Ebola Informational Brief 01 October 2014 UNCLASSIFIED//FOUO Not Cleared for Public Release

Policy NAVADMIN 196/14 Requires all service members traveling to the U.S. Africa Command (AFRICOM) AOR, whether on duty or in a leave status, receive detailed threat briefs on Ebola Viral Disease (EVD) risks and precautions. Commanders will ensure service members are aware of medical threats, preventive measures, mitigation strategies and importance of compliance with appropriate personal protective precautions Health Affairs memorandum date 22AUG2014, Updated Guidance for Department of Defense Personnel for the Ebola Virus This is the largest Ebola outbreak in history and first in West Africa Risk of Ebola virus transmission to U.S. DoD personnel continues to be low, primary prevention measures are the cornerstone to controlling this viral outbreak This explains “why” they are getting this brief! NEPMU7@eu.navy.mil UNCLASSIFIED//FOUO Not Cleared for Public Release 1

EBOLA – the Basics What is Ebola? A virus that causes hemorrhagic fever How is it transmitted? Ebola is transmitted through direct contact with blood or bodily fluids of an infected person, or through exposure to objects (such has needles) that have been contaminated with infected secretions Ebola is not a respiratory disease like the flu, so it is not transmitted through the air Ebola is not transmitted through contaminated food or water A person infected with Ebola virus is not contagious until symptoms appear How is it treated? Aggressive supportive treatment. There is no vaccine or specific treatments currently available (although there are clinical trials underway) How to prevent the disease? Through primary prevention efforts and strict infection control measures What is Ebola? Ebola is not spread through the air or by water or, in general, by food; however, in Africa, Ebola may be spread as a result of hunting, processing, and consumption of infected animals (e.g., bushmeat). **Because there is no vaccine or treatment currently available – primary prevention and early diagnosis is CRITICAL. ** Source: CDC Questions and Answers on Ebola, 1 Aug 2014

DEPARTMENT OF DEFENSE (AFHSC) West Africa Ebola Surveillance Summary #34 29 SEP 2014 Source: Armed Forces Health Surveillance Center UNCLASSIFIED//FOUO

DEPARTMENT OF DEFENSE (AFHSC) West Africa Ebola Surveillance Summary #34 29 SEP 2014 Source: Armed Forces Health Surveillance Center UNCLASSIFIED//FOUO

BLUF: Risk to DoD Personnel According to the National Center for Medical Intelligence, there is significant risk to U.S. military medical personnel who care for critically ill Ebola patients or handle patients or samples without essential barrier precautions. THE RISK TO NON-MEDICAL DoD PERSONNEL IS LOW BLUF – what is the risk UNCLASSIFIED//FOUO Not Cleared for Public Release Source: National Center for Medical Intelligence, updated 12 Sep 2014

Background on Ebola Ebola viruses are found in several African countries. The first Ebola virus was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. Researchers believe that Ebola virus is animal-borne and that bats are the most likely reservoir. Ebola is NOT spread through the air or by water or, in general by food; however in Africa, Ebola may be spread as a result of handling bushmeat -wild animals hunted for food including non-human primates (monkeys, apes) and contact with infected bats. Reporting for medical care early is very important for individual’s care. Background This outbreak has been propagated primarily through human to human transmission. While infected animals may have been the original source of the outbreak, it does not appear to be a primary mode of transmission Source: CDC Key Messages -Ebola Virus Disease West Africa 9 Sep2014

Mode of Transmission The virus is spread through direct contact (through broken skin or mucous membranes) with the body fluids (blood, urine, feces, saliva, sweat, semen and other secretions) of a person who is sick with Ebola Many current cases have resulted from the touching of bodies as part of traditional burial practices. Healthcare providers caring for Ebola patients and the family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with the blood or body fluids of sick patients. Ebola virus is stable in the environment for several days but is killed by simple 1:10 dilution of chlorine ordinary household bleach. Recovered individuals may excrete virus for up to 8 weeks in body fluids. Source: NAVADM 196/14 and Health Affairs memorandum date 22AUG2014

