have Ebola virus disease or in contact with

a person known or suspected to have Ebola and they begin to have symptoms, they

should seek medical care immediately.

Any cases of persons who are suspected to have the disease should be reported to

the nearest health unit without delay. Prompt medical care is essential to

improving the rate of survival from the disease. It is also important to control

spread of the disease and infection control procedures need to be started

immediately.

6. What is the treatment?

Severely ill patients require intensive supportive care. They are frequently

dehydrated and need intravenous fluids or oral rehydration with solutions that

contain electrolytes. There is currently no specific treatment to cure the disease.

Some patients will recover with the appropriate medical care.

To help control further spread of the virus, people that are suspected or confirmed

to have the disease should be isolated from other patients and treated by health

workers using strict infection control precautions.

*Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A* (3/6)

Contact & sources

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7. What can I do? Can Ebola be prevented?

Currently there is no licensed vaccine for Ebola virus disease. Several vaccines are

being tested, but none are available for clinical use right now.

Raising awareness of the risk factors and measures people can take to protect

themselves are the only ways to reduce illness and deaths.

Ways to prevent infection and transmission

While initial cases of Ebola virus disease are contracted by handling infected

animals or carcasses, secondary cases occur by direct contact with the bodily fluids

of an ill person, either through unsafe case management or unsafe burial practices.

During this outbreak, most of the disease has spread through human-to-human

transmission. Several steps can be taken to help in preventing infection and limiting

or stopping transmission.

Understand the nature of the disease, how it is transmitted, and how to prevent it

from spreading further. (For additional information, please see the previous

questions about Ebola virus disease in this FAQ.)

Listen and follow directives issued by your country’s respective Ministry of Health.

If you suspect someone close to you or in your community of having Ebola virus

disease, encourage and support them in seeking appropriate medical treatment in

a care facility.

If you choose to care for an ill person in your home, notify public health officials of

your intentions so they can train you and provide appropriate gloves and personal

protective equipment (PPE), as well as instructions as a reminder on how to

properly care for the patient, protect yourself and your family, and properly dispose

of the PPE after use.

When visiting patients in the hospital or caring for someone at home, hand washing

with soap and water is recommended after touching a patient, being in contact

with their bodily fluids, or touching his/her surroundings.

People who have died from Ebola should only be handled using appropriate

protective equipment and should be buried immediately.

Additionally, individuals should reduce contact with high-risk infected animals (i.e.

fruit bats, monkeys or apes) in the affected rainforest areas. If you suspect an

animal is infected, do not handle it. Animal products (blood and meat) should be

thoroughly cooked before eating.

*Source: http://www.who.int/en/

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Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

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8. What about health workers? How do they protect themselves from the high

risk of caring for sick patients?

Health workers treating patients with suspected or confirmed illness are at higher

risk of infection than other groups.

In addition to standard health care precautions, health workers should strictly

apply recommended infection control measures to avoid exposure to infected

blood, fluids, or contaminated environments or objects – such as a patient’s soiled

linen or used needles.

They should use personal protection equipment such as individual gowns, gloves,

masks and goggles or face shields.

They should not reuse protective equipment or clothing unless they have been

properly disinfected.

They should change gloves between caring for each patient suspected of having

Ebola.

Invasive procedures that can expose medical doctors, nurses and others to

infection should be carried out under strict, safe conditions.

Infected patients should be kept separate from other patients and healthy people,

as much as possible.

9. How does WHO protect health during outbreaks?

WHO provides technical advice to countries and communities to prepare for and

respond to Ebola outbreaks. WHO actions include:

• disease surveillance and information-sharing across regions to watch for

outbreaks;

• technical assistance to investigate and contain health threats when they

occur – such as on-site help to identify sick people and track disease

patterns;

• advice on prevention and treatment options;

deployments of experts and the distribution of health supplies (such as

personal protection gear for health workers) when they are requested by

the country;

• communications to raise awareness of the nature of the disease and

protective health measures to control transmission of the virus;

• activation of regional and global networks of experts to provide assistance,

if requested, and mitigate potential international health effects and

disruptions of travel and trade. *Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

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Definitions

Precautions

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Contact & sources

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For any question:

[email protected]

Our sources:

• WHO - World Health Organization

• CDC - Centre for Disease Control and Prevention

• AXA Assistance Response Team

o Local and international coordinating doctors

o International medical network

o International Operations Direction

o Health Business Unit

• Ministries of Foreign Affairs

• iJET

10. What about rumours that some foods can prevent or treat the infection?

WHO strongly recommends that people seek credible health advice about Ebola

virus disease from their public health authority.

While there is no specific drug against Ebola, the best treatment is intensive

supportive treatment provided in the hospital by health workers using strict

infection control procedures. The infection can be controlled through

recommended protective measures.

11. During an outbreak, numbers of cases reported by health officials can go up

and down? Why?

During an Ebola outbreak, the affected country’s public health authority reports its

disease case numbers and deaths. Figures can change daily. Case numbers reflect

both suspected cases and laboratory-confirmed cases of Ebola. Sometimes

numbers of suspected and confirmed cases are reported together. Sometimes they

are reported separately. Thus, numbers can shift between suspected and confirmed

cases.

Analyzing case data trends, over time, and with additional information, is generally

more helpful to assess the public health situation and determine the appropriate

response.

12. Is it safe to travel during an outbreak? What is WHO’s travel advice?

During an outbreak, WHO reviews the public health situation regularly, and

recommends any travel or trade restrictions if necessary.

The risk of infection for travelers is very low since person-to-person transmission

results from direct contact with the body fluids or secretions of an infected patient.

WHO’s general travel advice

Travelers should avoid all contact with infected patients.

Health workers traveling to affected areas should strictly follow WHO-

recommended infection control guidance.

Anyone who has stayed in areas where cases were recently reported should be

aware of the symptoms of infection and seek medical attention at the first sign of

illness.

Clinicians caring for travelers returning from affected areas with compatible

symptoms are advised to consider the possibility of Ebola virus disease.

*Source: http://www.who.int/en/

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A* (6/6)

Contact & sources

Page 19: ebola outbreak  axa assistance health update

19

Intro

Epidemic evolution

Available healthcare and cases

per country

Restrictions on crossing borders

and at airports

Travel recommendations

What is Ebola?

Definitions

Precautions

Q&A* (6/6)

Contact & sources

For any question:

[email protected]

Our sources:

• WHO - World Health Organization

• CDC - Centre for Disease Control and Prevention

• MSF - Médecins sans frontières

• Ministries of Foreign Affairs

• iJET

• AXA Assistance Response Team

o Local and international coordinating doctors

o International medical network

o International Operations Direction

o Health Business Unit