About Ebola (Ebola Virus Disease)


What is Ebola?

The Ebola virus causes a rare and very serious infectious disease that occurs in Africa and is accompanied by haemorrhaging (bleeding) in the body. The disease is contagious only through direct physical contact with a patient, or as a result of slaughtering and eating a sick wild animal (bush meat). When contaminated, there is a considerable risk of dying; there is no vaccine against or proper treatment of Ebola, and treatment mainly consists of fighting complications. Ebola causes severe complaints that always require nursing, especially when they are at the peak of contagiousness.

How is the disease controlled?

An Ebola outbreak is controlled by quickly recognising and separating (isolating) patients to prevent new contaminations. Anyone who has been in contact with a patient (without protection) is monitored for three weeks to see whether they become ill too. If so, they are immediately admitted to hospital, where they are nursed separately from other patients. Doctors and nurses who treat these patients wear protective clothing and comply with strict rules to prevent contamination and spreading of the disease.

Is Ebola dangerous?

There is no proper treatment or vaccine against the Ebola virus, and about 70% of those contaminated die of the disease.

Who is at risk of becoming sick?

People at risk are mainly carers of patients, such as healthcare practitioners and family members. Contamination is possible through direct contact with a patient, during which the virus is transferred via body fluids (such as blood, saliva, or sweat). People can also be contaminated by eating sick animals.

Where does the Ebola outbreak occur?

There has been an outbreak of Ebola in West Africa since February 2014, which probably originated in the rain forest in southeast Guinea, presumably after eating meat from contaminated animals from the jungle. The outbreak then spread through funeral rituals. People from Guinea, Sierra Leone and Liberia cross the borders to pay their deceased relatives a traditional last honour, which has caused many people from Liberia and Sierra Leone to become infected. In July 2014, a small number of people in Nigeria were also contaminated with Ebola. 9 May 2015, The World Health Organization declared Liberia free of Ebola virus transmission.

Can Ebola spread to the Netherlands?

The chance of someone becoming infected with the Ebola virus and bringing it into the Netherlands is extremely limited. People can only become sick after immediate contact with other sufferers or by preparing or eating bush meat (raw monkey or bat meat). Ebola is contagious only if someone actually has symptoms, which is why those who take care of sufferers in particular, are at risk of becoming contaminated.

Does a treatment exist?

No, there is no vaccine or medicine available against Ebola, and treatment mainly consists of fighting complications. Each case of Ebola causes enough severe complaints for people to require medical care, especially during the time when they are most contagious. Currently, an experimental treatment is provided on a very limited scale with a non-registered medicine, which has not been previously administered to patients. It is as yet unknown whether it affects the course of the disease.

Can Ebola be transferred through unprotected intercourse?

Yes, the virus has been found in sperm, even after recovering from an Ebola infection, so be sure to avoid unprotected intercourse with a recovered Ebola patient until six months after recovery.

How long does the Ebola virus survive outside the body?

Depending on various factors, such as the amount of virus, the body fluid in which the virus occurs, the contaminated surface, and temperature, the Ebola virus can survive a couple of hours to many days outside a patient. The virus breaks down after heating to 60℃ for an hour or by boiling for five minutes. Cleaning with disinfectants such as chlorine, bleach, or alcohol also breaks down the virus. Freezing or cooling, however, does not kill it.

Is there a risk of contamination with the Ebola virus when shaking hands or kissing on the cheek?

In the Netherlands and other European countries, there is no risk of contamination with the Ebola virus by shaking hands or giving a kiss on the cheek. However, shaking hands with or kissing an Ebola patient must be avoided.

Can the Ebola virus be transferred by mosquitoes?

There is no proof of mosquitoes transferring Ebola. When a mosquito sucks blood, the Ebola virus ends up in the mosquito’s stomach, where the blood and the virus are digested. The Ebola virus cannot multiply in the mosquito and can thus not be transferred in this way.

Does wastewater present any risk of catching Ebola?

If a patient is not yet seriously ill, the faeces and urine of patients are not very contagious, and there is no problem for patients to visit the lavatory at that time. As a patient becomes sicker, the faeces, urine and vomit become increasingly contagious. This is why in hospital faeces and urine of an ebola patient are contained, and the virus is eliminated from it. Should a seriously ill patient go to a normal lavatory anyway, causing the Ebola virus to end up in the wastewater, the virus will be strongly diluted into harmless amounts; in addition, the Ebola virus is extremely fragile and will probably not survive at all.
Scientific research demonstrates that surface water (such as ditches and rivers) does not play any role in the spread of Ebola. The virus cannot enter our drinking water.

