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Case Count

  • Total Confirmed: 9 [1] [2] [3]
  • Fatalities: 3
  • Imported: 8
  • In-country origin/transmission: 1

Updated 24 Oct. 2014

Travel Restrictions

  • Official Travel Advisories and Warnings
  • Belgium
Advice to travellers is provided by the Royaume de Belgique Affaires Etrangeres. Currently all trips to Guinea are discouraged [4] except for medical personnel involved in the fight against EVD. The main source of EVD is located in a forest in the prefecture of Guinea Guékédou. Cases have also been reported in the prefectures of Macenta Kissidougou Dabola, Conakry and recently Télimélé and Boffa.The advice notes potential limitations in the movements of travellers, and options to leave the country are becoming increasingly more limited. Similar advice is given for Liberia [5] where many land borders are also closed, and Sierra Leone [6]. Vigilance is recommended for Mali [7]
  • Netherlands
Dutch nationals living in the West Africa countries affected by EVD have been asked to ensure that they are registered with their nearest embassy. There are no embassies in the affected countries, so Dutch nationals in Guinea are asked to register with the embassy in Senegal, and residents in Sierra Leone and Guinea to register with the embassy in Ghana. Registration can be undertaken online. [8]
  • United Kingdom
Advice to travellers is provided by the Foreign and Commonweath Office. Its advice for Sierra Leone is as follows: The Foreign and Commonwealth Office (FCO) advise against all but essential travel to Sierra Leone, except for those involved in the direct response to the Ebola outbreak, due to the narrow commercial options for flights and the impact of the outbreak on medical facilities. [9]
The website contains information on the specific geographical areas most affected, and suggests travellers use the Facebook page of the Sierra Leone Ministry of Health and Sanitation to stay updated.
Similar advice exists for Guinea, Liberia and Mali.

  • Suspended Outgoing Flights
  • Belgium
Brussels Airlines is continuing to fly to the West African nations affected by the 2014 outbreak. It has no plans to stop flying into Guinea, Sierra Leone or Liberia in the immediate future. “It is our humanitarian duty to operate there,” said Geert Sciot [10], a vice president at Brussels Airlines. “Without our fights it would become almost impossible for medical staff to reach the country.” The WHO had asked senior airline officials to continue the service.
  • Netherlands
Dutch airline KLM's partner, Air France, has suspended its services to Sierra Leone [11] Air France flights to Conakry, Guinea, are continuing.
  • United Kingdom
British Airways has suspended flights to Sierra Leone and Liberia until 31 March 2015 due to the deteriorating public health situation [12].
Guinea Bird had planned to open up an air corridor with a twice weekly flight from London Gatwick to Sierra Leone commencing October 2014. However, the Department of Transport has revoked the licence to fly, citing concerns about deteriorating public health in the country [13]. The airline is to appeal against the decision. According to this source, only Brussels Airlines and Royal Air Maroc are currently flying to Freetown.[14]

  • Suspended Incoming Flights
  • Belgium
Brussels Airlines is continuing to receive flights from the outbreak area [15]. The Belga News Agency reports that some 1,000 passengers arrive weekly in Brussels from the three countries, with 80% continuing to other destinations [16].
  • Netherlands
Dutch airline KLM's partner, Air France, has suspended its services from Sierra Leone [17] Air France flights to Conakry, Guinea, are continuing.
  • United Kingdom
British Airways has suspended incoming flights from Sierra Leone and Liberia until 31 March 2015 due to the deteriorating public health situation [18].

Entry/Exit Control and Restrictions

  • Officially Designated Entry Airports, Border Crossings and Harbors
  • Belgium
All passengers leaving the outbreak area are screened on departure with temperatures being taken and a questionnaire completed[19]. Airline crew are not allowed to spend the night in locations considered to be at risk, so they travel on a Brussels Airlines flight to Senegal when they need to overnight in the area. Entry screening has now been added at Brussels Airport, again with temperature checks and a questionnaire [20].
  • Netherlands
The Netherlands is currently relying on exit screening from the affected countries. No entry screening is being undertaken at any Dutch airports, and no plans exist to introduce such screening [21]. Public health institute RIVM said that screening already exists at exit points and 'if screening is to be introduced at destinations as well, it should happen in countries with a direct connection to Liberia, Sierra Leone and Guinea.' RIVM also notes that an aircraft captain is able to notify Schiphol should any passenger present onboard with potential symptoms of the disease [22] From 30 October 2014 GGD [23] is providing passengers originating in Sierra Leone, Liberia and Guinea with a letter of advice. [24] The CIb (Centre for infectious diseases, RIVM) has ​​arrangements in place with GGD Kennemerland and the medical service at Schiphol to collaborate in the management of any returning traveller with EVD; the arrangements cover reception of the traveller, transport, recording and contact tracing [25].
  • United Kingdom
Entry screening is currently in place at London Heathrow Airport and London Gatwick Airport for passengers who have travelled from Guinea, Sierra Leone and Liberia. The screening comprises a questionnaire and is voluntary. Introducing screening at Heathrow and Gatwick covers approximately 90% of passengers coming from the region with through tickets for the UK. The Government states that less than 1,000 passengers arrived by air from the affected countries in September and around 85% arrived at Heathrow. Border Agency staff are responsible for liaison with airlines to determine the travel path of passengers.
Screening is also in place at the Eurostar terminal at St Pancras in London. It is due to be extended to Manchester and Birmingham airports, although no further information on timescales was forthcoming.
Ports are also on standby to adopt screening measures, and there are Port Medical Officers working with Public Health England to address any issues of sick passengers or crew.

  • Quarantine/Monitor Policies for Incoming Travelers
  • Belgium
  • Netherland
  • United Kingdom
The UK protocol for managing incoming travellers suspected of having contracted EVD was demonstrated when a man flew into Birmingham International Airport from Nigeria.[26] He complained of feeling feverish when leaving the plane, which had connected via Berlin and Paris. He was taken to hospital by ambulance and later tested negative for the disease. A statement from the Department of Health confirmed the all clear, and added:

"Protecting the public from infectious diseases is a priority and we lead the world in this field. We are well-prepared to identify and deal with any potential cases of Ebola, though there has never been a case in this country.

"Any patients with suspected symptoms can be diagnosed within 24 hours and they would also be isolated at a dedicated unit to keep the public safe. Our specialist staff are also working with the World Health organisation to help tackle the outbreak in Africa.”''

  • Quarantine/Monitor Policies for HCW's Returning from Outbreak Zone
  • Belgium
  • Netherlands
Two Dutch doctors were exposed to EVD when treating patients at a clinic in Yele, Sierra Leone for the Lion Heart Foundation. Nick Zwinkels and Erdi Huizenga treated three patients with assumed malaria; all three died and tested positive for ebola. The Dutch health ministry recommended evacuation, and the two doctors were subsequently transported by a private charter flight by International SOS. Both doctors spent 14 days in voluntary quarantine in the Netherlands and tested clear on 30 September 2014 [27] Huizenga had developed a fever, but tested positive for malaria [28]. Reuters [29] reports that the clinic in Yele has subsequently been closed.
  • United Kingdom
Public Health England (PHE) has set out guidance for humanitarian aid workers [30] encompassing preparation for travel, clinical practice whilst in the outbreak area, and protocols to follow on return to the UK. Health and social care workers returning to the UK must be assessed before they can return to any work involving patient contact. The sponsoring organisation for the HCW provides contact details to PHE, and follow up activity is determined by the category into which the HCW falls.

Category 1 covers those not having direct exposure to an ebola case, and does include those who have had casual contact, such as visiting a home without direct contact with an ebola patient there. HCWs falling into this category are subject to no monitoring requirements and can continue their normal activities.

Category 2 covers HCWs who dealt directly with ebola patients while wearing appropriate PPE and with no known breaches of that PPE. These HCWs may return home with ordinary social contact, use public transport and resume work with some restrictions in clinical practice. Category 2 workers must monitor their temperature twice daily for 21 days after their return and report any instances of a raised temperature (over 38 degrees C) or any other suspicious symptoms to PHE.

Category 3 covers HCWs having direct exposure to ebola patients either without PPE, or with a suspected breach in PPE. These workers are able to return home, have normal social contact and travel on UK transport as agreed by PHE. They may only undertake office work and may not be involved in patient care. Category 3 workers must monitor their temperature twice daily and report the results daily to a monitoring team at PHE.

Any HCW becoming unwell within the monitoring period is advised to see a clinician by calling 111(non emergency) or 999. Where an ambulance is needed, the circumstances should be explained to the crew. The PHE monitoring team should also be notified.

PHE's guidance also provides advice on dealing with the experiences of humanitarian aid workers, various coping strategies, accessing support and adjusting to the UK again.

