Ebola in Liberia

Warning - Level 3, Avoid Nonessential Travel

Alert - Level 2, Practice Enhanced Precautions

Watch - Level 1, Practice Usual Precautions

Updated: November 16, 2014

CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leonebecause of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick, because of the possibility they may be sick with Ebola.

At a Glance

Total Cases: 6878
Laboratory-Confirmed Cases: 2562
Total Deaths: 2812

What is the current situation?

An outbreak of Ebola has been ongoing in Liberia since March 2014. Outbreaks are also occurring in Guinea, Mali, and Sierra Leone; these outbreaks of Ebola are the largest and most complex in history. Civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health infrastructure of Liberia is being severely strained as the outbreak grows.

CDC recommends that US residents avoid nonessential travel to Liberia. If you must travel, such as for humanitarian aid work in response to the outbreak, protect yourself by following CDC’sadvice for avoiding contact with the blood and body fluids of people who are sick with Ebola.

This recommendation to avoid nonessential travel is intended to help control the outbreak and prevent continued spread in two ways: to protect US residents who may be planning travel to the affected areas, and to enable the Liberian government to respond most effectively to contain this outbreak. CDC is committed to the multinational effort to help Liberia control the outbreak and is scaling up its response activities by, among other things, deploying additional staff to the affected countries. Substantial international humanitarian assistance is required, and CDC encourages airlines to continue flights to and from the region to facilitate transport of teams and supplies essential to control the outbreak. Healthcare and management experts who have specialized skills and experience working in this kind of environment are needed to help in countries with Ebola. All aid workers should be affiliated with a recognized humanitarian aid organization.

For more information, visit 2014 Ebola Outbreak in West Africa on the CDC Ebola website.

What is Ebola?

Ebola is a rare and deadly disease. The disease is caused by infection with one of the Ebola virus species (Zaire, Sudan, Bundibugyo, or Tai Forest virus). Ebola is spread by direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola,
objects (like needles and syringes) that have been contaminated with the virus, and
infected fruit bats or primates (apes and monkeys).

Signs of Ebola include fever and symptoms such severe headache, fatigue (feeling very tired), muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.

Who is at risk?

Travelers could be infected if they come into contact with blood or body fluids from someone who is sick or has died from Ebola. Healthcare workers and the family and friends in close contact with Ebola patients are at risk of getting sick because they may come in contact with infected blood or body fluids.

People also can become sick with Ebola if they come into contact with infected wildlife or raw or undercooked bushmeat (wild animals hunted for food) from an infected animal.

What can travelers do to prevent Ebola?

There is no approved vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.

Avoid nonessential travel to Liberia, Guinea, and Sierra Leone.
If you must travel, please make sure to do the following:
- Before your trip, check your health insurance plan to learn what is covered in the event that you become sick. CDC recommends that anyone traveling to Liberia have full coverage, including coverage for emergency medical evacuation.
  - Information about medical evacuation services can be found on the US Department of State’s website on the Air Ambulance/MedEvac/Medical Escort Providers page.
  - Some insurance providers are excluding medical evacuation coverage for people who have Ebola. Check with providers to ensure you have the coverage you need.
  - Be sure to check the coverage limits for evacuation insurance. Also check to see if the policy covers evacuation to the United States or to the nearest location where adequate medical care is offered.
- Practice careful hygiene. For example, wash your hands frequently with soap and water or use an alcohol-based hand sanitizer.
- Avoid contact with blood and body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen).
- Do not handle items that may have come in contact with an infected person’s blood or body fluids.
- Avoid contact with dead bodies, including participating in funeral or burial rituals.
- Avoid contact with animals (such as bats or monkeys) or with raw or undercooked meat.
- Do not eat or handle bushmeat (wild animals hunted for food).
- Avoid hospitals in West Africa where Ebola patients are being treated. The US Embassy or consulate is often able to provide advice on facilities that are suitable for your medical needs. The US Embassy Monrovia can be reached at +(231) 77-677-7000.
- Seek medical care immediately if you develop fever (100.4°F / 38°C or above) or other symptoms such as severe headache, fatigue (feeling very tired), muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising.
  - Limit your contact with other people when you travel to the doctor. Do not travel anywhere else.

Special Recommendations for Travelers Who Will Be Working in Healthcare Settings

If you will be working in a healthcare setting while in Liberia, you should be prepared to care for patients in a region where resources are limited and the healthcare system is strained.

How can I be exposed to Ebola?

