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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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
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
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
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.
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
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
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: