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Occupational Health Advisory - Ebola Virus Disease - November 25, 2014

Specialized Health Services Directorate, Health Canada

  • This advisory from Health Canada’s Specialized Health Services Directorate (SHSD) is to provide Federal Departments with guidance on recommended occupational health measures, based on the current knowledge of Ebola virus.
  • In August 2014, the World Health Organization (WHO) declared the outbreak of Ebola virus disease in West Africa a Public Health Emergency of International Concerns that requires a coordinated international response to stop the spread.
  • The public health risk posed by Ebola for Canadians is considered very low at this time.
  • Federal employees should continue to follow general measures aimed at preventing infectious diseases.
  • This advisory is based on the latest knowledge of the Ebola virus, which continues to evolve.

Purpose

The purpose of this advisory is to provide Federal Departments with occupational health advice on the Ebola virus. It is based on currently available information on Ebola. As more information becomes available, this occupational health advisory will be updated.

Issue

An Ebola virus disease outbreak is ongoing in West Africa. Countries with widespread and intense transmission include Guinea, Sierra Leone and Liberia. Other countries, including Nigeria, Senegal, Spain, Mali, and the United States, have also reported an initial case or cases, or with localized transmission. There was also a separate outbreak of Ebola in the Democratic Republic of Congo unrelated to the outbreak in West Africa. As a result of their work duties, federal public service employees either working in Canada or overseas could potentially come into contact with individuals who may be infected with the Ebola virus.

Background

In March 2014, the WHO confirmed that the Ebola virus was spreading in areas of Guinea, Sierra Leone and Liberia, with high mortality rates in infected individuals. Subsequently, in August 2014, the WHO declared the outbreak of Ebola virus in West Africa a Public Health Emergency of International Concerns that required a coordinated international response to stop the spread.  There is ongoing and widespread transmission in West Africa. Following a successful response in Senegal and Nigeria of imported cases, both of these countries were declared free of Ebola virus transmission on 17 October and 19 October 2014, respectively by the WHO.  Spain reported one infected case in early October that was successfully treated.  With no further cases reported, Spain could be declared free of Ebola in early December.  In the United States, there have been limited cases from a traveller, a returning health care worker and local transmission. At the time of this advisory, there is no active case in the US. The Democratic Republic of Congo also experienced a separate outbreak of Ebola in the Equateur province unrelated to the current Ebola outbreak that originated in West Africa. This outbreak is presently contained with no new cases since mid-October and the country was declared free of Ebola on November 20, 2014.

For up to date information on the current status of the Ebola outbreak, it is suggested to consult the WHO website where regular Situation reports on the Ebola response roadmap can be found.

What is Ebola virus disease?

Ebola virus disease is a rare and severe viral disease that causes haemorrhagic fever in humans and animals. The virus can infect both humans and non-human primates (monkeys, gorillas, etc.). When infected, people can get very sick, initially with fever, chills, weakness, headache, sore throat and muscle pains.  Additional symptoms include nausea, vomiting and diarrhea as well as bleeding from different parts of the body (i.e. haemorrhage). The time from infection to symptoms can range from 2 to 21 days. There is currently no licensed treatment or vaccine for Ebola virus disease. Early diagnosis and early supportive therapies are key to reducing the disease’s morbidity and mortality rates.

How is Ebola transmitted?

The Ebola virus can spread through:

  • Person to person with direct contact (i.e. through broken skin or mucous membranes) with blood or body fluids from an infected and sick person or from the remains of someone who died from Ebola.
  • Contact with medical equipment, such as needles, contaminated with infected blood or body fluids of an infected and sick person.
  • Contact with infected animals (bats, monkeys, gorillas, pigs, etc.)

Ebola virus is not spread through casual contact. Airborne transmission in humans has not been demonstrated. In the absence of direct contact (through broken skin or mucous membranes such as lips, nostrils, mouth or eyes) with blood or body fluids of an infected individual who is showing symptoms of Ebola, there is a low risk of contracting Ebola in a setting where the disease is present. Ebola is not transmitted from people who don’t have symptoms. Where the virus is present and there is a risk of exposure such as in the health care setting, the risk is also very low if precautions such as appropriate personal protective equipment and infection prevention and control measures are implemented and followed.

What is being done to protect federal employees?

The Public Health Agency of Canada (PHAC) is taking precautions to prevent and control the spread of communicable diseases such as Ebola in Canada through administration of the Quarantine Act. The Quarantine Act is administered 24 hours per day, 7 days per week at all points of entry into Canada. The Government of Canada is supporting the provinces, territories and local health authorities to assist with the quick identification, testing, diagnosis and management where an Ebola case is suspected.  Additionally, the Government of Canada is also working closely with the WHO and international partners to better understand the situation and contain/limit the transmission. The PHAC and the SHSD will provide any updated documentation and guidance from the WHO and other Health Authorities as needed.

For the latest updates on Ebola, including the total number of cases and deaths, please visit the World Health Organization's Global Alert and Response website. Also read and follow information from the Public Health Agency of Canada on Ebola.

Risk to federal employees

The public health risk posed by Ebola in Canada is considered very low at this time. There is currently no confirmed case of Ebola in Canada. Although the disease is rare, it has potential for person-to-person transmission, especially among healthcare workers, family members or others who provide care and / or have direct contact with an infected person.  For employees and their families residing overseas, the risk is also considered very low as long as precautions are taken to avoid contact with blood or body fluids and contact with sick or ill looking individuals.

Recommendations for federal employees

Federal employees who may come into contact with potentially ill individuals should follow general measures aimed at preventing the spread of infectious diseases in the workplace.  These measures include personal hygiene such as: frequent hand washing, avoiding touching your eyes, nose and mouth and avoiding close contact with people who are sick. Additionally, commonly used and shared surface areas should be regularly cleaned and disinfected, with maintenance of good housekeeping in the workplace environment.

Recommendations for workplaces with potential Ebola cases

At federal work sites in Canada and in Canadian Missions abroad, federal employees may encounter individuals of unknown health status appearing ill (i.e., fever, coughing, sweating). In these situations, and if risk factors for Ebola are present such as travel history from an affected area or other risk factors, such as direct contact with someone who is sick with Ebola,  the individual should be isolated in a separate area or room away from the normal flow of travellers, visitors and staff. It is then recommended to contact the appropriate health authorities for further management including a health risk assessment.  Employees should avoid all contact with blood and other body fluids of the individuals and should also follow recommended infection prevention control measures applicable to their work setting. This includes cleaning and disinfection procedures as well as waste management procedures applicable to the specific setting. Federal employees who may come into contact with Ebola virus may also refer to the “Questions and Answers for the workplace environment” document.

There are also federal departments with employees who due to the nature of their work, may be at greater risk of encountering individuals potentially infected with Ebola. These departments and employees include the Canada Border Service Agency (Border Service Officers), the Public Health Agency of Canada (Quarantine Officers, Laboratory Technicians), Citizenship and Immigration Canada (Immigration Officers), Transport Canada and the Department of National Defense (First Responders) and the Department of Foreign Affairs, Trade and Development. It is recommended that these departments review and apply their standard operating procedures to ensure that safety and control measures are in place in accordance with their roles, activities and the associated risks. Guidance documents including Infection Prevention and Control measures to support these roles are available on the PHAC Ebola website.

Travel related recommendations

It is recommended that Canadian federal employees avoid all non-essential travel to countries where there is active and widespread transmission of Ebola. At present, this includes Guinea, Liberia and Sierra Leone. When this is not possible, employees who travel or work in affected areas should read and follow the protective measures as recommended in the Public Health Agency of Canada’s travel health notices for these destinations.

Prior to departure and while travelling:

  • Consult with a health care provider or visit a travel health clinic at least six weeks before departure.
  • Avoid direct contact with blood and other body fluids of people with Ebola or unknown illnesses.
    • Avoid direct contact with bodies of people who have died of Ebola or unknown illnesses.
    • Avoid contact with any objects, such as needles, that have been contaminated with blood or body fluids.
    • Avoid unprotected sexual activity with an infected person or a person recovering from Ebola.
  • Healthcare workers are at higher risk of exposure and should adhere to strict infection prevention and control measures.
    • Healthcare workers should practice strict infection control measures including the appropriate use of personal protective equipment to protect all exposed skin (i.e., gowns, masks or respirators, goggles, face shields and gloves) when providing care for suspected or confirmed cases.
    • In addition to routine practices for all patients, precautions for contact, droplet and aerosol generating procedures are recommended.
    • Patients with Ebola should be isolated.
  • Avoid close contact with or handling of animals.
    • Avoid live or dead animals, as both can spread the virus. Animals such as chimpanzees, gorillas, monkeys, forest antelope, pigs, porcupines, duikers and fruit bats may be carriers.
    • Avoid handling of raw or undercooked meat.
  • Practice strict hand washing routines.
  • Avoid hospitals in West Africa where treatment of patients with Ebola is occurring.
  • Know the symptoms of Ebola virus disease and see a health care provider if they develop during travel.
  • Know the symptoms of Ebola and see a healthcare provider if they develop during travel or while residing in a region affected by the Ebola outbreak.
    • If residing overseas, you may contact Canadian embassy or consulate mission for further advice on where to obtain the necessary medical care.

Travelling back to Canada:

  • Airports in Ebola affected countries are screening travellers for signs of Ebola or a fever and/or the possibility that they may have been exposed to Ebola virus.  Those who have been exposed or are showing symptoms of Ebola will not be allowed to travel on commercial flights as well as on any commercial buses, trains or ships.
  • Under the Quarantine Act, when arriving in Canada, all travellers must disclose to a Border Services Officer (BSO) if they have, suspect to have, or have been in close proximity with someone who has a communicable disease.  Ebola specific enhanced measures have been put in place at Canada’s borders. As part of the new measures, BSOs refer all travellers who have, in the past 21 days, been in Guinea, Liberia, Sierra Leone, or Mali or those who have had contact with a person with Ebola, to a Quarantine Officer for a detailed screening, including a temperature check.  The Quarantine Officer will determine further measures to be taken with these travellers under the Quarantine Act, based on an assessment of symptoms and risk of exposure to Ebola.
  • Additionally, these travellers will be provided with an Ebola Self-Monitoring Kit that includes a thermometer and instructions for self-monitoring for symptoms of Ebola for up to 21 days following entry into Canada and what the traveller should do if symptoms develop.
  • Those travellers who are determined to be exhibiting symptoms compatible with Ebola will be required to undergo a medical examination and sent to a medical facility for isolation and investigation.
  • For more information about specific requirements for travellers entering Canada from the Guinea, Liberia and Sierra Leone, refer to the Order in Council Minimizing the Risk of Exposure to Ebola Virus Disease in Canada Order (no.2) of the Quarantine Act.

After returning to Canada:

  • Monitor your health upon your return or entry into Canada from a region affected by the Ebola outbreak. Those who have received an EVD self-monitoring kit should follow the directions provided by the Quarantine Officer.
  • Seek medical attention immediately, if a fever and/or any other symptoms arise within three weeks after your return to Canada.
  • Be sure to call your health care provider before your appointment that you have travelled to a region where Ebola virus disease was present and inform them of your symptoms, activities and work you participated in.  This way, the health care provider can arrange to see you safely without exposing others.  If you are concerned that you are infected, it is important to limit your contact with others as much as possible until you can be assessed by the health care provider.

Healthcare workers

Healthcare workers and humanitarian workers are at higher risk of exposure to the virus due to the nature of their work when caring for Ebola patients if they do not wear adequate personal protection equipment (PPE) and if they do not follow strictly the recommended measures for infection prevention and control. Other risks for workers involved in health care and epidemic response include psychological distress, stigma, violence, long working hours, heat stress and dehydration from using heavy PPE and ergonomic problems from handling bodies and heavy loads. It is essential that workers involved in the care and management of Ebola patients (including suspect cases) receive appropriate occupational health training and adhere to strict infection prevention and control measures in accordance to those established by their Occupational Health and Safety unit and with guidance offered from local and public health authorities.

Guidance documents

The following guidance documents from the PHAC can assist departments with their internal procedures. As some of these documents are ongoing revision or will be updated, it is important to verify for the most up to date version on the Ebola website under “Additional resources” on the Health Professionals webpage:

Infection Prevention and Control:

Biosafety:

References

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