Ebola disease: information sheet for category 4 returnees from an Ebola-affected area
Advice for workers returning from an Ebola-affected area who have had high risk contact with Ebola.
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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 had close contact or direct with someone with Ebola disease, you should stay at home and away from other people for 21 days after your last exposure to Ebola and regularly check yourself for symptoms of Ebola disease. 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 continue to 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 are a household or overnight contact of a confirmed symptomatic case
or
- you have had significant exposure to material from a confirmed case, for example a needlestick injury or body fluids from a case of Ebola disease splashed on your mucous membranes
Because of your level of exposure, you are at risk of developing Ebola disease. We would therefore like to closely monitor you for a period of 21 days from when you were last exposed to Ebola. You should also carry out the actions listed below to minimise the risk to you and others close to you.
What you need to do
Because you are at risk of developing Ebola disease, you should take the following actions for the 21 days from when 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 that you would otherwise have come into contact with, particularly vulnerable people that you may normally have contact with as part of your work:
- self-isolate in private accommodation (unless an alternative arrangement has been agreed with UKHSA and your deploying organisation). See the information below on how to self-isolate. It is particularly important to self-isolate in order to protect your family, friends, and wider community (particularly vulnerable people that you may normally have contact with as part of your work) from any potential exposure to Ebola disease.
- record your temperature and monitor yourself for other symptoms of Ebola disease twice per day at the same times each day
- report these temperatures to your designated UKHSA contact (see below for details) by 12 noon each day. They will want to know whether your temperature is below, equal to or above 37.5°C, and will arrange further evaluation as necessary. They will explain the local arrangements for accessing healthcare
- if you become ill with any of the symptoms listed above in between reporting to your designated contact, take your temperature and phone your designated UKHSA contact immediately. See below for further information on what you should do if you become ill
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.
Depending on the strain of Ebola that you have been exposed to, you may be offered a vaccine to prevent you from developing Ebola, or, if you do develop Ebola disease, to help to prevent you from becoming very sick. You should still report any symptoms that you develop, however mild, to your designated contact.
How to self-isolate
You should self-isolate for 21 days from when you were last exposed to Ebola. This means you should stay at home and not go to work, school or public areas. You should not travel, either within the UK or internationally. Self-isolating is important as it the most effective method of protecting your loved ones and the wider community from potential exposure to Ebola.
You should self-isolate in a separate room from other members of your household, and avoid all contact with them, including sexual contact. You should sleep in a separate room to other people and use separate bathroom facilities for going to the toilet and for washing.
You should only leave your home if it is essential, for example in an emergency, for an urgent medical appointment, or for urgent health and wellbeing issues. If there is time for you to contact your designated contact before leaving your home, phone them on the number listed at the top and bottom of this sheet. If you cannot phone your designated contact before leaving your home, you should phone them when it is safe for you to do so after leaving your home. You should also not have visitors to your home.
If you need help with groceries or other essentials, ask friends or family to drop your shopping off, or order online. Ask your friends, family or delivery drivers to leave your shopping at your front door to avoid contact with them.
Do not share items which you use, such as bedding, towels, wash cloths, toothbrushes, or razors. You should also use separate items for eating and drinking, such as cutlery, cups, or plates, to other people in your household.
Postpone any non-essential medical or dental treatment. You should discuss any essential treatment required with your designated contact before attending a healthcare facility.
After 21 days, if you do not develop any symptoms of Ebola disease, you should be able to resume normal activities following advice from your UKHSA designated contact. If you are a healthcare worker, UKHSA will contact your occupational health team to support with clearance for you to resume patient care.
If you are finding it difficult to follow any of this advice, phone your designated contact using the number given at the beginning and end of this document to discuss.
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
If you are feeling unwell or develop any of the symptoms of Ebola disease (including a temperature of 37.5°C or higher) within the 21 days from when you were last exposed to Ebola please remain 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. If there is any delay in making contact, phone 111 reporting your recent contact with someone with Ebola disease. In an emergency, you should call 999 and tell them about your symptoms and your recent contact with Ebola.
Your designated UKHSA contact number is 020 8745 7209.
More information
More information about Ebola disease can be found at: