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Ebola - questions and answers

Here you will find frequently asked questions and answers on Ebola transmission, how to protect oneself, risks by travelling to affected areas, preparedness etc.

How does the Ebola virus damage the body?

The immune cells are infected first, but then the virus also attacks other cells in the body. The liver is the organ where cell damage is most widespread, but the spleen, lungs and kidneys are also damaged. Thin capillary walls are damaged, which allows plasma to leak and bleeding. After a while, the body may go into a state of shock.

The progress of Ebola depends on many factors, including the immune system, route of infection, viral load and genetic factors in the infected person. In severe cases, multiple organ failure and shock may occur.

How is Ebola transmitted?

During an outbreak, the Ebola virus transmits from person to person through direct contact with blood and other bodily fluids. Family members, health workers and others in close contact with sick and deceased patients are most often infected. There is nothing to suggest that the virus is transmitted through normal social contact, even in the time from infection until symptoms appear (incubation period).

The transmission risk increases during the course of the disease and is greatest during the bleeding stage because of the increased possibility of coming into contact with blood and other bodily fluids from patients.

What is the difference between "airborne" and "droplet" transmission?

There are three different terms used which are often mixed and cause confusion:

Aerosols are small, fine solid or liquid particles suspended in a gas (such as air). Coughing, sneezing, breathing, vomiting and talking are examples of activities that form aerosols of various sizes. 

Droplets greater than 5-10 micrometres fall to the ground or stick to other surfaces within seconds and will not travel further than one metre. When viruses or bacteria are transmitted via such large drops, this is called droplet transmission. 

Smaller droplets may remain in the air for long periods and will quickly evaporate, with the result that their contents remain in a free state in the air. These are called "droplet nuclei" and can remain suspended in the air for hours. If the virus or bacteria can infect others through droplet nuclei, we call it airborne transmission.

Activities such as vomiting and coughing generate both droplets and droplet nuclei. 

Based on current knowledge, there is no reason to suspect that Ebola infects humans via airborne transmission. The cause is not fully understood, but it may be because the virus does not tolerate drying up and / or other factors it encounters outdoors. However, it is likely that infection can occur by droplet infection, where droplets of bodily fluids from Ebola patients, particularly blood or vomit, enter the mucosa through the eyes, nose or mouth. 

Infection can thus probably occur from droplets near a sick patient (up to 1 metre). But there are no signs that Ebola can be transmitted via airborne infection, i.e. via droplet nuclei.

Could the Ebola virus mutate so that it can be transmitted through the air?

The chance of this is extremely small. For a virus to change its properties so drastically that its mode of transmission changes, there would need to be many mutations in all the right places on the virus. Viruses do not usually change their mode of transmission even if they mutate millions of times. An example of this is HIV, which has infected millions of people and has mutated billions of times, but still has the same mode of transmission as when it was first discovered.

Is it safe to use the same toilet as an Ebola patient?

There would be some risk of transmission if faeces, urine, blood or other bodily fluids from the Ebola patient are visible on the toilet and they come into contact with mucous membranes or skin wounds.

Can Ebola be transmitted if a patient has touched an object?

This is highly unlikely, as long as you do not get visible bodily fluids such as blood or vomit from an Ebola patient into the mouth, nose, eyes or skin wounds. In laboratory studies, Ebola can survive for several hours on surfaces at room temperature, but the virus has not been proven to be contagious on surfaces outside a laboratory.

Can Ebola be spread through the air-conditioning system on a plane?

For this to happen, Ebola would need to be transmitted by air, for which there is no evidence.

How does an outbreak of Ebola start?

The Ebola virus can be found in a variety of wildlife species in Africa. An outbreak starts when a person is infected by an animal. This person may then transmit the virus to others through direct contact with blood and other body fluids/secretions from someone who is sick. The risk of infection is greatest when the patient is bleeding. The first outbreak of Ebola was in 1976 and since then there have been numerous smaller outbreaks in Africa.

What are the symptoms?

Symptoms of Ebola virus disease include a severe headache, high fever, weakness, muscle pain, vomiting, diarrhoea, and rash. After 5-7 days, internal and external bleeding may occur. Mortality from Ebola virus disease in the current outbreak in West Africa seems to be around 50-60 per cent. The time from infection to the appearance of symptoms (incubation period) is usually 2-21 days.

Is there any treatment?

There is no approved treatment for Ebola virus disease. Patients require good care and treatment of symptoms in hospital. For the current outbreak in West Africa, the World Health Organization has declared that they will allow the use of some unapproved medicines that show promising results in laboratory and animal tests.

Do I need to take special precautions when I return from a country with an outbreak?

If you are healthy and have no signs of disease, you do not need to take precautions. It is not possible to take blood samples from healthy people to see if they have been in contact with the virus.

What should I do if I get sick after returning from a country with an outbreak?

If you come from one of the countries with an Ebola outbreak and develop symptoms after arriving in Norway, call 113 and say where you have been - do not go to your doctor or to hospital.

I'm expecting a visit from someone from one of the countries with outbreaks. Do I need to take special precautions?

If they are healthy and show no signs of disease, you do not need to take any precautions. There is no reason to avoid people who have been to the outbreak areas and they do not need to be tested or isolated, as long as they have not been in contact with someone who is sick. If you receive a visit from someone who has been to one of the countries with an Ebola outbreak and they develop symptoms after they arrive, call 113 - do not take them to the doctor or to hospital.

