The current outbreak of Ebola has centered largely on West Africa, with some isolated cases reaching further afield. Preparations are being made should cases reach the UK.
While the UK might see cases of Ebola infection in people returning from countries affected by the current epidemic, this is extremely unlikely to result in further substantial person-to-person spread in the UK.
As a result of awareness-building, both among health-care professionals and returning travellers, if an infected person were to develop symptoms in the UK, we would anticipate them seeking medical attention promptly. The ready availability of health-care in the UK means that they would be rapidly risk-assessed, isolated, treated and tested. Rapidly-available appropriate healthcare is pivotal to reducing any opportunity for transmission in the community.
UK preparedness in case of an imported Ebola case was tested in an elaborate 8 hour national exercise as part of the contingency plan set up by the government 8-Oct-14. The exercise was deemed successful, and hospitals have also run simulation exercises to test their own preparedness.
The Ebola virus is not airborne and is only transmitted through direct contact with the bodily fluids of an infected person.
Exit screening is expected to be more effective than entry screening. Entry screening happening at Heathrow, Gatwick, London St Pancras Eurostar terminal. Review of extending this to other ports. Border Force officials identify passengers travelling from affected areas. The main impact of this is probably to ensure awareness among returning travellers, rather than identification of a symptomatic case at the moment of transit.
Temperatures are taken, a questionnaire about current health completed, and recent travel history, including potential for contact with infected persons is explored. Advice is given should they develop symptoms later. Passengers will be allowed to continue their journey, or undergo further clinical assessment by PHE staff as appropriate.
Because of its incubation period, typically 8-10 but up to 21 days, screening can only be of limited effectiveness at preventing entry of disease into UK and will only identify individuals who are symptomatic at the time of entry.
The initial symptoms of Ebola (fever, malaise, fatigue, body aches) are shared with many other diseases. Malaria is a far more likely diagnosis in a traveller returning from West Africa.
Contact tracing monitors anyone who has come in direct contact with a symptomatic Ebola patient for 21 days since last contact. Temperature and symptoms are monitored.
Aid workers returning to the UK are assessed on the basis of perceived risk, and classified into three categories:
Category 1: visited area but no direct contact with an Ebola case. No restrictions, they can return to usual activities in the UK. There is no monitoring or reporting requirement.
Category 2: Had direct (close) contact with Ebola cases (or body fluids), wore appropriate PPE with no known breaches. Permitted to return to family and work (restricted if certain types of clinical work if a healthcare worker), have to measure temperature twice daily for 21 days after return and report any raised temperature/other symptoms to PHE.
Category 3: Same as above but concerns that they may have had a breach in these protective measures or have had direct contact with an Ebola patient’s blood, urine or secretions without being protected. Family and social contact allowed as is office-based work (not patient care areas), can take agreed UK transport (as discussed with monitoring team at PHE), required to check temp daily for 21 days after return and to report daily to monitoring team at PHE.
All major hospitals have made preparations in case of possible cases presenting to their facility. Cases will be assessed, isolated and cared for at local facilities until results of testing for Ebola infection are completed (usually within 24 hours). During this time, patients will also be investigated for other infections which may give the same initial symptoms, such as malaria or influenza.
If diagnosed with Ebola, the initial response would be to transfer the patient to the Royal Free Hospital London, which houses the only High Level Isolation Unit with two high-security containment beds within isolation “bubbles”, specially-designed tents with controlled ventilation allowing staff to provide clinical care while containing the infection.
Contingency plans for escalation include transferring patients to 3 other designated centres:
The Royal Liverpool and Broadgreen University Hospital has 13 isolation cubicles, 8 of which have negative pressure (isolating air-flow) facilities.
Newcastle upon Tyne Royal Victoria Infirmary Infectious and Tropical Medicine services has highly specialised isolation facilities including 2 containment beds.
The Sheffield Teaching Hospitals Royal Hallamshire Hospital has 33 dedicated beds, more than half of which are isolation rooms.
Specialist staff trained to treat wide range of infections and tropical diseases. Experience of dealing with decontamination, nursing and clinical procedures that involve isolation. Healthcare workers in the UK have been briefed about detecting and dealing with Ebola.
Access to Royal Free unit restricted to a team of specially trained medical staff. Patient bed surrounded by specially-designed tent with controlled ventilation allowing staff to provide clinical care while containing the infection. Autoclaves to decontaminate waste, dedicated laboratory for carrying out tests, air purification to prevent spread within hospital, prepared at very short notice.
Other hospitals say risk to general public and visitors is minimal. However, security level lower than at Royal Free.
Initial treatment for patients would normally include intravenous delivery of fluids or oral rehydration with electrolyte-containing solutions, anti-emetics, analgesics, and medication for fever relief. Exclusion of other diseases with a similar presentation, such as malaria, is a key part of clinical management.
Staff caring for at-risk patients will use PPE to minimise any risk of viral transmission, and policies and procedures are in place for dealing with waste and contaminated materials.
The SMC has also produced factsheets on Ebola virus background information, as well as Ebola treatments and vaccines.
This is a factsheet issued by the Science Media Centre to provide background information on science topics relevant to breaking news stories. This is not intended as the ‘last word’ on a subject, but rather a summary of the basics and a pointer towards sources of more detailed information. These can be read as supplements to our roundups and/or briefings.