  • Passport and Visa Controls
  • Belgium
  • Netherlands
  • United Kingdom

Public Health Preparations and Actions

  • Official Government Announcements
  • Belgium
The Superior Health Council of Belgium [31] has published guidelines in the management of Ebola and Marburg VHFs. The document sets out risk levels against which a patient may be assessed. It also lists the various Public Health Inspectors covering the country.
  • Netherlands
The Government of the Netherlands believes that the best way of ensuring Ebola does not reach the Netherlands is by halting the outbreak in West Africa [32]. Responsibility for public health falls to the care sector in association with the National Institute for Public Health and the Environment (RIVM) which has set out protocols to manage any Ebola case in the Netherlands. Ebola is treated as a notifiable 'A' disease (A-ziekte), requiring any suspect cases to be reported directly to the Municipal Health Service.
  • United Kingdom
The United Kingdom Government has set out its response to EVD through various channels, including providing public information through Public Health England and the NHS, noting measures taken to prevent the spread of the virus to the UK and helping in the relief effort to tackle the West Africa outbreak at source. [33]

  • Public Awareness and Education
  • Belgium
  • Netherlands
The RIVM has set up an information helpline for public questions about Ebola via the freephone number 0800-0480. Healthcare professionals, companies and other institutions such as schools and police should instead contact the Municipal Health Service (GGD) [34]
  • United Kingdom
Public information is provided by Public Health England and the NHS, both of which collaborate with the Department of Health and the Department for International Development through the Government website [35].
  • Designated Hospitals, Quarantine Facilities, and Ebola Treatment Units (ETU's)
  • Belgium
The Institute of Tropical Medicine in Antwerp [36] is taking the lead on Ebola. It is the national reference centre for tropical diseases and is also spearheading efforts to use blood and plasma products from recovered EVD patients to help others with the disease. It was here that the Ebola virus was first identified by Peter Piot in 1976.

Dr Erika Vlieghe, the infectiologist who heads the ITM's hospitalisation unit at Antwerp University Hospital, has been appointed as Belgium's Ebola Commissioner. Dr Vlieghe is Antwerp University's Head of Tropical Medicine. She is also responsible for ensuring that health professionals and the public at large get the right information about Ebola.

Several Belgian hospitals including Antwerp University Hospital, Leuven University Hospital and Saint-Pierre University Hospital (ULB) are prepared to treat suspected cases of Ebola. Tests to confirm any diagnosis can be carried out at the ITM.
  • Netherlands
Plans are in place for a new small isolation unit for 4 patients, which is likely to be built at the De Lichtenberg Hospital in Amersfoort [37]. A single unit in the centre is considered to be sufficient for a country of small geographic size such as the Netherlands. Currently there is one "Plastic Bed Isolator" in the Harbour Hospital at Rotterdam, and a "Plastic Airport Transit Isolator" at Amsterdam Schiphol Airport. The big quarantine station at the Heyplaat in Rotterdam is considered obsolete for VHF. Utrecht University's teaching hospital has set aside four beds in its "calamity unit" for international medical staff who have been infected with EVD. The unit has 200 beds but is only used in emergencies. If EVD patients are brought to the unit, it will be sealed off and no other cases admitted.[38]
  • United Kingdom
The two specialist beds for the UK are located at the Royal Free Hospital London. A BBC video [39] shows the unit where nurse William Pooley received his treatment. The hospital’s website [40] describes the facilities as follows:
The Royal Free Hospital has the UK’s only high level isolation unit (HLIU), used for the treatment of infectious diseases. The HLIU is run by a dedicated team of doctors, nurses and laboratory staff from the Royal Free London infectious diseases service. It was set up at the Royal Free Hospital in 2006 and has since looked after several cases of viral haemorrhagic fever.
Access to the unit is restricted to the team of specially trained medical staff. The HLIU is designed to ensure our medical staff can safely treat a patient with a dangerous infectious disease. A specially-designed tent with controlled ventilation is set up around the patient’s bed and allows the staff to provide clinical care while containing the infection.
There are various facilities in place including a specific entrance for the patient, autoclaves which decontaminate waste and a dedicated laboratory for carrying out tests, all of which help to ensure the patient can be treated safely and securely. All the air leaving the unit is cleaned so there is no risk to anyone at the hospital.
The high level isolation unit is always fully prepared to admit a patient with a highly infectious disease at very short notice.
In August 2014, the Mail Online [41] raised its concerns about the limited facilities in the UK.
Further locations are also geared up to deal with EVD cases should the need arise:

• Newcastle’s Royal Victoria Infirmary (north east)

• Liverpool’s Royal Liverpool Hospitals (north west)

• Sheffield’s Royal Hallamshire Hospital (north east)
It is anticipated that no more than two patients would be treated in each unit at a time, although more would be accommodated if the need arose. The three hospitals outside London would provide overspill capacity to the Royal Free, or take locally diagnosed cases.
Sir Leonard Fenwick, Chief Executive of Newcastle Hospitals NHS Foundation Trust said [42]:

“Each of the four hospitals have [sic] first-class infectious diseases units and all are capable of taking Ebola patients, but it is all about quantum.