Is it likely that the Ebola virus will spread to Norway?

During previous outbreaks of Ebola, there have been very few cases of transmission to countries outside the outbreak area. There is a small possibility that an infected person will arrive in Norway, but with the good infectious disease control and hygienic conditions we have, it is very unlikely that it will spread further.

Why is it unlikely that Ebola will spread in Norway?

The Ebola virus is not spread in the same way as influenza or other respiratory infections. To contract Ebola you must have been in direct contact with the bodily fluids of people who are already infected and have symptoms, or have touched objects contaminated with biological material containing the virus. The probability of being infected is therefore very low. 

The Norwegian health system is well prepared for cases where an infected person is transported to Norway for treatment. Healthcare professionals will use modern protective equipment and are trained to follow strict infectious disease control procedures. It is therefore extremely unlikely that the virus will spread further in Norway. 

Cabin crew on planes are trained to react quickly if a passenger develops symptoms of Ebola infection during a flight to Norway from outbreak areas. They will adopt measures to limit the chance that other passengers will be infected, and will also notify the Norwegian health authorities. There are no documented cases where someone has been infected by being on the same plane as a carrier.

Can the Ebola virus be spread via sewage and waste water from hospitals?

The sewage and waste water from the isolation rooms at Oslo University Hospital, Ullevål are automatically processed to kill any microorganisms before being released into the sewer system, so live Ebola virus will therefore not be released. The isolation departments at other hospitals may not have this system, so the recommendation is to not flush urine and faeces from patients with Ebola down the toilet, but to collect and process them to kill the virus before releasing them into the sewer system.

How is Norway prepared if it does spread?

If a case is diagnosed in Norway in someone who has stayed in an outbreak area, the person will be quickly followed up. There is little risk that the disease will spread further in the country. Norway has a high level of preparedness to deal with such a situation.

Can health workers completely protect themselves from infection?

So far we know of one case in Europe and one case in the United States where hospital staff who have treated patients with Ebola have been infected with the virus. 

We can never give a one hundred per cent guarantee that health care workers will not be infected by any infectious disease. Ebola is transmitted by contact with a sick person or their bodily fluids. As Ebola is such a serious illness, we recommend that the procedures are followed as if the infection was also potentially airborne. Hospitals in Norway that can accept Ebola patients have established very strict security routines. 

A critical point in contact with Ebola patients can be when removing protective equipment. This must done be done very carefully to avoid contact with any viruses on the suits. Personnel in the Norwegian hospital departments that may receive Ebola patients should practise dressing and undressing from protective suits. The isolation unit at Oslo University Hospital, Ullevål has been treating a patient with Ebola and the procedures, facilities and equipment in place will safeguard the employees’ safety in the best possible way.

Health care workers have become infected with Ebola: why?

It is understandable that people are concerned when they hear that health care professionals in Europe and the USA were infected with Ebola when caring for patients.

The American Center for Disease Control and Prevention (CDC) is now carefully investigating what happened in the hospital in the USA where two health care workers caring for an Ebola patient became ill. Their findings will be important because they can teach us more about how we can avoid these situations in the future. 

Unfortunately, accidents happen even with good procedures in place. To prevent accidents, it is important to follow strict routines and have well-trained personnel caring for Ebola patients. Although we have seen isolated cases of infection in the USA and Spain, the risk of spread is still very low in these countries. Potentially transmitted contacts will also be carefully monitored and isolated if necessary. 

I am travelling to one of the countries in the Ebola outbreak as an aid worker. How can I protect myself?

The Norwegian Institute of Public Health is advising small, unorganised groups not to travel to areas affected by the Ebola virus disease to provide assistance. Contact with patients and people who have died requires access to adequate protective equipment and a professional knowledge of how to use it. Lessons learnt from previous crises and disasters have shown that lack of organisation among volunteer aid workers can increase the local burden.

Healthcare and other aid workers who may come in contact with sick people in outbreak areas should protect themselves against infection with protective clothing, gloves etc., Strict protective measures are necessary. Very strict protection measures are in place and guidelines have been developed by the WHO. The measures are necessary for anyone who will come into close contact with sick people, not just healthcare workers.

I am travelling to one of the countries in the Ebola outbreak. How can I protect myself?

The Ministry of Foreign Affairs has reviewed travel advice to the affected countries. Current travel advice is available through the webpage of the Ministry of Foreign Affairs: www.landsider.no

People travelling to an area with outbreaks should avoid: 

  • contact with sick people 
  • close contact with wild animals (including monkeys, antelopes, rodents and bats) 
  • caves and other typical bat habitats 
  • consumption of bush meat, i.e. meat from wild animals killed by hunting

It is always important to have good hand hygiene when travelling abroad. It is recommended to follow general travel advice for Africa. There is no vaccine against the disease.

Is it dangerous to travel to a country with outbreaks of Ebola?

The Ministry of Foreign Affairs has reviewed travel advice to the affected countries. Current travel advice is available through the webpage of the Ministry of Foreign Affairs: www.landsider.no

With an outbreak of ebola virus, there is very little risk of infection for tourists or others who are staying in the country but are not in contact with sick people.