The Ebola outbreak in West Africa in 2014 dominated national and international news. While the chance that the virus could be introduced in the Netherlands was small, the risk could not be disregarded. This led to considerable media attention and questions from the general public and professionals. Under the direction of the RIVM Centre for Infectious Diseases Control (CIb), many parties within and outside the health care sector made preparations to respond, if required.
Preparations
Partners in the health care chain prepared for two potential introduction routes. The first was the repatriation of persons exposed to or with confirmed Ebola, and the second was persons with suspected Ebola who reported unannounced at hospital accident and emergency departments, general practitioners or ambulance services. CIb calculated that with the correct intervention, the risk of spread of the disease in the Netherlands would be extremely low. Preparation for prolonged treatment of an Ebola patient has a considerable impact on a hospital, and thus in consultation, three academic hospitals and a major incident hospital were designated. In cooperation with the European Centre for Disease Prevention and Control (ECDC) and other EU (European Union)partners, an Ebola case definition was established.
Guidelines
As there were no guidelines for many aspects of the prevention of Ebola, guidelines were established under Clb coordination. Triage guidelines were set up for hospital emergency departments, general practitioners and ambulance personnel. There were consultations with Schiphol Airport, Central Agency for the Reception of Asylum Seekers (COA), police and fire brigade services, and also with funeral and cremation services, and waste processing, and cleaning and sanitation companies. Many different parties participated in preparing various scenarios. CIb was involved in intensive cooperation with many different organisations and with many that would not normally be involved in infectious diseases control.
Contingency planning
The potential seriousness of Ebola and of a long-duration outbreak required multidisciplinary coordination and contingency planning. Weekly surveillance reports were made available and the expected course of the epidemic was calculated. The emergency services for infectious diseases control were strengthened with additional personnel, and progress on response activities was reviewed twice a week. The Outbreak Management Team (OMT) was also set up and two expert meetings of academic medical centres were convened. The complexity and intensity of the situation was exceptional.
Possible Ebola cases
In 2014, there were 61 reports of patients with fever who may have had Ebola, or possible contact with Ebola patients. The diagnosis for four people was made on the basis of realistic suspicion. Two exposed health care professionals were repatriated to the Netherlands. In 2014, one Ebola patient was treated in the Netherlands. This was a Nigerian with the UN (United Nations ) Peace Keeping Force, who was treated at the request of the World Health Organisation (WHO). The patient was treated in the major incident hospital and recovered from Ebola. There was no spread of the virus.
National information line
The long duration of the outbreak and the media attention to the disease outside the Netherlands led to much unease, and many concerns were raised by people in the Netherlands. To answer these questions, a national Ebola information line was opened on 20 October 2014 and was contacted 836 times before it was closed on 1 February 2015.