Infection control; Ebola counselling

• Name and age of the patient
• Exact details of complaints/symptoms and their onset and severity
• Information on previous illnesses and medication, e.g. vaccinations and malaria prophylaxis (does not exclude malaria in principle).
• Exact period of stay in an Ebola outbreak area
• Type and location of accommodation
• Precise indication of the itinerary
• Staying in (bat) caves
• Professional activities in laboratories
• Further information on the stay, e.g. tourism, visit to relatives, professional activity in the outbreak area
• Contact with wild animals, consumption of wild animal meat
• Sick persons in the environment, participation in funerals

• § 4 Protection against Infection Act (IfSG)
• § 7 Protection against Infection Act (IfSG)

How is Ebola transmitted?

The Ebola virus can be transmitted from person to person. Transmission occurs through direct physical contact with Ebola fever patients or deceased persons, especially through direct contact with their body fluids, e.g. blood, saliva, sweat, urine, stool or vomit. Before symptoms appear, people infected with the Ebola virus are not contagious.

Transmission through the air could not be proven so far.

Transmission is also possible via objects that have come into contact with infectious fluids, e.g. needles, surgical instruments, clothing or bed linen.

The Ebola virus can also be transmitted to humans through contact with infected animals or infectious animal products, e.g. during hunting, meat preparation or consumption of undercooked meat (so-called "bushmeat") from animals from affected areas.

How long is the incubation period?

The incubation period is at least two, but usually eight to ten days, and after 21 days it can be assumed that disease is no longer to be expected.

How high is the risk of contracting the disease from infected persons?

There is a very high risk of infection only in the case of unprotected direct contact with body fluids and excretions of Ebola fever patients and deceased persons, e.g. blood, saliva, sweat, urine, stool or vomit. Therefore, sufficient protective measures must be taken during care, treatment and burial activities. General hygiene measures, especially hand hygiene, are also of particular importance.

How long is the risk of infection?

A few days after the symptoms have subsided, patients are no longer considered contagious.

Transmission through semen during sexual intercourse is still possible for several weeks. Those affected must be informed about this and advised on necessary preventive measures.

Which risk groups are there in Germany?

Mainly people who have had direct physical contact with Ebola fever patients or deceased persons or their body fluids belong to the risk group. In addition to medical staff, this risk mainly affects family carers of Ebola fever patients without sufficient protection. Laboratory personnel who have worked with specimen material from Ebola fever patients can also be affected if protective measures against Ebola viruses were insufficient.

Symptoms

The early symptoms are non-specific and resemble a flu-like infection: fever, headache, musculoskeletal pain, vomiting, diarrhoea and abdominal pain.

In the course of the disease, other symptoms may occur, but not always all of them: Internal and external bleeding (haemorrhages), which can be very severe, rash on the skin (exanthema), redness of the conjunctiva, sore throat, chest pain, difficulty swallowing and shortness of breath.

Direct contact with an Ebola patient should be avoided. Medical staff attending to a confirmed case must follow strict hygiene and isolation rules.

What should a patient do if he or she suspects Ebola?

It is very important to remain calm. A doctor should be contacted by telephone with information about the suspected Ebola fever, a more detailed description of the symptoms, the travel destinations and travel duration. Then the doctor will discuss the further procedure with the patient.

However, even if you have travelled to one of the affected areas within the last three weeks, the likelihood of Ebola virus infection is very low if you have not been in contact with a person who is sick or has died of Ebola fever.

Doctor's procedure: If the doctor can confirm a suspicion of infection with the Ebola virus, the responsible health office should be informed and contact should be made with a specialised centre. Often, however, apparent suspicions can already be ruled out in the telephone call to a specialised centre.

Contact details of specialised centres can be found at www.stakob.de.

If condition permits, the patient should remain on site until confirmation or exclusion of suspected Ebola, e.g. at home, in the doctor's office or in isolation on the hospital ward. No referral to an emergency department should be made. Transport should also be avoided if possible to prevent infection.

What are the prevention measures?

Unprotected direct contact with an Ebola fever patient or deceased person must be strictly avoided. Medical staff caring for a reasonably suspected case or a patient with confirmed Ebola virus infection must follow strict hygiene and isolation rules.

There is no approved vaccine.

Is there a specific therapy?

There is no approved specific therapy. Treatment is therefore exclusively symptomatic, and the quality of medical care has an impact on mortality. The few specific therapeutic approaches are experimental.

What do travellers need to be aware of?

The Federal Foreign Office provides information on its website about medical risks abroad. It provides information on countries and leaflets on diseases. Information for travellers in several languages is also provided by the Federal ÖGD Association and the ECDC.

Individual counselling for travellers is offered not only by specialised doctors in private practice, but also by tropical institutes and, in some cases, public health offices.

How likely is it that Ebola fever will occur in Germany?

The risk of travellers bringing the disease to Germany or Europe is low, but it cannot be ruled out. People in the immediate vicinity of the infected persons would be at risk of infection due to human-to-human transmission. However, there is no risk to the population because Germany is thoroughly prepared for the treatment of people who have contracted Ebola fever. There is a network of special isolation wards that are designed both in terms of medical expertise and technical requirements for the treatment of such diseases (Working Group of Competence and Treatment Centres, STAKOB, www.stakob.rki.de). The staff there is specially trained for this situation and regularly trains to care for patients under isolation conditions.

What happens if a case of Ebola fever is brought to Germany?

There is only a low risk of a person infected with the Ebola virus entering Germany. Should a patient nevertheless enter, the spread of the Ebola virus in Germany is practically impossible due to the good medical care and preparations for such events.

If air travellers experience symptoms typical of ebola during the flight, the pilot should inform the relevant airport, which must have the status of a sanitary airport, in accordance with international health regulations. There, the patient would be isolated and questioned by a doctor from the relevant health department. If the suspicion of Ebola fever is confirmed, the traveller would be taken to a special isolation ward for diagnosis and treatment. At the same time, persons who were in close contact with such patients (seat neighbours and persons who directly cared for the patient) would be registered by the health office and asked to watch out for symptoms typical of Ebola in the next 21 days (maximum incubation period).

If a person infected with the Ebola virus first falls ill in Germany, he or she would - as soon as the reasonable suspicion of Ebola fever is established - also be admitted to a special isolation ward. All persons who had close contact with her are identified and registered by the responsible health office by interviewing the patient and her relatives or caregivers, informed about the possible infection and monitored in their everyday environment for 21 days for symptoms typical of Ebola.

Before symptoms appear, people infected with the Ebola virus are not contagious.

As the National Public Health Institute, the RKI works closely with the federal states on infection control. Federal states with an international airport have experience in dealing with diseases brought in from the tropics.

• www.stakob.de
• Notes on countries and fact sheets on diseases
• ÖGD

Further information:

• Information on Ebola at the Robert Koch Institute
• Travel and safety information on the website of the Federal Foreign Office
• General information on Ebola for citizens