Ebola disease: information sheet for category 2 returnees from an Ebola-affected area
Advice for workers returning from an Ebola-affected area who have been close to someone with Ebola while wearing personal protective equipment (PPE).
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You have been given this information sheet because you have been working in an area affected by Ebola disease. As you reported that you were close to someone with Ebola disease, or material contaminated with a virus that causes Ebola disease, you should follow the advice in this information sheet and check yourself for symptoms for 21 days after you were exposed to Ebola. This is important to both help make sure you can receive prompt treatment if you need it, and to protect your loved ones and wider community from any potential exposure to Ebola disease. If you develop symptoms of Ebola disease within 21 days of your last exposure to Ebola, you should stay at home and call your designated contact immediately.
Your designated UKHSA contact number is 020 8745 7209
About Ebola disease
Ebola disease is a rare but serious disease caused by orthoebolaviruses. There are 6 identified species of orthoebolavirus, 4 of which cause disease in humans.
Outbreaks of Ebola disease have previously occurred in the Democratic Republic of the Congo (DRC, formerly Zaire), Sudan, Gabon, Uganda, and the Republic of Congo.
In 2014, Ebola disease outbreaks occurred for the first time in West Africa, in Guinea, Liberia and Sierra Leone, and in these countries there was intense transmission in urban areas.
How Ebola spreads
The viruses that cause Ebola disease can spread by:
- direct contact with the organs, blood, secretions, or other bodily fluids of an infected person (including sexual transmission)
- contact with objects, such as needles or soiled clothing, that have been contaminated with infected secretions
- contact with an infected animal, such as chimpanzees, gorillas or fruit bats, either if they are found ill or dead, or collected as bushmeat
Ebola viruses are not spread through routine, social contact (such as shaking hands or sitting next to someone) with people who do not have symptoms. There is no evidence that Ebola viruses can spread through the air.
It can take up to 21 days from when someone is exposed to the virus or symptoms to appear.
Symptoms of Ebola disease
The onset of illness is sudden, with:
- high fever
- severe headache
- intense weakness
- muscle pain
A few days later symptoms can include:
- severe watery diarrhoea
- abdominal pain
- abdominal cramping
- nausea
- vomiting
Some patients with severe illness may develop internal and external bleeding.
Ebola disease is fatal in between 25% to 90% of all clinically ill cases, depending on the virus strain, the person’s age, and other factors including whether the person has a weakened immune system. Starting supportive treatment promptly after symptoms begin can improve the likelihood of surviving the disease.
Preventing and treating Ebola disease
There are currently 2 licensed vaccines that offer protection from Zaire orthoebolavirus, which is the species of orthoebolavirus that has caused most of the large outbreaks. Vaccines are used to protect high risk individuals (for example, frontline workers and those reporting high risk contacts with confirmed cases) during outbreaks. There are no licensed vaccines for the other strains of orthoebolaviruses that affect humans.
To avoid orthoebolaviruses spreading between people, those caring for individuals with possible or suspected Ebola disease should avoid contact with the patient’s bodily fluids and should wear personal protective equipment (PPE).
Treatment for Ebola disease is with supportive care, including balancing fluids and electrolytes, maintaining a person’s oxygen status and blood pressure, and treating any co-infections. Supportive care improves survival, particularly if started early.
Currently, there are 2 approved antiviral treatments that can be used for Ebola disease caused by Zaire orthoebolavirus, known as monoclonal antibodies. These are available in the UK as well as supportive care.
Your risk of developing Ebola disease
You reported that:
- you did not have direct physical contact as part of providing clinical care, but you were close (within 2 metres) to someone who had Ebola disease, or their body fluids, while wearing appropriate PPE
or
- you did not clinically care for someone with Ebola disease, but you may have been exposed to contaminated materials including body fluids while wearing appropriate PPE
We would like to monitor you for a period of 21 days from your last possible exposure to Ebola. This will mean that we can act quickly in the unlikely event that you develop symptoms, reducing the risks to you and to others close to you.
What you need to do
Your family and household contacts are not at risk of catching Ebola disease from you if you do not have any symptoms. However, we are advising you to take certain public health actions in the 21 days after your last exposure in order to help protect other people in the event that you did develop symptoms, particularly those who are most vulnerable to severe illness.
You should take the following actions for 21 days after you were last exposed to Ebola. These public health recommendations will help to make sure that you can receive prompt treatment if you need it, and will help to protect the people you live with, and any other people you come into contact with , particularly vulnerable people that you may normally have contact with as part of your work:
- record your temperature and monitor yourself for other symptoms suggestive of Ebola disease (as listed above) twice per day at the same times each day
- report to your designated UKHSA contact (see below for their details) if you develop a temperature of 37.5°C or higher, or other symptoms, so that they can arrange for you to be assessed. They will explain the local arrangements for accessing healthcare
- you may return to work. However, if you have direct physical contact with other people as part of your job, for example as a healthcare worker, you should not have direct contact with or provide direct care to other people for 21 days
- there are no restrictions on travel or social activities
- do not share towels, bed linen, toothbrushes or razors
- use barrier contraception or avoid unprotected sexual contact with other people
- postpone any non-essential medical or dental treatment including vaccination. If you need essential medical or dental treatment, inform your healthcare provider about your travel and work in an Ebola-affected area
If you are finding it difficult to follow this advice, phone your designated contact using the phone number at the beginning and end of this document to discuss.
If it is not clear when your last exposure to Ebola was, your designated UKHSA contact will discuss with you about how long you should carry out these actions for. This may be up to 21 days after leaving the Ebola-affected area.
Use of medicines such as aspirin, paracetamol or ibuprofen
Certain medicines, such as paracetamol, ibuprofen and aspirin, can reduce your body temperature during a fever (antipyretic) for up to 8 hours. Thermometer measurements may therefore show a lower temperature than would be expected for up to 8 hours after taking an antipyretic.
You must call your designated UKHSA contact for further advice if you need to take an antipyretic medicine.
Please take your temperature before you take paracetamol, ibuprofen or aspirin. If your temperature is 37.5°C or higher, you must call your designated UKHSA contact immediately.
A temperature of 37.5°C or higher is always significant, whether you are taking one of these medicines or not, and must be reported urgently.
What to do if you become ill
It is unlikely that you have caught Ebola disease. However, if you are feeling unwell or develop any of the symptoms of Ebola disease (including a temperature of 37.5°C or higher) within 21 days from when you were last exposed to Ebola, stay at home and away from other people. Take your temperature if you have not done this already. Phone your designated UKHSA contact immediately (see below for details), who will arrange for you to be assessed by an appropriate clinician. In an emergency, you should call 999 and tell them about your symptoms and possible contact with Ebola.
Your designated UKHSA contact number is 020 8745 7209.
More information
More information about Ebola disease can be found at: