On 8 August 2014, WHO declared the Ebola outbreak in West Africa to be a Public Health Emergency of International Concern (PHEIC) because,
- the Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
- the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.
- a coordinated international response is deemed essential to stop and reverse the international spread of Ebola.
The WHO encouraged all countries to ensure that:
- There should be no general ban on international travel or trade; restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented.
- States should provide travellers to Ebola affected and at-risk areas with relevant information on risks, measures to minimize 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 travellers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained febrile illness.
- 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.
My Department continues to work closely with the HSE, the WHO, the European Centre for Disease Prevention and Control (ECDC), the EU Commission, Member States and other partners.
The Management of Viral Haemorrhagic Fevers in Ireland is the national guidelines for the management of any case of VHF, including Ebola, in Ireland. They were published by the Health protection Surveillance Centre (HPSC) in 2012. Parts of this guidance have been updated in light of the recent EVD outbreak in West Africa.
The key elements of the guidelines include:
- the need for vigilance in considering the possibility of VHF in a person with a fever who has recently returned (within 21 days) from travel to an endemic area,
- the institution of appropriate infection control measures if a case is suspected,
- rapid testing and diagnosis of the case, and
- the management of his/her contacts.
Given appropriate infection control measures, onward transmission to others is extremely unlikely.
On 29 May 2013 a VHF education day was held for relevant professionals to launch guidance on Management of VHF produced by the Scientific Advisory Committee of the HPSC. This education day concentrated particularly on providing a practical guide to the management of an imported VHF case, including ambulance transfer.
Following the announcement on 8 August 2014 a number of additional actions in relation to guidance, communications and transport were put in place, beyond those already in existence. An urgent teleconference was convened between the Department of Health, the HPSC, HSE-Public Health, HSE-Emergency Preparedness and HSE-Communications to review the following areas:
- Travel advice – advice would issue from DOH advising against non-essential travel
- Posters in airports
- Repatriation of Irish citizens
In addition, the HSE’s Port Health Group – a group tasked with providing guidance and advice in relation to measures in ports and airports.
On the day of the announcement, advice for travellers, including features of the disease, modes of transmission, and methods to prevention were posted on the HPSC website. An extensive Ebola virus disease travel section was developed as a portal for those who would travel between West Africa and Ireland.
The advice document Advice for healthcare workers, including humanitarian aid workers, returning to or coming to Ireland following travel from an area affected by the Ebola Virus Disease (EVD) outbreak (most recent version 5 September 2014) was produced and posted on the HPSC’s website.
Advice for airport and port managers that had been developed was circulated to all relevant stakeholders. This information has been posted on the website for the HPSC. The guidance document, Update for Airport Managers and Airlines on Ebola Virus Disease was posted on 22 August 2014 and the guidance document Update for Port Managers and Ferry Companies on Ebola Virus Disease was posted on 5 September 2014.
Posters (in English, French and Irish) - Returning from West Africa? Important information about Ebola – were printed and distributed to all Airports and the main designated Seaports. They have been placed in prominent positions in full line of sight of all arriving passengers/crews in the arrivals areas of these locations.
Following the declaration of PHEIC, a modified EVD Risk Assessment for use by Ambulance Personnel was developed from an existing document to ensure that transport of suspected EVD patients was placed on a clear and systematic footing. This document provides highly specific guidance for ambulance personnel on the transfer of patients suspected as having EVD. This algorithm allows for remote risk assessment of a patient suspected as having EVD arriving at one of the country’s airports, by an expert physician from the National Isolation Unit in the Mater Hospital. This guidance document lays out clear procedures whereby ambulance personnel would protect themselves and others from possible infection. It stipulates the necessary isolation of a potentially infected person, personal protective equipment to be deployed by ambulance crews and the necessary urgent communication pathways required.
Beyond this initial contact, extensive guidance is also available for hospital clinicians, general practitioners and other healthcare workers, to enable rapid identification of suspected Ebola patients, in other settings, and their urgent management. There is also extensive guidance on the necessary steps that staff must take to ensure that they protect themselves and other patients.
Healthcare staff in the NIU and hospitals around the country have received information and advice on identification and management of EVD. In addition, staff in the National Isolation Unit (NIU) have received specific training in the use of the appropriate PPE to be used in the management of a suspected EVD patient.
There is ongoing contact between my Department and the Department of Foreign Affairs and Trade and updated travel advice is available on the Foreign Affairs' website. The Department of Foreign Affairs and Trade strongly advises against all non-essential travel to Liberia, Guinea and Sierra Leone.
In conclusion, considerable public health planning is underway with a range of bodies and professionals in relation to the Ebola emergency in West Africa.
