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    Questions and Answers

    Maryland Department of Health and Mental Hygiene

    Updated June 19, 2015

    General Information

    What is Ebola virus disease?

    Ebola virus disease is a severe, often fatal, viral disease. Currently, there are Ebola outbreaks in two Western African nations. For the most current information regarding Ebola and outbreaks caused by Ebola, visit http://www.cdc.gov/vhf/ebola/.


    What are the symptoms of Ebola virus disease?

    Ebola virus disease symptoms usually include fever. Other symptoms may include headache, diarrhea, vomiting, weakness, joint and muscle aches, stomach pain, lack of appetite and bleeding. The symptoms can be similar to other, more common, infections. Symptoms appear 2-21 days after exposure to the virus, but most commonly occur 8-10 days after exposure.

    How is Ebola spread?

    Individuals who do not have a fever are not contagious and cannot transmit the disease to another person. The Ebola virus is transmitted through direct contact with the blood or body fluids of an infected person with symptoms or through exposure to objects (such as needles) that have been contaminated with infected body fluids. Transmission can also occur from directly handling bats, rodents or primates in areas where Ebola occurs.  

    How Ebola is Spread

    Who is at risk for Ebola?

    Individuals who have recently been in a country with known Ebola, and who also have:

    • Contact with blood or other body fluids of a patient or dead body known to have or suspected to have Ebola, or
    • Direct handling of bats, rodents or primates.

      If someone has symptoms of Ebola virus disease and a possible exposure, that person should see a health care provider.

    What is the treatment for Ebola?

    There is no specific treatment for Ebola; treatment is limited to close monitoring and supportive care in a hospital. For information about experimental treatments, visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-experimental-treatments.html.

    Ebola and Maryland

    What is the risk of Ebola in Maryland?

    Currently, the risk of acquiring Ebola in Maryland is extremely low. If a case is identified, there are established infection control guidelines to prevent transmission.

    What is the Department of Health and Mental Hygiene (DHMH) doing?

    DHMH has established standards to respond to reports of infectious diseases in Maryland and to prevent their transmission. Health care providers are required by law to report any cases of illness that might pose a risk to public health. These include Ebola virus disease, MERS-CoV, measles, polio, tuberculosis, pandemic influenza and about 100 other diseases.

    DHMH works in partnership with the CDC, other states, organizations and programs as part of the planning process for response to outbreaks of illness. Maryland is part of the Emerging Infections Program, a national resource for surveillance, prevention and control of emerging infectious diseases. Hospitals throughout Maryland are skilled in surveillance and infection control procedures. All-hazards public health emergency planning has established partnerships among health care and emergency response agencies.

    DHMH has taken these steps:

    1.         Surveillance/Disease Reporting –Ebola is a reportable condition. Providers and labs are required to report all suspected cases immediately.

    2.         24/7 Possible Case Investigation and Response – DHMH and local health departments have a 24/7 system to respond to and investigate possible Ebola cases and to monitor that appropriate isolation is in place while an assessment is underway.

    3.         Provision of Infection Prevention Guidance to Health Care Providers – Guidance, including how to properly isolate a suspected patient and appropriate use personal protective equipment for health care workers and others has been disseminated to:

    ·         hospital emergency departments;

    ·         hospital infection prevention officials;

    ·         nursing homes/long-term care facilities;

    ·         clinical laboratories; and

    ·         general health care providers

    4.         Development of Ebola Lab Testing Capacity – DHMH Laboratories Administration has the capacity to test for Ebola.

    5.         Coordination/Communication with other States and CDC – DHMH participates in regular Ebola-related calls and webinars with other states and with CDC (including the Dulles/BWI CDC Quarantine Station) to ensure up-to-date and coordinated responses.

    Where can I get the most up-to-date information on Ebola?

    For more EVD information, visit: http://www.cdc.gov/vhf/ebola/. To learn about the current Ebola situation in Maryland and links to Maryland guidance and fact sheets, visit dhmh.maryland.gov/ebola.

    Ebola and the Outbreak in West Africa

    How do I protect myself against Ebola?

    If you must travel to an area affected by the Ebola outbreak, protect yourself by doing the following:

    • Wash hands frequently or use an alcohol-based hand sanitizer.
    • Avoid contact with blood and body fluids of any person, particularly someone who is sick.
    • Do not handle items that may have come in contact with an infected person’s blood or body fluids.
    • Do not touch the body of someone who has died from Ebola.
    • Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.
    • Avoid hospitals in West Africa where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.
    • Seek medical care immediately if you develop fever (temperature of 100.4°F/ 38°C) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.
    • Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a health care facility.

    What is CDC doing in the U.S. about the outbreak in West Africa?

    CDC has activated its Emergency Operations Center (EOC) to help coordinate technical assistance and control activities with partners. CDC has deployed several teams of public health experts to the West Africa region and plans to send additional public health experts to the affected countries to expand current response activities.

    If an ill traveler arrives in the U.S., CDC has protocols in place to protect against further spread of disease. These protocols include having airline crew notify CDC of ill travelers on a plane before arrival, evaluation of ill travelers, and isolation and transport to a medical facility if needed. CDC, along with Customs & Border Patrol, has also provided guidance to airlines for managing ill passengers and crew and for disinfecting aircraft. CDC has issued a Health Alert Notice reminding U.S. health care workers about the importance of taking steps to prevent the spread of this virus, how to test and isolate patients with suspected cases, and how to protect themselves from infection.

    Can hospitals in the United States care for an Ebola patient?

    Any U.S. hospital that is following CDC’s infection control recommendations and can isolate a patient in their own room‎ with a private bathroom is capable of safely managing a patient with Ebola. For more information on infection control in health care settings, visit http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.

    Ebola and Travel

    What is being done to prevent ill travelers in West Africa from getting on a plane?

    In West Africa

    CDC’s Division of Global Migration and Quarantine (DGMQ) is working with airlines, airports, and ministries of health to provide technical assistance for the development of exit screening and travel restrictions in the affected areas. This includes:

    • Assessing the ability of Ebola-affected countries and airports to conduct exit screening,
    • Assisting with development of exit screening protocols,
    • Training staff on exit screening protocols and appropriate PPE use, and
    • Training in-country staff to provide future trainings.

    During Travel

    CDC works with international public health organizations, other federal agencies, and the travel industry to identify sick travelers arriving in the United States and take public health actions to prevent the spread of communicable diseases. Airlines are required to report any deaths onboard or ill travelers meeting certain criteria to CDC before arriving into the United States, and CDC and its partners determine whether any public health action is needed. If a traveler is infectious or exhibiting symptoms during or after a flight, CDC will conduct an investigation of exposed travelers and work with the airline, federal partners, and state and local health departments to notify them and take any necessary public health action. When CDC receives a report of an ill traveler on a cruise or cargo ship, CDC officials work with the shipping line to make an assessment of public health risk and to coordinate any necessary response.

    In the United States

    CDC has staff working 24/7 at 20 Border Health field offices located in international airports and land borders. CDC staff are ready 24/7 to investigate cases of ill travelers on planes and ships entering the United States.

    CDC works with partners at all ports of entry into the United States to help prevent infectious diseases from being introduced and spread in the United States. CDC works with Customs and Border Protection, U.S. Department of Agriculture, U.S. Coast Guard, U.S. Fish and Wildlife Services, state and local health departments, and local Emergency Medical Services staff.

    Relatively few of the approximately 350 million travelers who enter the United States each year come from these countries. Secondly, most people who become infected with Ebola are those who live with or care for people who have already caught the disease and are showing symptoms. CDC and health care providers in the United States are prepared for the remote possibility that additional travelers could get Ebola and return to the U.S. while sick. 

    Beginning Oct. 27, 2014, Maryland began active monitoring of all travelers returning from Guinea, Liberia and Sierra Leone.  Screening and active monitoring of travelers returning from Mali began on Nov. 17, 2014.  Maryland continues to actively monitor travelers arriving from Guinea and Sierra Leone, however, the active monitoring of travelers from Mali and Liberia has been discontinued.  For more information, click here.

    Should people traveling to Africa be worried about the outbreak?

    Ebola has been reported in multiple countries in West Africa (see Affected Countries). For the most up-to-date information on travel notices to these countries, visit http://wwwnc.cdc.gov/travel/notices.

    CDC currently does not recommend that travelers avoid visiting other African countries. Although spread to other countries is possible, CDC is working with the governments of affected countries to control the outbreak. Ebola is a very low risk for most travelers – it is spread through direct contact with the blood or other body fluids of a sick person, so travelers can protect themselves by avoiding sick people and hospitals in West Africa where patients with Ebola are being treated.

    Why were the ill Americans with Ebola brought to the U.S. for treatment? How is CDC protecting the American public?

    A U.S. citizen has the right to return to the United States. Although CDC can use several measures to prevent disease from being introduced in the United States, CDC must balance the public health risk to others with the rights of the individual. In this situation, the patients who came back to the United States for care were transported with appropriate infection control procedures in place to prevent the disease from being transmitted to others.

    Ebola poses no substantial risk to the U.S. general population. CDC recognizes that Ebola causes a lot of public worry and concern, but CDC’s mission is to protect the health of all Americans, including those who may become ill while overseas. Ebola patients can be transported and managed safely when appropriate precautions are used.

    Is there a danger of Ebola spreading in the U.S.?

    Ebola is not spread through casual contact; therefore, the risk of an outbreak in the U.S. is very low. We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases similar to Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

    Ebola and Animals

    How are animals involved in Ebola outbreaks?

    Because the natural reservoir host of Ebola has not yet been confirmed, the way in which the virus first appears in a human at the start of an outbreak is unknown. However, scientists believe that the first patient becomes infected through contact with an infected animal, such as a fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person transmission follows and can lead to large numbers of affected persons. In some past Ebola outbreaks, primates were also affected by Ebola, and multiple spillover events occurred when people touched or ate infected primates. In the current West African epidemic, animals have not been found to be a factor in ongoing Ebola transmission.

    Can dogs get infected or sick with Ebola?

    At this time, there have been no reports of dogs or cats becoming sick with Ebola or being able to spread Ebola to people or other animals. Even in areas in Africa where Ebola is present, there have been no reports of dogs and cats becoming sick with Ebola. There is limited evidence that dogs become infected with Ebola virus, but there is no evidence that they develop disease.

    Here in the United States, are our dogs and cats at risk of becoming sick with Ebola?

    The risk of an Ebola outbreak affecting multiple people in the United States is very low. Therefore, the risk to pets is also very low, as they would have to come into contact with blood and body fluids of a person with Ebola. Even in areas in Africa where Ebola is present, there have been no reports of dogs and cats becoming sick with Ebola.

    Can I get Ebola from my dog or cat?

    At this time, there have been no reports of dogs or cats becoming sick with Ebola or of being able to spread Ebola to people or animals. The chances of a dog or cat being exposed to Ebola virus in the United States is very low as they would have to come into contact with blood and body fluids of a symptomatic person sick with Ebola.

    Can my pet’s body, fur, or paws spread Ebola to a person?

    We do not yet know whether or not a pet’s body, paws, or fur can pick up and spread Ebola to people or other animals. It is important to keep people and animals away from blood or body fluids of a person with symptoms of Ebola infection.

    What if there is a pet in the home of an Ebola patient?

    CDC recommends that public health officials in collaboration with a veterinarian evaluate the pet’s risk of exposure to the virus (close contact or exposure to blood or body fluids of an Ebola patient). Based on this evaluation as well as the specific situation, local and state human and animal health officials will determine how the pet should be handled.

    Can I get my dog or cat tested for Ebola?

    There would not be any reason to test a dog or cat for Ebola if there was no exposure to a person infected with Ebola. Currently, routine testing for Ebola is not available for pets.

    What are the requirements for bringing pets or other animals into the United States from West Africa?

    CDC regulations require that dogs and cats imported into the United States be healthy. Dogs must be vaccinated against rabies before arrival into the United States. Monkeys and African rodents are not allowed to be imported as pets under any circumstances.

    Can monkeys spread Ebola?

    Yes, monkeys are at risk for Ebola. Symptoms of Ebola infection in monkeys include fever, decreased appetite, and sudden death. Monkeys should not be allowed to have contact with anyone who may have Ebola. Healthy monkeys already living in the United States and without exposure to a person infected with Ebola are not at risk for spreading Ebola.

    Can bats spread Ebola?

    Fruit bats in Africa are considered to be a natural reservoir for Ebola. Bats in North America are not known to carry Ebola and so CDC considers the risk of an Ebola outbreak from bats occurring in the United States to be very low. However, bats are known to carry rabies and other diseases here in the United States. To reduce the risk of disease transmission, never attempt to touch a bat, living or dead.

    Information adapted from the Centers for Disease Control and Prevention's Questions and Answers on Ebola, http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html, and Questions and Answers about Ebola and Pets, http://www.cdc.gov/vhf/ebola/transmission/qas-pets.html, 'DHMH protocols, partnerships help guard Maryland’s public health' http://dhmh.maryland.gov/newsroom1/Pages/DHMH-protocols,-partnerships-help-guard-Maryland%E2%80%99s-public-health.aspx and the DHMH Ebola fact sheet, http://phpa.dhmh.maryland.gov/OIDEOR/SIPOR/Shared%20Documents/DHMH%20Ebola%20General%20Fact%20Sheet%20FINAL.pdf.

    Note: The information on this page will be updated as needed. For the most current information on national and international cases and guidance, see http://www.cdc.gov/vhf/ebola/. For the most current information on the situation in Maryland, see dhmh.maryland.gov/ebola.