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.

Travelore News: Rules Vary About Travel To Countries Hit By Ebola

By The Associated Press

FILE- In this Thursday, Oct. 16, 2014, file photo released by U.S. Customs and Border Protection, U.S. Coast Guard Health Technician Nathan Wallenmeyer, left, and CBP supervisor Sam Ko, right, conduct prescreening measures on a passenger who has arrived from Sierra Leone at O'Hare International Airport's Terminal 5 in Chicago. Demands are rising in Washington for the U.S. to ban travelers from countries in West Africa, but the Obama administration is resisting and says the screening measures already in place for travelers are more effective. (AP Photo/U.S. Customs and Border Protection, Melissa Maraj, File)

Demands are rising in Washington for the U.S. to ban travelers from countries in West Africa, but the Obama administration is resisting and says the screening measures already in place for travelers are more effective.

There are no direct flights from Liberia, Guinea or Sierra Leone to the U.S. Officials say that about 150 passengers a day arrive in the U.S. from those countries after making a connecting flight, usually in Europe. Most arrive at one of five airports, where screening for fever - a symptom of the disease - began this week.

Here's what different countries are doing about travel to and from the Ebola hot spots:

EUROPE:

United Kingdom: No formal ban. No direct flights from the three affected countries to London's Heathrow Airport since British Airways suspended service there in August due to the outbreak. There is passenger screening at Heathrow and soon at two other airports.

Germany: No ban and no plans for one. There is no formal monitoring or screening of arriving passengers. Like the U.S., Germany doesn't have any direct flights from those three African countries.

France: The government advises against non-essential travel to Liberia, Guinea or Sierra Leone. Air France suspended flights to Sierra Leone but has maintained once-a-day flights from Guinea, a former colony. Beginning Saturday, temperature checks for passengers arriving in Paris from the Guinean capital of Conakry.

Netherlands: The government advises against travel to the same three nations and urges Dutch citizens in those countries to leave. No direct flights. Currently no extra screening at Amsterdam's Schiphol Airport, although passengers on flights to and from Nigeria receive flyers with information about Ebola.

Ireland: No ban planned. No Ebola monitoring at airports. Ryanair flies to Morocco but not to any of the countries in the Ebola epidemic. The U.S. has customs stations at Dublin and Shannon airports for U.S.-bound travelers.

Czech Republic: Starting Tuesday, medical checks at Prague's Vaclav Havel Airport for passengers who visited Liberia, Guinea or Sierra Leone in the previous 42 days.

Albania: No ban.

Turkey: Passengers from Liberia and Nigeria are undergoing more intensive screening. Those with high fever or other symptoms are being quarantined. Six travelers suspected of having Ebola turned out to have malaria instead.

MIDDLE EAST:

Israel: No direct flights. The government plans to ask passengers on connecting flights from West Africa, mostly through France or Ethiopia, to declare if they have been to one of the Ebola countries recently and if they feel ill.

Egypt: Airport officials say there is no travel ban.

Saudi Arabia: People from Liberia, Guinea or Sierra Leone could not get visas for the annual Hajj pilgrimage, a move that affected more than 7,000 travelers. Stopped issuing work visas to nationals of those countries.

United Arab Emirates: Dubai-based Emirates halted flights to Guinea in August. Dubai International Airport, a major hub for global air traffic, has no specific Ebola screening.

Qatar: Qatar Airways advises against non-essential travel to Liberia, Guinea or Sierra Leone and does not fly there.

LATIN AMERICA and CARIBBEAN:

Colombia: Bars entry by any travelers requiring visas who have been in Liberia, Guinea, Sierra Leone, Nigeria or Senegal.

Haiti: The prime minister tweeted that the UN stopped sending peacekeepers from Africa to Haiti as a preventive measure.

Jamaica: Bans entry by anyone who has been in Liberia, Guinea or Sierra Leone within four weeks.

Guyana: Diplomatic missions have been told not to issue visas to people from the affected West African countries.

Trinidad and Tobago: Denies entry to residents of Liberia, Guinea, Sierra Leone, Nigeria and Democratic Republic of Congo. Others who have visited those countries within six weeks will be quarantined for 21 days.

Saint Lucia: Visitors from Liberia, Guinea and Sierra Leone can't enter until the Ebola outbreak is under control. Travelers from Nigeria need to present a recent medical certificate declaring them free of the virus.

Antigua: No entry to anyone who has been in affected countries within the past 21 days and suspended granting of visas.

Saint Vincent and the Grenadines: Bans nationals from Nigeria, Sierra Leone and Guinea.

Belize: Issued a ban Friday on visas to persons from West African countries.

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

Follow us on Twitter: @TraveloreReport

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

A Guide For Fliers Worried About The Ebola Outbreak

Contributed by Scott Mayerson, AP.

FILE - In this Aug. 4, 2014 file photo, a South Korean quarantine officer, right, checks the body temperature of a passenger against the possible infection of Ebola virus at Incheon International Airport in Incheon, South Korea. South Korea has been stepping up monitoring of its citizens returning from trips to West Africa and other areas affected by the deadly Ebola virus. (AP Photo/Yonhap, Shin Jun-hee, File) KOREA OUT As the Ebola outbreak in West Africa grows, airlines around the globe are closely monitoring the situation but have yet to make any drastic changes. Below are some key questions about the disease, what airlines are doing and how safe it is to fly.

Q: Why are airlines concerned?

A: Airlines quickly take passengers from one part of the globe to another. One sick passenger on a plane could theoretically infect hundreds of people who are connecting to flights to dozens of other countries. Health and airline officials note, however, that Ebola only spreads through direct contact. Outbreaks of diseases that can spread through the air, such as the flu and severe acute respiratory syndrome, or SARS, are more problematic for airlines.

Q: Should people travel to West Africa?

A: The Centers for Disease Control and Prevention on Thursday issued a warning for Americans to avoid nonessential travel to the West African nations of Guinea, Liberia, and Sierra Leone.

Q: Is Ebola deadly?

A: Very much so. If contracted, there is no vaccine and no specific treatment. Ebola has a fatality rate of at least 60 percent. The World Health Organization estimated Monday that there have been 887 deaths from the current outbreak.

Q: How is Ebola transmitted?

A: The virus only spreads through direct contact with the blood or fluids of an infected person, according to the CDC. It can also be spread through objects, such as needles, that have been contaminated with infected fluids. No airborne transmission has been documented.

Q: Do U.S. airlines fly to West Africa?

A: Delta Air Lines flies to Dakar, Senegal; Accra, Ghana and Lagos, Nigeria. The airline also flies to Monrovia, Liberia, but for unrelated business reasons previously announced it will cancel that service at the end of September. Delta is letting passengers with flights to the region in the next two weeks push back travel until the end of the month. United Airlines also flies to Lagos, but has not issued any travel waiver. American Airlines does not fly to Africa.

Q: What are U.S. airlines saying about it?

A: There have been no flight cancellations. All three airlines said they are in regular communication with government agencies and health officials and will follow their recommendations.

Q: What about airlines from other countries?

A: European carriers such as Air France-KLM, British Airways and Lufthansa all fly to Western Africa from their hubs in Paris, Amsterdam, London and Frankfurt.

Lufthansa notes that "there is no risk of getting infected by the Ebola virus via air circulation during flight." Crews on Brussels Airlines flights have access to special thermoscans to check passengers' temperature, if they feel it's necessary. And British Airways has briefed all crew members flying to the region about the "causes and symptoms of Ebola." The only airline, so far, to cancel any flights is the Middle East airline Emirates. It has suspended its service to Conakry, Guinea, until further notice. It is still flying to Dakar.

Q: Are passengers leaving Africa being screened?

A: Since the outbreak erupted, the CDC has sent about two dozen staffers in West Africa to help try to track cases, set up emergency response operations and provide other help to control the outbreak. Last week, CDC officials said the agency will send 50 more in the next month. CDC workers in Africa also are helping to screen passengers at airports, according to CDC director Dr. Tom Frieden.

Q: Is the U.S. government doing anything extra for arriving passengers?

A: Border patrol agents at Washington's Dulles International Airport and New York's John F. Kennedy International Airport, in particular, are looking out for travelers who might have been exposed to the virus. They're watching for signs of fever, achiness, sore throat, stomach pain, rash or red eyes. The CDC also has staff at 20 U.S. airports and border crossings evaluating travelers with signs of dangerous infectious diseases and isolating them when necessary.

Q: Has the airline industry dealt with any outbreaks in the past?

A: In 2003, there was a global outbreak of severe acute respiratory syndrome, or SARS. The disease was first reported in Asia but quickly spread to more than two dozen countries in North America, South America and Europe. Unlike Ebola, SARS can spread when an infected person coughs or sneezes. During the 2003 outbreak, 8,098 people worldwide became sick with SARS; 774 of those died. Airports started screening incoming passengers for fever. The disease was devastating for airlines because fearful passengers stayed home.

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With reports from AP Medical Writer Mike Stobbe, New York.

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Scott Mayerowitz can be reached at http://twitter.com/GlobeTrotScott.

Travelore News: US Warns Against Traveling To Ebola-Hit Countries

Contributed by Mike Stobbe, AP.

 U.S. health officials on Thursday warned Americans not to travel to the three African countries hit by an outbreak of Ebola.

The travel advisory applies to non-essential travel to Guinea, Liberia and Sierra Leone. The outbreak in those West Africa countries has killed more than 700 people this year.

The Centers for Disease Control and Prevention say the risk of the deadly disease coming to the United States remains small. The last time the federal agency issued such a travel warning was in 2003 because of a SARS outbreak in Asia.

At the White House, press secretary Josh Earnest said the U.S. is looking into Medevac options to bring two American aid workers diagnosed with Ebola back to the U.S. While the U.S. government would facilitate the response, private companies would be used.

Earnest said that type of response would be consistent with how the U.S. handled other situations, including outbreaks of SARS and drug-resistant tuberculosis, and the goal would be to ensure Americans can benefit from modern medical treatment available in the U.S.

Although the CDC has concluded it's unlikely Ebola would spread if detected in the U.S, Earnest said the CDC is alerting health care workers in the U.S. and reminding them how to isolate and deal with cases of Ebola.

The CDC has about two dozen staffers in West Africa to help try to control the outbreak. Officials announced Thursday they will send 50 more in the next month.

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White House reporter Josh Lederman contributed from Washington.

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Online:

CDC notice: http://wwwnc.cdc.gov/travel/notices