“Once you have more than two patients there is a true challenge in relation to staffing and all that entails. In fact, one patient will be challenging because the staff ratio is that on the hour the one-to-one staff ratio must change to ensure procedure protocol is strictly adhered to without exception.

“It is the staffing and the refresh training, the vigilance and support that is the overriding requirement.”

  • WHO Certified Laboratory Support and Testing
  • Belgium
Tests to confirm any diagnosis can be carried out at the Institute of Tropical Medicine in Antwerp[43]. The Institute has the most highly secured labs in Belgium. The Antwerp Institute is equipped with a BSL3 laboratories i.e. labs that meet the second highest bio safety levels. The institute reserves a specific area to the diagnosis of Ebola with even stricter safety measures, such as the use of protective gear.
  • Netherlands
  • United Kingdom
The Public Health England laboratories are located at Porton Down near Salisbury. A Channel 4 video of the laboratory can be viewed here [44]. Where there is a high likelihood of ebola diagnosis, the laboratory can provide a result within 4 hours of the blood sample being delivered to the Rare and Imported Pathogens laboratory [45]. Testing by the Imported Fever Service is available 24/7 and the Service has tested 10-15 suspected ebola cases each week for the period August-October 2014.

Recent research at Porton Down has identified [46] a potential way of slowing the virus growth by the use of a heart drug. The drug, ouabain [47] ,is derived from a tribal arrow poison and affects the human protein VP24 that the virus uses in order to multiply. It could slow the progress of the virus by up to 50% and buy the infected patient additional time for their immune system to fight the virus. As the drug is already licenced, it is estimated that around £3 million would be needed to trial in humans.
  • Evacuation of Ebola-positive Citizens from Outbreak Zone
  • Belgium
  • Netherlands
  • United Kingdom
British nurse William Pooley, currently the only Ebola case transferred to the UK for treatment in the 2014 outbreak, was airlifted from Sierra Leone to London by the RAF, landing at RAF Northolt [48]. He was transferred under police escort to the Royal Free Hospital London for treatment.
  • Drills and Exercises
  • Belgium
  • Netherlands
Medecins Sans Frontieres has set up a training programme for medical workers and support staff who will be working in West Africa. MSF is setting up a field hospital in an old factory in Amsterdam without electricity and running water, and will be running courses from November 2014. [49] The charity has found 13 volunteer medics, but says it needs 100. A similar training programme exists in Brussels.
  • United Kingdom
A national exercise [50] took place on 11 October 2014 to test preparedness. Different scenarios were tested including:

• A collapsed shopper at Gateshead Shopping Centre, Tyne and Wear, who was transported to Newcastle Royal Victoria Infirmary and placed in isolation. After blood tests ruled out malaria, the patient was conveyed to the Royal Free Hospital London on suspicion of EVD, with samples being sent to Porton Down laboratory for testing. A simulated contact tracing exercise also took place.

• A separate case of an individual recently returned from West Africa presented at Hillingdon Walk-In Centre, was initially tested for malaria, isolated, samples sent to Porton Down and prepared for transport to the Royal Free.

All NHS staff have access to PPE, and a protocol has been put in place to isolate any patient presenting with potential EVD whilst advice is sought. In addition to the specialist hospitals, every acute hospital has an infectious disease unit ready to assist.

Sources for Official Information

The UK’s response is coordinated by Public Health England (Twitter feed @PHE_uk). [51]. Its guidance includes:

• An overview of EVD and maps of the affected areas

• Guidance on clinical management for emergency departments, acute hospital care, primary (community) healthcare, patient management, infection control and protection for staff

• Risk assessment and management for educational establishments, police, prisons and immigration removal centres and environmental cleaning arrangements for non-healthcare settings

• Information and advice for humanitarian aid healthcare workers and their families

• Information to support diagnosis and laboratory testing

  • Further

  1. “Ebola Facts: Where Are the Most New Cases Being Reported?” Jeremy Ashkenas, et al. New York Times 22 Oct. 2014; Web. 23 Oct. 2014
  2. “Ebola Response Road Map Situation Report 22 October 2014”. World Health Organization 22 Oct. 2014. Web. 23 Oct 2014 <>
  3. “Epidemiological update: outbreak of Ebola virus disease in West Africa”. European Centre for Disease Prevention and Control”. 24 Oct. 2014. Web 24 Oct. 2014>
  4. Royaume de Belgique Affaires Etrangeres undated web
  5. Royaume de Belgique Affaires Etrangeres undated web
  6. Royaume de Belgique Affaires Etrangeres undated web
  7. Royaume de Belgique Affaires Etrangeres undated web
  8. "Call to register for Dutch in Ebola countries" 8 Aug 2014 Web
  9. "Foreign Travel Advice: Sierra Leone" Updated 24 October 2014
  10. "Why One Airline Flies To West Africa Despite Ebola" Time 10 Oct 2014 web
  11. "Air France Suspends Flights to Freetown, Sierra Leone Over Ebola Outbreak" Robert Wall, Wall Street Journal 27 Aug 2014 web
  12. FCO web Updated 24 Oct 2014
  13. "Ebola: UK cancels resumption of direct flights to Sierra Leone" Lisa O'Carroll The Guardian web 13 Oct 2014
  14. "Ebola: Flights from London to Sierra Leone open humanitarian corridor" The Guardian web 2 Oct 2014
  15. "Why One Airline Flies To West Africa Despite Ebola" Time 10 Oct 2014 web
  16. "Belgian Airport To Begin Fever Screenings Amid EU Talks On Ebola" Morning Star 20 Oct 2014 Web
  17. "Air France Suspends Flights to Freetown, Sierra Leone Over Ebola Outbreak" Robert Wall, Wall Street Journal 27 Aug 2014 web
  18. FCO web Updated 24 Oct 2014
  19. "Why One Airline Flies To West Africa Despite Ebola" Time 10 Oct 2014 web
  20. "Belgium finally starts screening incoming passengers after sparking Ebola scare in Europe by accepting four flights a week from West Africa" Mail Online 20 October 2014 web
  21. "Dutch have no plans to introduce screening at Schiphol airport" Dutch News web 31 October 2014
  22. "Frequently asked questions about ebola" National Institute for Public Health and the Environment web 20 Oct 2014
  23. "Cooperation in Schiphol" GGD (Public Health Service)
  24. "Information about Ebola Virus Disease for travellers from Sierra Leone, Liberia and Guinea" GGD Oct 2014
  25. "Ebola" GGD undated
  26. "Ebola alert at Birmingham airport as man tested for deadly virus" ITV News 30 Jul 2014 Web
  27. "Ebola Evacuees - Who Are They?" Nsikan Akpan Goats and Soda web 18 Oct 2014
  28. "Tropical Doctors Nick and Erdi are Ebola Free" Hanneke van Houwelingen 1 Oct 2014
  29. "Netherlands to evacuate two doctors who had contact with Ebola victims" Reuters 12 Sep 2014
  30. "Information for humanitarian aid workers working in Ebola-affected countries in West Africa" Public Health England 26 Sept 2014 web
  32. "Ebola" Government of the Netherlands web undated
  33. "Ebola virus: UK government response" last updated 2 Nov 2014 web"
  34. "No screening, but Ebola leaflet for passengers at Schiphol" de Volkskrant web 20 Oct 2014
  35. "Ebola virus: UK government response" Updated 2 Nov 2014 web
  36. "ITM takes lead in fight against Ebola" Flanders News 28 Oct 2014 web
  37. "The Planning of a Modern Isolation Unit in the Netherlands" H Bijkerk Geneeskundige Hoofdinspectie van de Volksgezondheid, Afdeling Infectieziekten, Dokter Reijersstraat 8, Leidschendam, The Netherlands. Undated Web
  38. "Ebola training centre to be set up in Amsterdam" 16 Oct 2014 Web
  39. "An Ebola Isolation Unit In London" BBC web 7 Aug 2014
  40. "High Level Isolation Unit" Royal Free London NHS
  41. "Is that it? Britain's two-bed Ebola virus unit" Mail Online 2 Aug 2014
  42. "Newcastle's Royal Victoria Infirmary is 'ready to deal with Ebola patients' says boss Chronicle Live 9 Oct 2014
  43. "ITM takes lead in fight against Ebola" Flanders News 28 Oct 2014 web
  44. "Inside Porton Down ebola laboratory" Channel 4 web 10 Oct 2014
  45. "Ebola: How well is the UK prepared" British Medical Journal web 17 Oct 2014
  46. "Porton Down scientists find a way to slow down Ebola virus" BBC News web 5 Sep 2014
  47. "Ebola breakthrough by Liverpool University researchers" Liverpool Echo web 11 Sep 2014
  48. "British Ebola victim lands at RAF Northolt" Mail Online web 24 Aug 2014
  49. "Ebola training centre to be set up in Amsterdam" 16 Oct 2014 Web
  50. Department Of Health web 11 Oct 2014
  51. Public Health England web updated 24 Oct 2014