You can be exposed to the Ebola virus if you have contact with blood or body fluids (such as urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person sick with Ebola without wearing the right protective clothing and equipment. For healthcare workers, this includes wearing a face shield or goggles, a medical mask, double gloves, a waterproof gown or coveralls, an apron, and waterproof boots.

This kind of exposure can happen if you —

Are stuck with a needle or splashed in the eye, nose, or mouth with blood or body fluids of someone sick with Ebola.
Handle blood or body fluids of a sick Ebola patient.
Touch a person who is sick with Ebola.
Touch the body of someone who died from Ebola.
Care for or live with a person who is sick with Ebola.
Spend a long amount of time within 3 feet (1 meter) of a person who is sick with Ebola.

Healthcare workers who may be exposed to people with Ebola should be sure to follow these steps:

Wear the recommended personal protective equipment (PPE).
Use proper infection control and decontamination measures.
Isolate patients with suspected, probable, or confirmed Ebola from other patients.
Avoid direct contact with dead bodies without wearing recommended PPE.
Immediately notify your organization, health officials, and the US embassy or consulate in Liberia if you think you have been exposed to someone with Ebola but were not wearing recommended PPE.

See CDC's resources on the Ebola: Non-US Healthcare Settings page and the CDC Safety Training Course for Healthcare Workers Going to West Africa in Response to the 2014 Ebola Outbreak. The World Health Organization also has advice in their Infection prevention and control guidance for care of patients in health-care settings, with focus on Ebola

document.

Leaving Liberia

Traveling to Liberia could affect your ability to return home. Travelers leaving Liberia are being screened at airports before departure.

You should be prepared for airport screeners to check your temperature and look for signs and symptoms of illness when you leave the country. You will also be asked to answer questions about possible exposures to someone with Ebola.

After the screening, authorities will decide if and when you can continue your trip.

If you have symptoms of Ebola or have had a high risk of exposure to Ebola, you will not be allowed to travel on commercial flights to the United States and potentially to other countries.
If you have symptoms of Ebola, you will not be able to travel until your symptoms go away, unless you are being medically evacuated to receive needed care.
If you have had a high risk of exposure to Ebola but are not sick, you will either have to arrange a charter flight home or stay in Liberia until 21 days after your last exposure and authorities ensure it is safe for you to travel.

Returning to the United States

Entry Screening

The United States now requires all air travelers to the United States whose trip starts in Guinea, Liberia, or Sierra Leone to enter through one of five US airports (JFK in New York, Newark in New Jersey, Dulles in Virginia near Washington D.C., Hartsfield-Jackson in Atlanta, and O’Hare in Chicago). Beginning November 17, 2014, air travelers to the United States whose trip starts in Mali will also be required to enter the United States through one of these five airports. These airports have enhanced entry screening, which helps identify travelers who may be sick with Ebola or may have had an exposure to Ebola and ensure that these travelers are connected with a health department and given medical care, if needed.

If you are traveling from Liberia to the United States,

You should be prepared for screeners to check your temperature and look for signs and symptoms of illness. You will also be asked to answer questions about possible exposures to someone with Ebola.
You will be given a CARE (Check and Report Ebola) Kit with information about Ebola and tools to help you check your temperature and symptoms each day for 21 days.

Symptom Monitoring and Movement Restrictions

You will be connected to a health department in your final destination. Public health workers will assess your health and Ebola risk level to decide how best to monitor you for symptoms and what other restrictions may be needed.

All returning travelers will be actively monitored, which means that public health workers are responsible for checking at least once a day to see if you have a fever or other Ebola symptoms. This will continue for 21 days after the last possible exposure (such as 21 days after leaving Liberia).
You will be asked to take your temperature 2 times a day and watch yourself for Ebola symptoms.
A public health worker will tell you how to report your temperature and any symptoms each day. You might do this by phone, during a daily visit, or online.
The public health worker will also tell you what to do if you have a fever (temperature of 100.4°F/38°C or above) or other symptoms (severe headache, fatigue [feeling very tired], muscle pain, vomiting, diarrhea, stomach pain, and unexplained bleeding or bruising).
- If you have a fever or other symptoms, it is very important that you get medical care right away. Follow the directions the public health worker tells you. But if you cannot reach someone right away, you can contact your state health department or call CDC at 1-800-232-4636. If you have a medical emergency, call 911.
Based on your level of possible exposure to Ebola, your travel and public activities may be limited.

See CDC’s Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola Factsheet and theQuestions and Answers about CDC’s Ebola Monitoring & Movement Guidance to learn more.