Over 10,000 screened for Ebola at Indian airports since 10 August

The Indian government has reported that 10,194 passengers from countries affected by Ebola virus disease (EVD) have been screened by the Immigration Department via airports at Delhi, Mumbai, Bengaluru, Chennai, Trivandrum, Kolkata and Kochi.

A number of individuals have tested negative for the disease as of 16 August, including two Nigerian nationals and an Indian national. Another Nigerian national is under observation at Dr RML Hospital. 

A quarantine cum isolation health facility at Delhi Airport is operational, and all suspect cases detected at Delhi Airport will now be admitted to this facility, the government said. Since 16 August, five citizens of Indian origin aged 38 (M), 38(F), 7(M), 2 (F) and 31(F) have been admitted to this facility. All of them have been found negative for EVD in tests done at NCDC.

The Integrated Disease Surveillance Programme (IDSP) is tracking such passengers, the details of whom are provided to them by the Airport Health Organization. Today, 90 passengers were enrolled for follow up in their respective states through State IDSP units. As of 17 August, a cumulative number of 267 passengers are being tracked. Most of them are in the States of Maharashtra, Kerala and Tamil Nadu.

The Control Room in the Ministry of Health & Family Welfare has received 557 calls since its inception on 9 August. Most of the callers have sought information on signs and symptoms of the disease and travel related risk of acquiring the infection.

WHO has reported a total of 2,127 cases and 1,145 deaths as of 13 August 2014 due to EVD from affected countries. 

WHO says Ebola unlikely to spread through air travel

The World Health Organization has stated that air travel to and from affected countries is not a high-risk activity for the spread of Ebola. Dr Isabelle Nuttall, speaking on behalf of WHO, said, “Air travel, even from Ebola-affected countries, is low-risk for Ebola transmission.”

Dr Nuttall emphasised that the disease is not spread by airborne particles, like influenza or tuberculosis. The infection is transmitted to others through direct contact with the bodily fluids of a sick person, such as blood, vomit, sweat, and diarrhoea. Even if an individual infected with Ebola virus disease (EVD) travels by plane, the likelihood of other passengers and crew coming into contact with the individual’s bodily fluids is very low.

The WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. The organisation stresses that contacts do not include properly-protected healthcare workers and laboratory staff.

As of August 13, the latest dates available as of August 15, there have been a total of 2,127 cases reported, including confirmed, probable and suspected cases, and 1,145 deaths, from the four West African countries dealing with the EVD outbreak. Between 12 and 13 August 2014, a total of 152 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 76 deaths were reported from Guinea, Liberia, Nigeria and Sierra Leone.

According to Flightstats, airlines in the Niddle East that fly to the four countries include Royal Air Maroc, which flies to all four countries, and Etihad, which flies to Conakry, Guinea and Lagos, Nigeria. Emirates and Qatar Airways fly to Lagos, Nigeria. Emirates had flights to Conakry but these are now suspended until further notice because of Ebola.

The WHO downplayed the possibility of a global pandemic here.

WHO downplays possibility of global ebola epidemic

The World Health Organization (WHO) provided an overview of the spread of Ebola virus disease (EVD) in West Africa on 11 August and stressed that in countries with well-developed health systems, an epidemic is highly unlikely "given the epidemiology of the Ebola virus and experiences in past outbreaks".

The organisation noted that fear has led to a very high level of vigilance and clinical suspicion worldwide, stating that "such a high level of alert further increases the likelihood that any imported case will be quickly detected and properly managed, limiting onward transmission."

On the downside, the WHO observes that the same fear is compromising outbreak control when it causes airlines to refuse to transport personal protective equipment and courier services to refuse to transport properly and securely packaged patient samples to a WHO-approved laboratory.

Facts about Ebola

• The Ebola virus is highly contagious, but is not airborne. 
• Transmission requires close contact with the bodily fluids of an infected person, as can occur during health-care procedures, home care, or traditional burial practices. 
• The incubation period ranges from two to 21 days, but patients become contagious only after the onset of symptoms. As symptoms worsen, the ability to transmit the virus increases. As a result, patients are usually most likely to infect others at a severe stage of the disease, when they are visibly, and physically, too ill to travel. 
• There is no cure. 
• Early detection and supportive care greatly improve prospects for survival. 

Read about the WHO announcement of the gravity of the EVD situation here, and how India and Singapore have prepared for the disease.

Singapore is on standby to act on Ebola

Singapore's Ministry of Health (MOH) has gone beyond WHO recommendations for Ebola virus disease (EVD), which it says it has already put in place as part of its preparedness plan against EVD. It is also ready to calibrate its measures as the situation evolves.

As recommended, the ministry is raising the awareness and knowledge of travellers about the potential risk of EVD. "Information on EVD has been provided to the public and potential travellers on MOH’s website, and in its media release issued on 7 August. Singaporeans have been advised to avoid non-essential travel to affected areas. Instructions have also been provided on precautions to take if there is a need to travel to affected areas," the ministry stated in a release on 8 August.

At the same time, all medical practitioners and hospitals have been alerted, through professional circulars, to the EVD situation in West Africa. "They are advised to remain vigilant to pick up cases of EVD early amongst patients with compatible symptoms and a travel history to affected areas. MOH has also provided guidance on the criteria for defining suspect EVD cases, and on how to notify MOH of such cases," the ministry said.

Singapore is no stranger to preparedness procedures for infectious diseases since dealing with SARS in 2003. According to the Ministry of Health, all public hospitals have put in place infection control procedures in the event of an imported EVD case. Processes have also been put in place include:

• Sending samples for EVD testing at the National Public Health Laboratory’s designated testing facilities. 
• Centralising the management of suspect cases of EVD in Tan Tock Seng Hospital (TTSH). Suspect cases who are seriously ill will be transported in specially configured ambulances, and all suspect cases will be managed in negative pressure isolation rooms with strict infection control procedures.

Contingency plans are also in place at Singapore's Changi Airport to manage passengers with signs of EVD. In 2013, Changi saw 53.7 million passengers arriving and departing. Such passengers will be isolated and transferred using a portable medical isolation unit (PMIU) to TTSH for further management.

Precautionary measures in Singapore's preparedness against EVD over and above the WHO recommendations include border health measures as well as contact tracing and quarantine. MOH has worked with the Civil Aviation Authority of Singapore (CAAS), the Immigration & Checkpoints Authority (ICA) and the Changi Airport Group (CAG) on border health measures. Individual health advisory notices (HANs) have been distributed to nationals from the affected areas at air and land checkpoints since 2pm on 7 August 2014.

The HAN advises travellers to consult a doctor early, and inform the doctor of their travel history if they become unwell, with sudden onset of high fever, stomach pains, diarrhoea, vomiting, rash or bleeding, within three weeks of being in any of the affected areas in West Africa. Similar advice is provided in Health Advisory posters at land and air checkpoints, which have been progressively put up from 8 August.

The MOH says it has been ready to conduct contact tracing in the event of a confirmed case of EVD since the beginning of the outbreak in West Africa. All close contacts will be quarantined and monitored for up to 21 days, either in their homes or in the Government Quarantine Facility (GQF) in Pasir Ris.

Read about the WHO announcement here.

India's preparedness measures are here.

India institutes Ebola preparedness measures

The Indian government is performing "intensive surveillance" to prevent the spread of Ebola virus disease (EVD) in the country. There are three local helpline numbers: 2306 3205, 2306 1469 and 2306 1302 operational as of 9 August at the Health Ministry to field calls.

Dr Harsh Vardhan, Minister for Health, has clarified that India does not have any confirmed or suspected Ebola victims. However, WHO had informed the government that one Indian passenger had travelled on the same flight on which an Ebola virus patient had travelled on, from Monrovia in Liberia to Lagos in Nigeria. Both countries are dealing with EVD outbreaks.

Thirty calls have been fielded so far. “Most of the callers to the helpline reflected a mature understanding of the collective responsibility in times like this. They wanted to know details about the symptoms and preventive measures,” Dr Vardhan said.

According to the government, the Indian passenger is back in India and being monitored. The Health Minister said: “We are happy to share that the said person is healthy, fit and fine.”

The government has already implemented the following steps:

1. Tracking of passengers arriving from the affected countries by the Airport Health Organizations based on the information provided by Ministry of External Affairs

2. Tracking and monitoring health of passengers, who travelled from the affected countries, in their respective States, by the Integrated Disease Surveillance Programme.

3. Designation of Dr. RML Hospital, New Delhi for management of cases in Delhi. The hospital has earmarked treatment facilities and a Nodal Officer.

4. The Government has advised Indians against non-essential travel to the four West African countries – Guinea, Liberia, Sierra Leone and Nigeria – which form the epicentre of EVD.

Read about the WHO announcement and the response from airlines here.

World Health Organization calls Ebola outbreak a public health emergency of international concern

The World Health Organization (WHO) has warned 8 August that the Ebola outbreak in West Africa is a Public Health Emergency of International Concern (PHEIC).

As of 4 August 2014, there have been 1,711 cases (1,070 confirmed, 436 probable, 205 suspect) of Ebola virus disease (EVD), including 932 deaths. Between 5 and 6 August 2014, a total of 68 new cases of EVD (laboratory-confirmed, probable, and suspect cases) as well as 29 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.

On 6 August, a Saudi man suspected of being infected with the Ebola virus passed away at 8.45am at a specialised hospital in Jeddah, Saudi Arabia. The patient had been admitted to the intensive care unit late on 4 August after exhibiting symptoms of viral hemorrhagic fever following a business trip to Sierra Leone, Saudi's Ministry of Health said. The cause of the infection is still under investigation, and people who had been in contact with the man are being traced or monitored for symptoms of Ebola.

The WHO further provides the following recommendations for states which are currently not affected by EVD nor adjacent to a state which is affected:

• There should be no general ban on international travel or trade; restrictions outlined in recommendations regarding the travel of EVD cases and contacts should be implemented.
• States should provide travelers to Ebola affected and at-risk areas with relevant information on risks, measures to minimise those risks, and advice for managing a potential exposure. 
• States should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD and, where appropriate, the capacity to manage travelers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained febrile illness (fever). 
• The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure. 
• States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola. 

On 11 August, WHO will convene a panel of medical ethics experts to begin looking at the use of experimental treatments in the ongoing EVD outbreak in West Africa. At this time, there are no registered medicines or vaccines against this deadly virus, though several experimental options are currently under development.

Emirates has already suspended flights to Conakry in Guinea until further notice due to the Ebola outbreak, the company said on its website. "We apologise for any inconvenience caused to our customers, however the safety of our passengers and crew is of the highest priority and will not be compromised," the company stated, asking affected customers to contact their travel agent or Emirates Call Centres for rebooking options, and visit the website for further updates.

Airlines flying to Sierra Leone include British Airways and Air France. British Airways has cancelled flights to Sierra Leone and Liberia till August 31. Air France also flies to Guinea, while Lufthansa flies to Nigeria.

Gulf Business has also reported that hajj visas are not being issued to pilgrims of the affected countries.

View the latest FAQ on EVD here.
Read about Singapore's preparedness activities here. Read about what India is doing about tracking nationals exposed to Ebola here.