Ebola Virus Disease (EVD)

In this Spotlight Members and clients will find the latest updates and advices from internal and external resources.

The WHO provides situation reports the latest can be found here http://apps.who.int/ebola/current-situation/ebola-situation-report-16-march-2016

During the last 2 months West African had been EVD (Ebola Virus Disease) free, however, several flare ups of EVD have been reported in recent weeks. These have also been isolated cases in rural communities. On 16 March 2016, health authorities from Guinea, Liberia and Sierra Leone and representatives of partner organizations have expressed confidence in the capacity of the three Ebola-impacted countries to effectively manage residual risks of new Ebola infections—pointing to the rapid government-led containment of recent flare-ups of the disease.

The deadliest Ebola outbreak in recorded history is slowly drawing to a close. The outbreak was unprecedented both in the number of infections (28639), deaths (11,316) and in geographic spread.

The Ebola virus has now hit many countries: predominantly Sierra Leone, Guinea, Liberia and to a lesser extent Mali.” Significant outbreaks in Nigeria, Mali and isolated incidents in Spain, Senegal, Italy, UK and the US have been contained

According to WHO’s latest Ebola update from 30 March, http://who.int/csr/disease/ebola/en/   the WHO Director-General has now declared the end of the Public Health Emergency of International Concern regarding the Ebola virus disease outbreak in West Africa. According to a WHO statement on 29 March 2016: “in the Committee’s view the Ebola situation in West Africa no longer constitutes a Public Health Emergency of International Concern and the Temporary Recommendations adopted in response should now be terminated. The Committee emphasized that there should be no restrictions on travel and trade with Guinea, Liberia and Sierra Leone, and that any such measures should be lifted immediately.”

While the risks have decreased significantly in regards to EVD, Members should consider the recommendations made in the previous SPOTLIGHT article (repeated below) as general good practice for the general avoidance of any contagious diseases and be incorporated as part of their general housekeeping and operations.

Members and clients are asked to consider the following recommendations and pass such on to their vessels:

• The Master should ensure that the crew are aware of the risks, how virus’ can be spread and how to reduce the risk.
• The ISPS requirements on ensuring that unauthorised personnel do not board the vessel should be strictly enforced throughout the duration of the vessel being in port.
• The Master should give careful consideration to granting any shore leave whilst in impacted ports.
• The shipowner/operator should avoid making crew changes in the ports of an affected country.
• After departure the crew should be aware of the symptoms and report any occurring symptoms immediately to the person in charge of medical care.

Latest WHO advice and recommendation for ships

In case of a passenger presenting with symptoms compatible with EVD (fever, weakness, muscle pain, headache, sore throat, vomiting, diarrhoea, bleeding) on board of a ship, the following precautions must be applied:

• Keep his/her cabin doors closed, if not placed in an medical isolation room on board.
• Provide information about the risk of Ebola transmission to persons who will take care of the patient or enter the isolation area.
• A log listing all people entering the cabin should be maintained.
• Anyone who enters the cabin to provide care to the person in isolation or to clean the cabin must wear PPE with:
  • A surgical protection mask; and eye protection or a face shield
  • Non-sterile examination gloves or surgical gloves;
  • Disposable impermeable gown to cover clothing and exposed skin. A waterproof apron should be worn over a non-impermeable gown or when coming in close contact with the person in isolation
  • Before exiting the isolation the PPE should be removed in such a way as to avoid contact with the soiled items and any area of the face.
  • Limit the movement and transport of the patient from the cabin for essential purposes only. If transport is necessary, the patient should wear a surgical mask.
  • Clean and disinfect spills without spraying or creating aerosol. Used linen, cloths, eating utensils laundry and any other item in contact with a patient’s body fluids should be collected separately and disinfected in such a way as to avoid any creation of aerosol or any contact with persons or contamination of the environment. Effective disinfectant is a dilution of sodium hypochlorite at 0.05 or 500 ppm available chlorine, with a recommended contact time of 30 minutes.
  • All waste produced in the isolation cabin must be handled according to the protocol of the ship for clinical waste. If incinerator is available on board, then waste must be incinerated. If waste must be delivered ashore, then special precautions are needed and the port authority should be informed before waste delivery.
• Start case investigation immediately. Protective equipment is not required when interviewing asymptomatic individuals, when a distance of one metre is maintained.
• Close contacts should be identified and asked to do passive self-monitoring of temperature (e.g. monitoring temperature only if feeling feverish) and symptoms or active self-monitoring (e.g. by regular temperature measurement twice a day and for 21 days.

In the event of a suspected diagnosis of EVD on a ship, immediate expert medical opinion should be sought and the event must be reported as soon as possible to the next port of call by the Captain.

The patient should disembark in such a way as to avoid any contact with healthy travellers and wearing a surgical mask. Personnel in contact with the patient during the medical evacuation should wear a surgical protection mask and PPE.

The competent authority at port may need to arrange depending on the situation: medical evacuation or special arrangements for disembarkation and hospitalization of the patient and laboratory diagnosis.

Passengers, crew members and cleaning staff who have been identified through contact tracing should be assessed for their specific level of exposure. Passive self-monitoring of temperature (e.g. monitoring temperature only if feeling feverish) and symptoms or active self-monitoring (e.g. by regular temperature measurement twice a day) for those at higher risk level should be continued for 21 days.

At the request of a governmental port health authority, ship operators shall also facilitate obtaining, from some or all passengers, to provide information on their itinerary and their contact details (should they need to be contacted) when there is a particular reason to believe they may have been exposed to infection on board of the ship. Additionally, countries may consider requiring arriving ships to complete and deliver the Maritime Declaration of Health (IHR Annex 8). Measures taken on board should also be noted on the IHR Ship sanitation control certificate (IHR Annex 3) 

The complete WHO guidelines for can be found at http://www.who.int/ith/updates/20140421/en/. Section 3.3, as extracted above, covers ships.