TRAVEL ADVISORY TO PREVENT THE IMPORTATION OF EBOLA INTO SOUTH AFRICA The purpose of this advisory is to notify travellers about the Ebola disease outbreak and inform them about preventative measures they can take and what Government is doing. 1. What is Ebola? Ebola is a rare and deadly disease caused by infection with the Ebola virus. It is only spread by direct contact with an infected person's blood or body fluids, contaminated objects or infected animals in affected countries. Ebola is not spread through the air or water. 2. What are the symptoms? Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhoea, vomiting and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients. 3. Who is at risk? People could become infected if they come into contact with blood or body fluids from someone who is infected or has died from Ebola. Health care providers caring for Ebola patients, family and friends in close contact with an ill person are at highest risk because they may come into direct contact with blood or body fluids. 4. What is the Department of Health doing about it? To date, there are no Ebola cases in South Africa. However, as part of enhanced precautionary measures to prevent occurrence or spread of Ebola into the country, the Department of Health is 1 P a g e
issuing a travel advisory. This advisory applies to all travellers coming to or leaving South Africa to or from affected countries. 4.1. Countries have been divided into three categories, viz: 4.1.1. High risk countries (Guinea, Liberia and Sierra Leone); 4.1.2. Medium risk countries (Nigeria, Democratic Republic of Congo, Kenya and Ethiopia). Please note that some of these countries like Kenya and Ethiopia have no Ebola yet, but are mentioned here because most people travelling from West Africa to South Africa travel via these countries; 4.1.3. Low risk countries (all other countries excluding the above). 4.2 For High Risk countries, there are four types of travellers likely to enter South Africa i.e.: 4.2.1. South Africans based in the affected countries; 4.2.2. People with permanent South African residence status who may come from affected countries; 4.2.3. South Africans who may be travelling to affected countries to conduct business; 4.2.4 Citizens of the affected countries who want to travel to South Africa. 4.3 Travel to and from High Risk Countries (Guinea, Liberia or Sierra Leone) 4.3.1 All South Africans and people with permanent South African residence status are advised to avoid non-essential travel to Liberia, Guinea or Sierra Leone. Essential travel may include Diplomatic or official health and humanitarian missions and business travel. 4.3.2 Non-South Africans travelling from high risk countries will not be allowed entry into South Africa unless the travel is considered absolutely essential. 4.3.3 In cases where travel to and from the high risk countries is unavoidable, permission to travel must be requested from the National Department of Health. The written request must be addressed to the Director-General: Health, for the attention of Dr Frew Benson and sent to the following address: Nathoc1@health.gov.za and Nathoc2@health.gov.za Tel: 012 395 9636 or 012 395 9637 4.3.4 The following information must be provided when requesting permission to travel: 2 P a g e
a. Full personal details, including residential addresses of South African citizens or in the case of non South Africans, the address of residence while in South Africa (i.e. hotel etc.) b. Next of kin details in the case of South African citizens c. Full details of the reasons for travel to or from South Africa. 4.3.5. The traveller must complete a Travellers Health Questionnaire and a Travellers Information Form prior to travel to and from high risk countries and submit the two documents with the request to travel. 4.3.6. The letter of application, the Travellers Health Questionnaire and the Travellers Information Form must be submitted to the National Department of Health 5 working days (excluding weekends) prior to departure; 4.3.7. A written response from the National Department of Health will be provided to the applicant informing him/her of the outcome of the request to travel. 4.3.8. In cases where permission is granted for travel to and from the high risk countries, the following will apply: a. Travellers must be screened in accordance with the World Health Organisation recommendations, prior to departure from the high risk area. b. Those found to have a high fever must not be allowed to board to depart for South Africa. 4.3.9 For those travellers where permission has been granted to transit through South Africa, the following will apply: a. On arrival into South Africa, travellers will be escorted to the transit facility by airport security personnel and they will remain there until their time of departure. b. At the time of departure, travellers must be escorted to ensure they board the aircraft for departure from South Africa. 4.4 Screening in South Africa 4.4.1 Upon arrival in South Africa the traveller will be subjected to rigorous screening and medical assessments before being allowed entry into the country; 4.4.2. The traveller must hand in the completed Travellers Health Questionnaires and the approval letter to Port Health officials on arrival, who will then apply the necessary measures. 4.4.3. If found to have any of the symptoms or signs suggestive of Ebola, the traveller will be escorted to a clinic at the Point of Entry for further examination. Where there is no clinic at the Point of Entry, the traveller will be kept apart in an identified area where 3 P a g e
there is no direct contact with other people until such time as the emergency services arrive for further medical examination or transport of the traveller; 4.4.4. If found to have no symptoms or signs suggestive of Ebola, the traveller will be provided with health information on Ebola. The traveller will also be monitored daily for a period of 21 days by the Department of Health for any symptoms such as fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash or red eyes. 4.5. Travel from medium and low risk countries The following measures shall apply for all travellers coming from medium and low risk countries. a. Those that show symptoms will be subjected to the same process as in paragraph 4.4 (c). b. Those that do not show symptoms will be cleared to follow the normal immigration procedures and will be provided with information on Ebola. 5. What can travellers do to prevent Ebola? There is no vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola. Avoid non-essential travel to Liberia, Guinea, and Sierra Leone. If you must travel to these countries, please make sure to do the following: a. Avoid restricted areas in affected countries; b. Practice careful hygiene. Avoid contact with blood and body fluids of sick persons. c. Do not handle items that may have come in contact with an infected person s blood or body fluids; d. Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola; e. Avoid contact with wild animals or with bush meat in affected countries. f. Avoid hospitals where Ebola patients are being treated; g. The South African Embassy or consulate is often able to provide advice on facilities that are suitable for your needs; h. Seek medical care immediately if you develop fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, or red eyes; i. Limit your contact with other people when you travel to the doctor. Do not travel anywhere else. 4 P a g e
6. Pay attention to your health after you return to South Africa, by doing the following: a. Inform the Port Health official of your occupation and travel history on arrival in South Africa; b. Monitor your health for 21 days if you were in an area with an Ebola outbreak, especially if you were in contact with blood or body fluids, items that have come in contact with blood or body fluids, wild animals or bush meat, or hospitals where Ebola patients are being treated; c. Seek medical care immediately if you develop fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, or red eyes. Tell the doctor about your recent travel and your symptoms before you go to the examination/emergency room or surgery. Advance notice will help the doctor care for you and protect other people who may be in the room. 7. Special recommendation for Health Care Workers Health care workers who may be exposed to people with the disease should follow these steps: a. Wear protective clothing, including masks, gloves, gowns, and eye protection; b. Practice proper infection control and sterilisation measures. For more information, see Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting. c. Isolate Ebola patients from unprotected people; d. Avoid direct contact with the bodies of people who have died from Ebola; e. Notify health officials if you have been exposed to someone with Ebola; f. Inform the Port Health official of your occupation and travel history on arrival in South Africa. For additional information on Infection Control for Viral Haemorrhagic Fevers go to: http://www.who.int/csr/resources/publications/ebola/whoemcesr982sec1-4.pdf Send all travel related queries to: National Department of Health Director General-Health Attention: Dr Frew Benson Nathoc1@health.gov.za and Nathoc2@health.gov.za Tel: 012 395 9637 9636 or 012 395 9637 5 P a g e