The current Ebola outbreak is by far the largest and the first multi-country outbreak of the disease ever reported in its 38-year history. Six countries in west Africa are affected: Guinea, Liberia, Sierra Leone, Nigeria, Democratic Republic of Congo and Senegal and are now reporting laboratory-confirmed cases.
The current epidemic trend of EVD remains precarious, with infection transmissions continuing to occur in urban communities and in health facilities across countries in western Africa. A number of countries in the WHO Eastern Mediterranean Region have international travel hubs that connect these countries with those of western Africa where the outbreak is ongoing. Although risk of transmission of Ebola through international travel is presumed to be low, in all likelihood, Ebola could be introduced to the Region through a passenger travelling to the Region from any of the affected countries in west Africa with widespread and intense transmission.
Considering this scenario of the threat of importation of EVD into the countries of the Region, the WHO Regional Office has stepped up its preparedness efforts in line with WHO’s global roadmap for response to this threat. This page summarizes possible scenarios for introduction of the virus in the Region and the key public health actions that countries should urgently implement to accelerate national efforts for early detection of Ebola introduction in their country and to rapidly respond in order to limit local transmission.
Possible scenarios for introduction of EVD in the WHO Eastern Mediterranean Region
Scenario 1. Introduction by travel and trade
By air
The risk of transmission of EVD through international travel by air is presumed to be low but, in all likelihood, this would be the most probable scenario of introduction of EVD in the countries of the Region as many countries are connected by daily/weekly flights to many cities in west Africa, and many travellers move frequently between these two WHO regions.
By land or sea
This carries risk as well. However, considering the time that it may take to cross the Sahara desert, and the strains of such a journey, it may be too much for an Ebola infected person to survive this long and strenuous journey before they arrive at their point of destination in the Region.
Trade
The importation of exotic animals (monkeys and other primates who are the intermediate host of the virus) carries very low risk.
Scenario 2. Silent importation and cases appearing in health facilities
Due to the long incubation period of EVD (2 to 21 days), someone with EVD may appear healthy when crossing any points of entry and therefore be screened out without any suspicion. However, at a later stage the symptoms of EVD may eventually appear in the case that was “silently” imported to the Region and a patient with full blown clinical symptoms and signs consistent of EVD may present in a health facility. This scenario is most likely to occur in countries of the Region which can catch the health system of the country off-guard and localized transmission may continue if adequate public health preparedness measures are not in place.
Public health measures for early detection and prevention of transmission
Related links
Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation
