Ebola virus disease - Frequently asked questions

Background information

General advice

The UK situation

UK screening

How do Ebola outbreaks start?

It's thought the Ebola virus has been living harmlessly in fruit bats for many years, building up in this population and spreading to other forest animals, including chimpanzees and gorillas.

It's likely the virus makes its way into people after they butcher or handle dead animals contaminated with the virus.

How does it spread among people?

People can become infected with the Ebola virus if they come into contact with the blood, body fluids or organs of an infected person.

Most people are infected by giving care to other infected people, either by directly touching the victim's body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood.

Traditional African burial rituals have also played a part in its spread. The Ebola virus can survive for several days outside the body, including on the skin of an infected person, and it's common practice for mourners to touch the body of the deceased. They only then need to touch their mouth to become infected.

Other ways people can catch Ebola are:

touching the soiled clothing of an infected person, then touching their mouth
having sex with an infected person without using a condom (the virus is present in semen for up to seven weeks after the infected person has recovered)
handling unsterilised needles or medical equipment that were used in the care of the infected person

A person is infectious as long as their blood, urine, stools or secretions contain the virus.

Ebola virus disease is generally not spread through routine social contact (such as shaking hands) with patients who do not have symptoms.

The virus is not, for example, as infectious as diseases such as the flu, as airborne transmission is much less likely. You'd need to have close contact with the source of infection to be at risk.

Who is at risk?

Anyone who cares for an infected person or handles their blood or fluid samples is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk.

Strict infection control procedures and wearing protective clothing minimises this risk – see What's the advice for healthcare and aid workers? Simply washing hands with soap and water can destroy the virus.

What are the symptoms?

An infected person will typically develop a fever, a headache, joint and muscle pain, a sore throat, and intense muscle weakness. These symptoms start suddenly between 2 and 21 days after becoming infected.

Diarrhoea, vomiting, a rash, stomach pain, and impaired kidney and liver function follow. The patient then bleeds internally, and may also bleed from the ears, eyes, nose or mouth.

Ebola virus disease is fatal in 50-90% of cases. The sooner a person is given care, the better their chances of survival.

How is it treated?

There's currently no licensed treatment or vaccine for Ebola virus disease, although potential new vaccines and drug therapies are being developed and tested.

Patients need to be placed in isolation in intensive care. Dehydration is common, so fluids may be given directly into a vein (intravenously).

Blood oxygen levels and blood pressure need to be maintained at the right level and body organs supported while the patient's body fights the disease and any other infections are treated.

ZMapp is an experimental treatment that can be tried, although it has not yet been tested in humans for safety or effectiveness. The product is a combination of three different antibodies that bind to the protein of the Ebola virus.

What is the UK government doing to respond to the Ebola crisis?

The UK is co-ordinating and leading the response to Ebola in Sierra Leone, and has committed to provide 700 Ebola treatment beds in at least four treatment centres in areas where the need is greatest.

To provide staff for these facilities, the UK will scale up the national Ebola Training Facility (which already trains 90 health workers a week) to train Sierra Leonean and international staff.

Public Health England staff have also been on the frontline as part of the international effort to tackle Ebola in West Africa. They have been supporting the Sierra Leone Ministry of Health by providing expert guidance on managing the outbreak and preventing the spread of the virus.

What is being done to try to find new treatments or cures?

The UK government, alongside the Wellcome Trust and the Medical Research Council, has co-funded clinical trials of a potential vaccine for Ebola virus disease.

What's the advice for healthcare and aid workers?

Any area affected by an outbreak should be immediately quarantined and patients treated in isolation.

Healthcare workers need to avoid contact with the bodily fluids of infected patients by taking the following precautions:

wear face masks, goggles, gowns and gloves
take extra care when handling blood, secretions and catheters, and when connecting patients to a drip
disinfect non-disposable medical equipment before reuse
sterilise and dispose of used needles and disposable equipment carefully
properly dispose of any secretions or body waste from the patient
carefully and frequently wash hands with soap and water (use alcohol hand rub if soap isn't available)
wash disposable gloves with soap and water after use, dispose of them carefully, then wash hands

Public Health England has developed a leaflet recommending the precautions humanitarian workers should take, as well as providing advice about what they should do if they suspect an infection. Read the leaflet for humanitarian aid workers on the GOV.UK website.

What's the advice for travellers in at-risk areas?

Following these simple precautions will minimise your risk of catching Ebola virus disease:

don't handle dead animals or their raw meat
don't eat bushmeat
avoid contact with patients who have symptoms
avoid having sex with people in risk areas (use a condom if you do)
make sure fruit and veg is washed and peeled before you eat it
wash hands frequently using soap and water (or alcohol hand rubs when soap is not available) as this destroys the virus

If you think you or a family member has symptoms of Ebola infection:

visit a healthcare provider immediately and inform them that you may have had contact with the Ebola virus (the nearest Embassy or Consular Office can help you find a provider in the area)
limit contact with others and avoid all other travel

It's more likely the cause of your symptoms is another disease, such as malaria, but you may need to be tested for Ebola as a precaution.

What if I think I might have Ebola in the UK?

If you feel unwell with symptoms such as fever, chills, muscle aches, a headache, nausea, vomiting, diarrhoea, a sore throat or a rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately telephone 111 or 999 and explain that you have recently visited West Africa.

These services will provide advice and arrange for you to be seen in a hospital if necessary so the cause of your illness can be determined.

There are other illnesses that are much more common than Ebola (such as flu, typhoid fever and malaria) that have similar symptoms in the early stages, so proper medical assessment is really important to ensure you get the right diagnosis and treatment.

It is also really important that medical services are expecting your arrival – calling 111 or 999 will ensure this happens.

What guidance has the UK government given schools and universities?

Guidance has been developed to assist universities and other further educational establishments that may have students returning or visiting from affected countries. Read the official guidance for educational establishments on the GOV.UK website.

How is it diagnosed?

It's difficult to know if a patient is infected with Ebola virus in the early stages as symptoms such as fever, headache and muscle pain are similar to those of many other diseases.

But specialist infection clinicians will make expert judgements on what the most likely diagnosis is based on the patient's history. If Ebola is considered a possibility on this basis, then a person would be tested for the disease.

Samples of blood or body fluid can be sent to a laboratory to be tested for the presence of Ebola virus, and a diagnosis can be made rapidly.

A suspect case would be isolated in a side room to minimise contact with other people while they are being tested. It is only if this test is positive that the case is considered to be "confirmed".

If the test is positive, the person will be transferred to a hospital-based high-level isolation unit.

If the result is negative, doctors will test for other diseases, such as malaria, typhoid fever and cholera.

Why is the risk low for people in the UK?

The likelihood of catching Ebola virus disease is considered very low unless you've travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects.

While it is possible that people infected with Ebola can arrive in the UK on a plane, the virus is not as easily transmitted as a respiratory virus such as influenza.

In past outbreaks, infection control measures have been very effective at containing Ebola within the immediate area. The UK has a robust public health system with the trained staff and facilities necessary to contain cases of Ebola.

Advice has been issued to the Border Force to identify possible cases of Ebola, and there are procedures in place to provide care to the patient and minimise the public health risk to others.

Also, people infected with Ebola do not become infectious until shortly before they develop symptoms. The disease then progresses very rapidly. This means infectious people do not walk around spreading the disease for a long period.

It typically takes 5-7 days for symptoms to develop after infection, so there is time to identify people who may have been exposed, put them under surveillance and, if they show symptoms, quarantine them.

Flight crew are trained to respond swiftly to any passengers who develop symptoms during a flight from Africa. They will take measures to reduce transmission onboard the plane. But this event is very unlikely, and so far there have been no documented cases of people catching the disease simply by being on the same plane as an Ebola victim.

I may have been on a flight with someone with Ebola. Am I at risk?

You cannot catch Ebola through social contact or by travelling on a plane with someone who is infected without coming into direct contact with the blood or body fluids of an infected person.

Cabin crew who identify a sick passenger with a suspected infectious disease onboard, and ground staff who receive the passenger at the destination, follow the International Air Transport Association guidelines for suspected communicable diseases (PDF, 37kb).

If there is someone unwell onboard a flight, the pilot of the aircraft is legally required to inform air traffic control. Arrangements will be made for medical assessments for the person on arrival. The exact arrangements will depend on the airport involved.