Can the Ebola virus be transferred via the air?

Contamination is not possible via coughing or sneezing, because it is not an infection that is transferred through tiny drops, as with the ‘flu. Ebola can be transferred through direct contact with bodily fluids; blood, vomit and diarrhoea are most contagious. Only when special medical treatments are executed with an Ebola patient, such as applying artificial respiration or draining the airways, contamination by means of small droplets cannot be excluded. Therefore extra protection measures are taken when executing these procedures.

Information for travellers

Do Schiphol airport and airline companies have the knowledge to deal with a potentially infected passenger?

National and international agreements (IATA guidelines, International Health Regulations) have been made to identify people with infectious diseases in time to catch the plane and at Schiphol. Captains of aircrafts notify Schiphol when passengers with symptoms consistent with infectious diseases are due to arrive at Schiphol. An assessment will be made about the care of the patient in consultation with Schiphol Airport, GGD Kennemerland and RIVM. The possibility of transmission to other co-passengers and crew on board the aircraft will be assessed by healthcare providers on arrival. These operational procedures are trained regularly at Schiphol.

Are travel restrictions imposed?

The Ministry of Foreign Affairs has adjusted its travel advice for the countries Guinea, Liberia, Nigeria, and Sierra Leone for security reasons. For the latest news on travel advice from the Ministry of Foreign Affairs, check their website www.rijksoverheid.nl/onderwerpen/reisadviezen

It is of utmost importance to take the following preventive measures:

  • Avoid contact with (deceased) Ebola patients and/or their body fluids
  • Avoid burial rites involving contact with the deceased Ebola patient
  • Avoid contact with materials of the patient potentially infected (eg. Syringes, clothing, linens, eating utensils)
  • Avoid contact with live or dead wild animals (monkeys, bats, bongos)
  • Do not eat raw meat or bush meat
  • Avoid unprotected sexual intercourse with a cured Ebola patient for six months after healing

What can you do to prevent infection while travelling?

These measures are in addition to the existing general travellers' advice.

  • Wash hands frequently with soap or other disinfectants
  • Avoid places where bats stay as caves, insulated shelters or mines

For more information on infection control measures, have a look at http://www.lcr.nl/ (Dutch only)

What should I do if I get sick when I get home?

In case of exposure to the Ebola virus, it may take 2-21 days before visible symptoms occur. If you get flu-like symptoms within that time, please call your general practitioner and mention your recent travel.

Are there any other diseases in those countries that cause fever (muscular pain and headaches)?

Yes. Malaria is a widespread disease in West Africa that causes fever, as well as other symptoms. The flu causes similar complaints. Ebola and malaria can be determined only by a laboratory test.

Can you be tested for Ebola if you experience symptoms?

Someone who has recently (up to 3 weeks ago) travelled to a country where Ebola occurs and experiences complaints such as fever, muscular pain and headaches, may be suspected of suffering from Ebola. If this is the case, the GP must be informed by telephone. If required, laboratory testing will be started in order to establish whether you have contracted Ebola; not everyone suffering from these symptoms has Ebola, because other diseases such as malaria, present similar complaints.

Am I at risk of being infected with Ebola if I have been to Sierra Leone, Liberia, Guinea or Nigeria?

The risks for tourists or people travelling into these countries or living there for business purposes generally are limited. The risk increases if you have had direct contact with a (deceased) Ebola patient or his/her body fluids. People are therefore advised against having contact with sick and deceased persons and their body fluids in these countries. The consumption of bush meat is also advised against.

I was sitting next to someone who looked ill on a plane from one of the affected countries; is there any reason for me to be concerned?

The risk of becoming infected with Ebola on a plane is limited; only passengers who have had direct contact with an Ebola patient are at risk. The contacts of suspected Ebola patients are mapped accurately; the contacts in the plane also. If you have had direct contact with a suspected sufferer or sat next to, before or behind him/her, you will be contacted.

I have visited a country where the Ebola virus occurs. Should I be tested?

For tourists or people travelling to Ebola-endemic countries for business and who have had no direct contact with Ebola patients, the risk of infection with the Ebola virus is limited. Therefore, it is not recommended to perform standard Ebola testing on people without symptoms.

In case you have been in an ebola endemic area, it is important to monitor your health in the three weeks after returning home. In case of illness, you are advised to seek medical advice by telephoning a General Practitioner. However, symptoms such as fever, muscle aches and headaches are also common in other diseases such as malaria or the flu. If your doctor thinks your symptoms might be related to Ebola, it may be necessary to perform laboratory testing to determine whether you have contracted Ebola.

