EU Ebola Response: Member States Send Additional Health Personnel To The Region

The European Union and its Member States continue to mobilize all available resources to help contain the largest Ebola epidemic on record.

In response to the EU's call for the mmobilization of qualified, trained and experienced health workers, Greece will send a team of six medical personnel - four doctors, a nurse and a paramedic- to the affected countries of West Africa through the Union Civil Protection Mechanism, as well as contributing to the funding of much-needed material. This was announced in a joint statement by EU Ebola Coordinator Christos Stylianides and the Greek Minister of Health, Mavroudis Voridis, on Saturday 6 December, in Athens.

"We welcome and applaud Greece's decision to deploy medical staff to the most affected countries,only the second Member State to do so. The European Union will provide all necessary support for this initiative," said Christos Stylianides, EU Ebola Coordinator and Commissioner for Humanitarian Aid and Crisis Response, who recently visited the three most affected countries Sierra Leone, Guinea and Liberia. "I call on all Member States to mobilise additional resources. More health personnel, more trainers for health workers, more epidemiologists are urgently needed on the ground."

Several Member states have already responded to the Commissioner's call. France, for instance, recently offered two additional medical teams who work in Guinea and Mali, and Sweden deployed 42 doctors, nurses and other health personnel via the EU Civil Protection Mechanism, who currently run a treatment center in Liberia.

To support the mobilization of international humanitarian aid workers, the EU member States' contributions are also strengthening the capacities to evacuate international aid staff who contract Ebola. Following Luxembourg which announced the availability of two planes for this purpose in November, Germany has now made available an airplane fully equipped for the treatment of severe Ebola cases.

To stop the epidemic from spreading further, mobile laboratories for early detection of the virus are deployed in the affected region. The most recent contribution was offered by Belgium on Friday; a mobile laboratory will be deployed to Guinea shortly with support via the EU Civil Protection Mechanism.

A coherent European response

The European Union has been active in the response to the Ebola emergency from the start. The total EU contribution to the fight against Ebola is over EUR 1.1 billion of which over EUR 374 million has been provided by the European Commission for humanitarian and development aid, early recovery assistance as well as medical research. The EU has also deployed humanitarian experts and specialists in infectious diseases to the region and coordinates the Member States' contributions in aid supplies, medical equipment, ambulances and field hospitals.

Background

West Africa is currently facing the worst Ebola epidemic on record. More than 17 000 people have been infected and more than 6 000 people have died in the affected countries.

The unprecedented scale of the Ebola epidemic requires a robust and effective coordinated international response. Beyond the human tragedy, the disease is having devastating effects on the security and economy of the whole region, including the collapse of health systems in Liberia and Sierra Leone as well as shortcomings in the food security and nutrition, governance, agriculture, security and other key areas.

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Travelore Update: World Health Organization Updates Personal Protective Equipment Guidelines For Ebola response

As part of the World Health Organization's commitment to safety and protection of healthcare workers and patients from transmission of Ebola virus disease, WHO has conducted a formal review of personal protective equipment (PPE) guidelines for healthcare workers and is updating its guidelines in context of the current outbreak.

These updated guidelines aim to clarify and standardize safe and effective PPE options to protect health care workers and patients, as well as provide information for procurement of PPE stock in the current Ebola outbreak.

The guidelines are based on a review of evidence of PPE use during care of suspected and confirmed Ebola virus disease patients. The Guidelines Development Group convened by WHO included participation of a wide range of experts from developed and developing countries, and international organizations including the United States Centers for Disease Control and Prevention, Médecins Sans Frontières, the Infection Control Africa Network and others.

“These guidelines hold an important role in clarifying effective personal protective equipment options that protect the safety of healthcare workers and patients from Ebola virus disease transmission,” says Edward Kelley, WHO Director for Service Delivery and Safety. “Paramount to the guidelines' effectiveness is the inclusion of mandatory training on the putting on, taking off and decontaminating of PPE, followed by mentoring for all users before engaging in any clinical care.”

Guidelines were developed from an accelerated development process that meets WHO's standards for scientific rigour and serves as a complement to the Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola, published by WHO in August 2014.

Experts agreed that it was most important to have PPE that protects the mucosae – mouth, nose and eyes – from contaminated droplets and fluids. Given that hands are known to transmit pathogens to other parts of the body, as well as to other individuals, hand hygiene and gloves are essential, both to protect the health worker and to prevent transmission to others. Face cover, protective foot wear, gowns or coveralls, and head cover were also considered essential to prevent transmission to healthcare workers.

“Although PPE is the most visible control used to prevent transmission, it is effective only if applied together with other controls including facilities for barrier nursing and work organization, water and sanitation, hand hygiene, and waste management,” says Marie-Paule Kieny, Assistant Director General of Health Systems and Innovation. Benefits derived from PPE depend not only on choice of PPE, but also adherence to protocol on use of the equipment.

A fundamental principle guiding the selection of different types of PPE was the effort to strike a balance between the best possible protection against infection while allowing health workers to provide the best possible care to patients with maximum ease, dexterity, comfort and minimal heat-associated stress. In this situation where evidence is still being collected, to see what works best and on an effective sustainable basis, it was considered prudent to provide options for selecting PPE. In most cases, there was no evidence to show that any one of the options recommended is superior to other options available for healthcare worker safety.

Further work is needed to gather scientific experience and data from the field in systematic studies, in order to understand why some health workers are infected in the current outbreak and to increase effective clinical care. WHO is committed to working with international partners on these issues to build this evidence base.

Five Myths About Germs On Aircraft

(Photo: Getty Images/iStockphoto)

It's hardly news that many travelers are concerned about germs and diseases when they fly these days. But in the airborne petri dish that contemporary aircraft have become, fliers may well be worrying about the wrong things. Here are five myths about germs in aircraft.

1. The most dangerous health hazard in the air is the cabin air itself.

"That's wrong," says Michael Zimring, director of travel medicine at Mercy Medical Center in Baltimore, and the author of Healthy Travel. "The cabin air is fine and aircraft are outfitted with HEPA filters to clean it."

The real problems lie on the chair upholstery, the tray table, the armrests and the toilet handle, where bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and E. coli can live for up to a week on airplanes that aren't properly cleaned. These findings are the result of a two-year study by a team of microbiologists and engineers at Auburn University in Alabama, who presented it at the American Society for Microbiology's annual meeting.

"I can't say I was surprised by the findings," said James Barbaree, professor associate and director of the Auburn University Detection & Food Safety Center and a 20-year veteran of the Centers for Disease Control and Prevention (CDC), who led the study. Tray tables had the highest levels of bacteria, and seat belts and armrests were also singled out as places where bacteria can survive. Barbaree and his researchers tested six types of bacteria and learned that MRSA could last for up to 168 hours on the back pocket of an airplane chair, while E. coli could remain active for 96 hours on the armrest. Although bacteria lived longer on porous surfaces and for shorter periods of time on hard plastic surfaces, those plastic surfaces were the most efficient at transmitting it to the next set of hands. Think of an armrest, the remote control or window shade, as well as the door handles of the bathroom.

2. The bagged airline pillows and blankets are OK to use.

Today's aircraft are short on creature comforts, so it's mighty tempting to grab a blanket and a pillow when boarding, one of the last "free" perks of any flight. But the sage advice is to give them a pass.

"I don't use any of them," says John Gobbels, vice president and COO of Medjet Assist, which arranges air medical transport for its members. "For a long-haul flight, I bring a fleece jacket to stay warm. If I ever use a blanket, it's one sealed in plastic but then only for my lower legs."

As for pillows, "never" is the operative term.

"I see them thrown in the overhead compartments," Gobbels says, "and no one is changing the pillow cases."

Bringing you own neck pillow is a much better idea, but Gobbels cautions that you should use one that can be laundered, because "it can transmit germs as well."

3. Airlines clean the aircraft between flights.

How often and how well an aircraft is actually cleaned is something of a secret. Removing trash and old magazines is one thing, but most industry watchers say that a proper cleaning doesn't occur that often. The FAA doesn't regulate or inspect aircraft cleaning, so frequency and thoroughness are left up to the airlines themselves. Gobbels of MedJet Assist says that as a rule of thumb, an aircraft is supposed to be completely wiped down after every 30 days of service or at 100 flying-hour intervals. But in theory, that means that an aircraft can be used for dozens of flights between deep cleanings.

"There's a lot of cost-cutting among the airlines, and cleaning is one area that gets cut," says Gobbles. "Yes, there are standard operating procedures and certain chemicals that are supposed to be used. But the airlines often use third-party cleaning services and much of the time, the cleaners seem more intent upon a fast turnaround and getting the seat ready for the next passenger to occupy."

How clean is the corner of the airline aisle seats that every passenger grabs on their way back to their seat after using the bathroom? Or the seat headrest? It's anyone's guess. Nor should you expect to see much cleaning during a flight.

"I just came back on a flight from Italy last week," says Zimring. "My advice is that if you need to use the bathroom on a long-haul flight, do it early on. Not after eight hours in the air. They don't clean bathrooms on a long flight."

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4. The airlines have taken steps to ensure that passengers can't contract diseases like the Ebola virus in the aircraft.

There have not been any reported cases of the Ebola virus spreading within the confines of an aircraft cabin. Ebola, Zimring points out, is not an airborne virus but is spread through blood and body fluids. But airline passengers should adhere to rigorous hygiene practices to limit exposure to the virus, says Gobbels of MedjetAssist.

"Ebola can be transferred through open wounds and mucus membranes such as the mouth and eye," says Gobbels, "so cover exposed areas of skin and be mindful of the method of transmission. Wash your hands often and use alcohol-based hand cleansers. Refrain from any contact with blood or body fluids and do not handle anything that could have come into contact with infected fluids. If you travel to or with people who may have come from Ebola-infected areas, watch your health for signs and symptoms of Ebola for 21 days after travel and seek immediate medical attention if required."

This is not the first time that the United States has had concerns about the Ebola virus, James Barbaree points out, noting that the CDC has been working on Ebola since an outbreak in Africa in 1976. Hygiene aside, Barbaree says that "there is very little that passengers can do about the Ebola problem except be patient as the new screening procedures and guidelines are put into place. It is unfortunate that our officials did not act promptly and prudently to protect our population."

5. Let's face it, there's not much I can do to protect myself when I'm trapped in an aircraft cabin.

Not true. There are multiple steps that every flier can take to prevent the spread of bacteria when they fly. First, they should travel with and use an alcohol-based hand sanitizer. They should also travel with a small pack of disinfectant wipes. Gobbels says that "the first thing I do when I sit down is to wipe down the armrest and tray table because that's where my arms will be. You need to decontaminate where you'll be spending your time and eating."

Staying hydrated also helps, says Zimring. So does using a tissue or a paper towel to open bathroom doorknobs and touch toilet handles. The most vulnerable area may well be your eyes, and medical professionals advise not going anywhere near them with your hands, as tear ducts are a fast route for germs to the nose and throat.

"There are people who now fly with a face mask, gloves and special jacket," Gobbels says. "We're going to see more of that."

Everett Potter, Special for USA TODAY

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Ebola & Travel: What You Need to Know

Anytime you turn on the news lately, you cannot help but hear more about Ebola. There has been a lot of uncertainty and questions about travel and Ebola, so we have gathered as many resources as possible in this post for you to share with your travelers on the topic.

Wednesday, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security’s (DHS) Customs & Border Protection (CBP) announced that they will begin new layers of entry screening at the five U.S. airports that receive more than 94 percent of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone. 

New York’s JFK International Airport will begin the new screening process this Saturday. The enhanced entry screening at Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta international airports will be implemented next week. Click here for a fact sheet from the CDC and DHS detailing the new screening process and

More News on the Advanced Screening:

Five U.S. Airports to Enhance Screening for Ebola – USA TodayU.S. to Begin Ebola Screenings at 5 Airports – The New York TimesWhy One Public Health Expert Thinks Airport Ebola Screening Won't Work – NPR

Information from ISOS
International SOS (ISOS), a medical and travel security services company, has created a video sharing what business travelers need to know about Ebola.
ISOS tracks the latest news on ebola here.
Ebola Facts
Education materials in multiple languages to understand and spread awareness of Ebola

Information from the CDC:
Facts About Ebola in the US - Infographic
Guidance on Air Medical Transport for Patients with Ebola Virus Disease
Signs & Symptoms
Questions and Answers on Ebola

Why Europe Cannot Ignore This:
More Cases of Ebola In Europe Unavoidable: WHO – Huffington PostAccording to the article, the World Health Organization said on Tuesday that Europe would almost certainly see more cases of Ebola after a nurse in Spain became the first person known to have caught the virus outside Africa.

Ebola in Europe: What Went Wrong – The Daily Beast

Other Helpful Articles on Ebola & Travel:F.A.Q on Ebola and Travel – The New York TimesAdvice for Business Travelers – ISOS
What Travelers Need to Know About the Ebola Virus Outbreak – PeterGreenberg.comWhat Role Do Airports Play in All of This – Politico Morning Transportation
Why hasn’t the U.S. closed its airports to travelers from Ebola-ravaged countries? – Washington PostEbola Patient in Dallas Hospital Dies – USA TodaySecond Possible Ebola Case Reported in Texas – Huffington Post

What’s Next?
On Friday, the House Homeland Security Committee will hold a field hearing on how the government is coordinating its response to the Ebola outbreak.

Looking to learn more? Tune in to a webinar, Risk Radar: Managing the Medical and Security Implications of the Ebola Epidemic - How will you protect your travelers? on October 22 at 12 p.m. ET. The webinar is the first installment of a special Risk Radar webinar series brought to you by the GBTA Risk Committee, and it will examine the Ebola outbreak from both a medical and security perspective to help participants develop a comprehensive understanding of its implications to traveler