The local public health team would be alerted if there was a possibility that the individual was suffering from an infectious disease so appropriate public health action could be initiated.

Now a case of Ebola has been confirmed in the UK, will we see an outbreak similar to West Africa?

A case of imported Ebola is extremely unlikely to result in a large outbreak in the UK. England has a world-class healthcare system with robust infection control systems and processes, and disease control systems that have a proven record of dealing with imported infectious diseases.

Is there a risk of Ebola transmission from illegal bushmeat?

The risk to the UK population of acquiring Ebola virus from bushmeat is very low.

It is illegal to import bushmeat into the UK. Cooking will kill the virus, but there is some risk in handling raw bushmeat. The official Food Standards Agency advice has always been that people should avoid illegal bushmeat, as you can never be certain of its safety.

Is there a risk of catching Ebola virus from sweat left on gym equipment?

It's unlikely a person who has symptoms of Ebola virus disease would be well enough to go to the gym – and, until they have symptoms, they are not infectious. The World Health Organization (WHO) says whole live virus has never been isolated from sweat.

What actions are being taken to halt the virus from coming to the UK?

The UK recently introduced a screening procedure at key UK ports, starting at Heathrow. The aim is to ensure that as many people as possible arriving from infected countries know the symptoms and how to get access to healthcare services as quickly as possible.

Why is the UK implementing screening?

The purpose of screening is to identify, and give advice to, passengers coming from high-risk areas who will be spending time in the UK. This is to provide them with relevant advice on the nature of the virus, what to be aware of, and what action to take should they begin to display any symptoms.

Does this mean the risk to the UK has increased?

No. The risk remains low, but the government is looking at the best options for keeping people safe.

Who will be affected by screening in the UK?

Using existing Border Force technology, passenger data will be used to identify those passengers who have recently travelled from Liberia, Sierra Leone and Guinea on routes with onward connection to the UK.

What is the screening process?

All those travelling from the affected countries will have their temperature taken and complete a questionnaire asking about their current health, recent travel history, and whether they might be at potential risk through contact with Ebola patients.

Based on the information provided and their temperature, passengers will either be given advice and allowed to continue their journey, or will undergo a clinical assessment by healthcare staff. If necessary, they'll be transferred to hospital for further tests.

Anyone who is well but may have been at increased risk of contact with the Ebola virus will be given printed information and a telephone number to call if they develop symptoms.

Where will the screening take place?

The government has currently asked for screening at Heathrow and Gatwick airports and at Eurostar terminals. Introducing screening at Heathrow and Gatwick will cover approximately 90% of passengers coming from the affected region with through tickets to the UK.

What about other airports?

Plans are in place for a further roll-out to other UK ports, if necessary. Screening has started at the highest risk airports, where most connecting flights from the affected regions arrive. This will be kept under review and the government will look at what further action is needed based on the latest medical advice.

How many people do you expect to check?

Less than 1,000 passengers arrived by air from the affected countries in September 2014, and around 85% arrived at Heathrow.

How will you know who to check?

Border Force, working with airlines, has the flight details of where people have been flying from with single tickets. It's also possible to identify passengers travelling on indirect connections.

Will this screening process stop cases arriving?

This is just one part of the screening process. Public Health England is also working with the international community and local health authorities to ensure robust exit screening remains in place at airports in Sierra Leone, Guinea and Liberia, which will pick up anyone with symptoms before they leave these countries.

Although no system can completely prevent a case of Ebola coming into the UK, the screening process will ensure that individuals at risk know exactly what to do if they start to feel ill and can get in touch with the expert advice they need immediately.

Where can I find information on the test for Ebola?

There is published guidance on the appropriate pathway for testing for Ebola virus disease, which includes samples to be taken, turnaround time for results, and other tests that may be carried out to look for alternative causes of illness. Read the guidance on Ebola testing on the GOV.UK website.

What is the process a patient will go through from being a possible to a confirmed case?

If a patient is thought to possibly be infected with Ebola, they would be tested for the disease (see above).

The person will be isolated in a side room, and healthcare staff treating the patient will wear personal protective equipment such as face masks, goggles, gowns and gloves. The case is only considered "confirmed" if tests come back positive.

A patient with a confirmed Ebola infection will be transferred to a high-level isolation unit at the Royal Free Hospital in London.