What measures do Dutch airports and seaports take to prevent the Ebola virus from spreading to the Netherlands?

All authorities at the airports and seaports are kept informed about the Ebola epidemic in West Africa. Guidelines are in order for these authorities, containing a description and exercise of how to act in the case of a possibly suspicious traveller.

Why does the Netherlands refrain from screening travellers upon entry?

The main reason is that there are no direct flights from and to Guinea, Sierra Leone and Liberia departing from or landing at Dutch airports. The risk of travellers from countries affected with symptoms of Ebola boarding a plane is extremely low, because commonly, by that time, people have become too ill to go without medical help. In African countries where Ebola is prevalent, passengers complete a questionnaire and their body temperature is taken before they are allowed to leave the country. This exit screening is executed to prevent travellers with initial symptoms of Ebola from leaving the country. The effect of screening upon entry,  also referred to as an entry screening, is thus very limited.

Ebola virus: Dutch response

How is Ebola controlled should it enter the Netherlands?

Should anyone who is contaminated with the Ebola virus enter the Netherlands, a slight risk of further spreading of the disease is presented. A patient is contagious only if he/she has symptoms of the disease, which will be serious enough to require medical treatment. In the Netherlands, it is common to contact a doctor, who is obliged to report any suspicion of an Ebola contamination (or similar virus) to the Community Health Service. RIVM and the Community Health Service map all of a patient’s contacts, whose health is monitored for three weeks. As soon as they show any symptoms, they are immediately nursed in isolation, which is an effective way to control spreading. This has shown good results in the Netherlands with a patient with the Marburg virus in 2008. The Marburg virus is closely related to the Ebola virus.

Can Dutch aid workers who have had unprotected contact with Ebola patients be repatriated?

Dutch aid workers who have spent time in Africa caring for and treating patients with Ebola are commonly posted by Doctors without Borders, which has strict protocols to prevent contamination.
In the unlikely event that a Dutch care provider abroad has had unprotected contact with anyone infected with Ebola, it can be decided to have them return to the Netherlands in order to provide them with proper relief and care in a Dutch hospital. Each situation is individually considered to establish whether repatriation is required.

Are aid workers who have had contact with Ebola patients monitored in the Netherlands?

If an aid worker has been exposed to an Ebola patient or his/her body fluids but has not developed any disease symptoms (yet), he/she is not contagious to others, and monitoring in the home situation will suffice. The person who has had direct contact with Ebola patients must daily take his/her body temperature for 21 days and immediately inform the Municipal Health Service if he/she develops disease symptoms such as fever, headaches or muscular pain. The person can join in daily life without any risk of others becoming infected with Ebola. Monitoring is followed up by the Municipal Health Services in the region where this person lives. The Netherlands is relatively highly experienced with monitoring contacts of possibly infected persons. It has been applied before with regard to the limitation of the contamination risk of a patient with a Marburg infection; a disease that causes viral haemorrhagic fever similar to Ebola. If someone who has been exposed to Ebola patients does have disease symptoms such as fever, headaches or muscular pain, he or she may indeed have contracted Ebola and may be contagious to his/her environment. In such cases, he/she is admitted to hospital in isolation for further examination.

Should aid workers who have had unprotected contact with Ebola patients always go to a hospital after returning to the Netherlands?

If a care provider has had unprotected contact with an Ebola patient, his/her health is assessed by doctors upon arrival into the Netherlands. Which medical doctor and whether this will take place in a hospital is determined per individual situation.

Can people from Ebola-endemic countries come to the Netherlands for training or work?

People from Ebola-endemic countries who have not been in contact with Ebola patients have a minor risk of infection with the Ebola virus. If they do not exhibit disease symptoms, there is no risk of infection for others. Standard testing for contagion with the Ebola virus is not recommended in view of the limited risk of infection.

It is important for everyone coming from an Ebola-endemic country to monitor their health during the first three weeks. Complaints such as fever, muscular pain and headaches are consistent with Ebola but are also common symptoms for diseases such as flu or malaria. If people develop these symptoms, they are advised to call their General Practitioner. GPs in the Netherlands are informed about the characteristics of Ebola. If a GP considers complaints suspicious and thinks it might be an Ebola case, the suspected person is admitted to hospital in isolation for further examination. If the doctor does not suspect Ebola, the person has no limitations and can continue work or training.