The Public Health Agency of Canada (PHAC) is monitoring an outbreak of Ebola haemorrhagic fever (EHF) in the Bundibugyo district of western Uganda. EHF is a rare and severe viral disease that is spread through direct contact with body fluids of an infected person. Although the risk of contracting EHF is generally considered low for travellers, there are precautions that should be taken – see: ‘PHAC Recommendations for Canadian Travellers’ below.
As of December 7, 2007, the Ugandan Ministry of Health has reported 93 suspected cases of EHF, including 22 deaths; four of the fatalities are health care workers. Laboratory analysis indicates that the viral strain involved in nine of these cases is distinct from the four known strains of Ebola virus.
Source: World Health Organization (WHO)
Ebola haemorrhagic fever (EHF) is a rare and severe viral disease, often causing death in humans and other primates (monkeys and chimpanzees). Outbreaks occur sporadically; inadequate infection control practices in health care settings and burial ceremonies where mourners have direct contact with the body of a deceased infected person contribute to the spread of the virus.
Although the incubation period of EHF ranges from 2 to 21 days, symptoms most commonly begin within a few days of becoming infected, with the sudden onset of high fever, weakness, muscle pain, headache and sore throat. This is quickly followed by more severe symptoms including vomiting, diarrhea, rash, decreased kidney and liver functioning, and internal and external bleeding. Specific laboratory blood tests are needed to confirm the diagnosis.
Ebola virus is spread through direct contact with body fluids (e.g., saliva, blood, semen, vaginal fluid, urine, organs) of an infected person or objects that have been contaminated with infected body fluids. People may also become infected through close contact with non-human primates infected with the disease.
For additional information on Ebola haemorrhagic fever, see the PHAC's Disease Information Backgrounder: Ebola.
PHAC Recommendations for Canadian Travellers
The risk to travellers of acquiring EHF is generally considered to be low unless they are caring for an individual infected with the Ebola virus or exposed to the body fluids of a person or animal suspected of having EHF.
Health-care professionals or lay individuals travelling to an area experiencing an outbreak of EHF and who are providing care for ill individuals should be fully informed on infection control guidelines and how to prevent direct exposure to blood and bodily fluids.
As a reminder to Canadians travelling internationally…
The Public Health Agency of Canada routinely recommends that Canadian international travellers seek the advice of their personal physician or travel clinic at least six weeks prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication and personal protective measures.
The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.
For information on infection control, see:
For additional information on general health and travel, visit the Public Health Agency of Canada’s web page on General Advice for Travellers
Know before you go!
Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.
The risk is yours
Risk assessment consultation
Some facts from the experts
Ebola haemorrhagic fever (EHF) is a severe and acute, often-fatal, haemorrhagic viral disease in humans and non-human primates (monkeys, gorillas and chimpanzees). Caused by the Ebola virus, of the family Filoviridae, EHF causes death in 50 – 90% of all clinically ill cases. It occurs in sporadic outbreaks, often centred in health care settings in developing countries, where social and economic conditions often favour the spread of the virus.
EHF is named after the Ebola River in The Democratic Republic of Congo (formerly Zaire), where it was first identified in 1976. Three of the four strains of the Ebola virus (Ebola-Zaire, Ebola-Sudan and Ebola-Ivory Coast) have been associated with human disease. The fourth strain, Ebola-Reston, is associated with fatal haemorrhagic disease in nonhuman primates (monkeys and chimpanzees). It was discovered in 1989 in the United States following an outbreak of viral haemorrhagic fever among monkeys imported from the Philippines to Reston, Virginia.
It is unknown how the first human case (i.e., index case) of Ebola infection in any outbreak occurs. Some researchers believe the virus is animal-borne (i.e., zoonotic), among non-human primates (monkeys, gorillas and chimpanzees) native to Africa and Asia, suggesting that the first human case occurs following contact with an animal. Other researchers suggest that Ebola's origin is a plant virus that subsequently caused infection in animals. (Based on laboratory tests indicating that some bat species can withstand infection without fatalities, there is speculation that bats may play a role in the virus's life cycle.
We do know that the Ebola virus can be transmitted in several ways, the most significant being person-to-person through direct contact with body fluids (e.g., blood, semen, vaginal fluid) of an infected person. The risk of transmission is high for health-care providers, family members of an infected individual and others in a health-care setting where contact with body fluids is frequent and sterilization of equipment may be unreliable. Transmission may occur through pregnancy and sexual activity. Studies show that transmission through semen may occur up to seven weeks after an individual has recovered from the virus. Risk is also high for family and others having direct contact with the infected body of a deceased individual during burial ceremonies. Transmission of the Ebola virus has also occurred in those handling ill or dead infected chimpanzees.
Geographic distribution and incidence trends
The Ebola virus' precise geographic origin remains unknown, but it is thought to be centred in the rain forests of Africa and Asia. In total, approximately 1,850 cases with over 1,200 deaths have been documented since 1976.
Since its discovery, the Ebola virus has been identified in the following countries.
Countries where virus occurs
The incubation period of the Ebola virus ranges from 2 to 21 days. EHF symptoms often begin abruptly, with the sudden onset of high fever, weakness, muscle pain, headache and sore throat. This is quickly followed by more severe symptoms including vomiting, diarrhea, rash, decreased kidney and liver functioning, and in some cases, both internal and external bleeding. Specific laboratory blood tests can confirm diagnosis.
There is no standard treatment yet available for Ebola haemorrhagic fever. M anagement of individuals with Ebola focuses primarily on comfort and supportive measures, especially rehydration to replenish fluids and electrolytes lost through vomiting and diarrhea. Efforts should be made to prevent the spread of infection.
Prevention and personal precautions
There is currently no vaccine that protects against the Ebola virus. Education regarding infection control measures to prevent the spread of the virus is paramount.
Unless you are travelling to an area where an Ebola outbreak is occurring and you have direct contact with an ill individual infected with Ebola, the Public Health Agency of Canada advises that the risk of acquiring Ebola virus is extremely low.
Health-care professionals or lay individuals travelling to an Ebola virus outbreak area and who are providing care for ill individuals, should avoid any exposure to blood and bodily fluids and be fully informed on guidelines for routine practice for infection control and be fully informed about how to reduce direct exposure to bodily fluids (e.g., blood, semen, vaginal fluids, organs).
Some things to think about...
While your chance of acquiring the Ebola virus is very low, if you develop a fever with skin rash or bleeding while in, or after leaving, an Ebola-outbreak area where you have cared for a sick person(s), seek medical attention immediately and report your travel history.
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This story was posted on Fri, January 16, 2004