Symptoms Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, though 8-10 days is most common Fever above 101.5°F Rash Headache Joint and muscle aches Unexplained hemorrhage (bleeding or bruising) Lack of appetite Diarrhea Vomiting Stomach pain History of contact with suspected or confirmed patient or dead or sick animal WHO Case Definitions Suspected (case definition used by mobile health teams or health stations and health center) Any person, alive or dead, suffering or having suffered from a sudden onset of high fever and having contact with: A suspected, probable, or confirmed EVD case A dead or sick animal Any person with sudden onset of high fever and at least 3 of the following symptoms: Headache Anorexia/loss of appetite Lethargy Aching muscles or joints Breathing difficulties Vomiting Diarrhea Abdominal pain Difficulty swallowing Hiccups Any person with inexplicable bleeding Any sudden, inexplicable death CDC Case Definitions Person Under Investigation (PUI) A person who has both consistent symptoms and risk factors as follows: Clinical criteria Fever greater than 38.6°C (101.5°F) And additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage Epidemiologic risk factors within the past 21 days before the onset of symptoms Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD Residence in—or travel to—an area where EVD transmission is active1 Direct handling of bats or non-human primates from disease-endemic areas A person is not contagious until symptoms appear Source: CDC, WHO, Health Affairs memorandum date 22AUG2014 and NAVADMIN 196/14

Protect Yourself – Primary Prevention Avoid physical contact with sick individuals Avoid contact with blood/body fluids of persons, especially those who appear ill Do not handle items that may have come in contact with an infected person’s blood or body fluids Wash hands frequently with clean water or use hand sanitizer Avoid any contact with deceased individuals or dead animals Avoid contact with wildlife, to include bats and non-human primates Do not touch or eat raw meat prepared from these animals- eat only thoroughly cooked meats from DoD approved food sources Must let your medical provider know immediately if you have had contact or exposure to infected person. Primary prevention is the key – know how to protect yourself! Source: Key Points – Ebola Virus Disease, West Africa . CDC- Updated August 19, 2014 . NAVADM 196/14 and Health Affairs memo date 22AUG2014

Protect Yourself- Primary Prevention Direct contact can potentially transmit the virus from a symptomatic infected person. Gloves (at a minimum) must be used for even the most minimal patient contact requiring hands and if more extensive contact is required such as lifting or carry an infected person, full barrier clothing should be used. Any U.S. DoD medical providers caring for Ebola patients must use appropriate personal protective equipment, to include wearing gloves, gowns, eye protection and a facemask (with or without a face shield) and respirator. It is key to seek medical care immediately if you develop fever, headache, muscle pain, diarrhea, vomiting, stomach pain, or (unexplained bruising or bleeding) following travel to a high threat area or contact with a high risk person Primary prevention is the key – know how to protect yourself! **Early aggressive supportive therapy has been linked to better outcomes! Early recognition/diagnosis is key!** Source: Key Points – Ebola Virus Disease, West Africa . CDC- Updated August 19, 2014 . NAVADM 196/14 and Health Affairs memo date 22AUG2014

Questions and Answers on Ebola Can Ebola be spread through mosquitos? There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus. Can Ebola be spread by water or food? No. However, in Africa, Ebola may be spread as a result of hunting, processing, and consumption of infected animals (e.g., bushmeat). Are there any cases of individuals contracting Ebola in the U.S.? No. Can Ebola be transmitted through the air? No. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air. Test your knowledge Source: CDC Questions and Answers on Ebola, 1 Aug 2014

Questions and Answers on Ebola Can I get Ebola from a person who is infected but doesn’t have fever or any symptoms? No. A person infected with Ebola is not contagious until symptoms appear. If someone survives Ebola, can he or she still spread the virus? Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months. Can I get Ebola from a person who is infected but doesn’t have any symptoms? No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms. Ebola is not spread through the air or by water or, in general, by food; however, in Africa, Ebola may be spread as a result of hunting, processing, and consumption of infected animals (e.g., bushmeat). Source: CDC Questions and Answers on Ebola, 1 Aug 2014

Additional Resources CDC’s Interim Guidance about Ebola Virus Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel is posted on CDC’s website at www.cdc.gov/quarantine/air/managing-sick-travelers/ebola-guidance-airlines.html.y a CDC 2014 Ebola Outbreak in West Africa. http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html WHO Global Alert and Response , Ebola virus disease. EV http://www.who.int/csr/disease/ebola/en/D WHO Global Alert and Response, Information resources on Ebola virus disease. http://www.who.int/csr/resources/publications/ebola/en/ Additional resources NEPMU7@eu.navy.mil

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