Association between travel and Ebola disease: an overview

Abstract

The outbreak of Ebola virus disease in West Africa has reminded public health authorities and international health agencies that, despite setting so many health-related goals, in reality there is much disparity in the health standards of people living in different parts of the world. Among multiple parameters attributed in increasing the incidence of the disease, migration and travel plays a crucial role. Two possible explanations — international travel of infectious cases or contacts and movement of people across land borders in affected nations — have been proposed to suggest the contribution of travel/migration in the current outbreak. In order to address this international emergency, the World Health Organization and concerned stakeholders have produced a package of interventions to reduce the caseload in affected nations. To conclude, orientation of people regarding different preventive measures at times of travel and preparedness from authorities can significantly reduce the risk of transmission of Ebola disease across international borders.

Keywords:

• Ebola disease
• international travel
• World Health Organization

Introduction

The outbreak of Ebola virus disease in West Africa has come as a reminder to public health authorities and international health agencies that despite setting so many health-related goals (e.g. Health for All, Millennium Development Goals, etc.), in reality there is much disparity in the health standards of people living in different parts of the world.^1,2 The outbreaks of Ebola virus are not de novo, in fact almost 20 such outbreaks have been reported to date, but unfortunately clinicians are even now empty handed — with no vaccine and no specific drug.^3,4 Furthermore, it has been reiterated that the 2014 Ebola outbreak, which eventually attained the status of an international public health emergency, could have been easily contained if the public health infrastructure of the affected nations was strong.^2,5

The Ebola virus is transmitted to the human population either through close contact with various body fluids of reservoir species or through direct contact (i.e. broken skin or mucous membranes) with different body fluids of infected people, and with surfaces and materials contaminated with these fluids.^1,4 Although trends of the disease have suggested that the disease has grown at an exponential rate, with the number of infectious cases doubling every 20–30 days,⁶ most of the factors (i.e. moderately long incubation period, incubatory carriers are non-infectious, no airborne transmission, etc.) do not favour the rapid transmission of the disease.^7,8

Ebola and travel

Among multiple parameters (such as no preparedness, poverty, no training of health professionals, etc.) involved in increasing the incidence of the disease, migration and travel plays a crucial role.^1,2,4 Two possible explanations — international travel of infectious cases or contacts and minimal vocational options for people in the affected nations, owing to which people move across the borders (hot zone) of Guinea, Liberia and Sierra Leone, where transmission is intense and hence people continue to re-infect each other — have been proposed to suggest the contribution of travel/migration in the current outbreak.^4,8

Recommended measures

In order to address this international emergency, the World Health Organization and concerned stakeholders have produced a package of interventions (i.e. intensive case and contact finding, appropriate response to patients and community, and preventive measures) to reduce the caseload in affected nations.^4,9 Furthermore, pertaining to safe travel, special guidelines have been released to provide early detection of potentially infected individuals; to assist public health authorities in implementing WHO recommendations related to Ebola management; and to prevent the spread of Ebola disease across international borders while allowing the authorities to avoid unnecessary restrictions and delays.¹⁰⁻¹² These recommendations enable health professionals to manage suspected cases at points of entry (i.e. a passage for international entry or exit of travellers, baggage, cargo, etc. as well as agencies and areas providing services to them on entry or exit).¹⁰ At the same time, a culturally sensitive approach has been designed to ensure community engagement and thus reduce the practice of travel across land borders.^2,6−8

Precautions during travelling

Although it has been revealed that any travel to and from Ebola-affected countries carries minimal risk (since transmission requires direct contact with body fluids of infected living or dead persons or animals), precautions such as avoiding direct physical contact with anyone who is displaying the symptoms (e.g. nonspecific flu-like symptoms, such as fever, chills, malaise, sore throat, muscle pain, and headache) of Ebola; not touching the body of a person who has died from Ebola; using alcohol rub/soap and water throughout the day; seeking prompt medical services, if a traveller has Ebola symptoms; alerting airline personnel about a fellow traveller who has Ebola symptoms, should be followed during travel to ensure the safety of the individual concerned as well as other travellers.^4,10,12 Furthermore, the contacts of affected individuals should be followed up for a minimum period of 21 days.¹³ In addition, development of an action plan by the countries where no case of Ebola has been detected can also augment the level of preparedness and thus further reduce the risk.^14,15

Conclusion

To conclude, orientation of people to different preventive measures at times of travel and preparedness on the part of the authorities can significantly reduce the risk of transmission of Ebola disease across international borders.