Cabinet decision on Ebola

21 Aug 2014

The Cabinet met on 20 August 2014 and was presented with an update on the Ebola outbreak in Guinea, Sierra Leone, Liberia and Nigeria by the Minister of Health, Dr Aaron Motsoaledi.

Cabinet noted with concern the extent of the outbreak and the increase of cases in three of these countries, i.e Guinea, Sierra Leone and Liberia, over the last week. Cabinet recognised that even though the outbreak has been limited to these countries in West Africa, the spread to other countries need to be contained. Cabinet recognized that containing the outbreak at source will be essential and limit the spread and mortality caused by the disease to these particular parts of the world.

Cabinet noted that the Department of Health has taken measures in South Africa to enhance surveillance, distribute guidelines to all hospitals in public and private sectors, designate health facilities for the treatment of patients, deployed personal protective equipment (PPE) to designated facilities, conducted training, activated outbreak response teams and is operating a hotline for clinicians through the NICD.

Countries have been divided into three categories, viz

1. High risk countries (Guinea, Liberia and Sierra Leone);

2. Medium risk countries (Nigeria, 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;

3. Low risk countries (all other countries excluding the above)

For the first category countries, that is the high risk countries, there are four types of travelers likely to enter South Africa i.e.

(a) South Africans based in the affected countries;
(b) People with permanent residence status who may come from affected countries;
(c) South Africans who may be traveling to affected countries to conduct   business; and
(d) Citizens of the affected countries who want to travel to South Africa

For all these travellers, Cabinet decided as follows:

• A total travel ban for all non-citizens travelling from these high risk countries, unless the travel is considered absolutely essential;
• For citizens of South Africa who wish to travel to these countries, they will be requested to delay their travel unless it is also absolutely essential for them to travel;
• For South African citizens returning from these countries, they will have to be subjected to a stricter screening process that is as follows:
  • Completing a comprehensive health questionnaire before being allowed entry back into the country;
  • If the comprehensive medical questionnaire and the temperature screening reveal something, they will have to subject themselves to a complete medical examination

For medium and low risk countries, the normal surveillance that has been going on will just be enhanced.

There is a special category of individuals who are South Africans but work there in the mines, communications, security and retail. For these groups, we have called a special meeting tomorrow (22 August 2014), which will deal with their unique situation.

Cabinet also accepted the Southern African Development Community's (SADC) decision that South Africa be a centre of excellence for training, laboratory diagnosis and clinical expertise.
Cabinet also established an Inter-Ministerial Committee (IMC) to deal with the coordination of the response. This IMC will consist of the following Departments:

• Department of Health (Convenor);
• Department of Agriculture, Fisheries and Forestry;
• National Treasury;
• Departments of Defence and Military Veterans (South African Military Health Service);
• Department of International Relations and Cooperation;
• Department of Transport;
• Department of Home Affairs;
• Department of State Security;
• Department of Tourism
• Department of Basic Education; and
• Department of Sports and Recreation

Funding

Cabinet further approved funding requested by the Department of Health to the tune of R32.5 million, from the African Renaissance Fund to support containment and prevent further spread of the virus to South Africa and other countries.

Part of the funds will be used to deploy the mobile laboratory in Sierra Leone, fund transport and accommodation for the team and training for health care workers.

Cabinet remains committed to ensuring the health and wellbeing of all our citizens and requests the public to adhere to limited travel restrictions announced in this briefing.

A travel advisory has also been prepared and copies are available and will be distributed to the media and relevant parties.

***

Travel advisory to prevent the importation of Ebola into South Africa

21 Aug 2014

The purpose of this advisory is to notify travellers about the Ebola outbreak and inform them about measures they can take to minimize the risks of contracting the disease.

What is Ebola?

Ebola is a rare and deadly disease. It is caused by infection with one of the Ebola viruses (Ebola, Sudan, Bundibugyo or Tai forest virus). It is spread by direct contact with a sick person's blood or body fluids. It is also spread by contact with contaminated objects or infected animals.

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.

Who is at risk?

Travellers could become infected if they come into contact with blood or body fluids from someone who is sick or has died from Ebola, sick wildlife or meat from an infected animal. 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 contact with blood or body fluids.

What is the Department of Health doing about it?

As part of enhanced precautionary measure to prevent the spread of Ebola into South Africa, the Department of Health is issuing a travel advisory for travellers both South African residents and non-residents coming into South Africa from or through Liberia, Guinea, Sierra Leone as well as those coming from non-affected countries.
 
All South Africans are hereby advised to avoid non-essential travel to Liberia, Guinea or Sierra Leone. South Africans are not restricted from travelling to these countries, however all returning travellers from these countries will be subjected to rigorous screening and medical assessments before being allowed entry into the country.

The following additional measures will be instituted:

1. All travellers and crew members arriving into South African Points of Entry must have completed a Travel Health questionnaire upon arrival. If found to have any of the symptoms or signs suggestive of Ebola, they will be referred to one of the designated hospitals for further investigations and management.

2. Passengers who travelled from or through Guinea, Liberia or Sierra Leone within the last month of arrival into South Africa must undergo additional screening at the Points of Entry.

2.1    For those who display symptoms related to Ebola: Travellers will be escorted to the clinic at the Point of Entry for further examination. Where there is no clinic at the Point of Entry, travellers will be kept apart in an identified area where there is no direct contact with other people until such time as the emergency services arrive for further examination or evacuation of the traveller.
2.2    For those with no symptoms: Travellers will be provided with health information on Ebola and subjected to quarantine surveillance i.e. required to report body temperatures daily to the Department of Health. They will also be required to report details of any symptoms such as fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash or red eyes.

3. Travellers from non-affected countries:

3.1    Those that show symptoms will be subjected to the same process as in paragraph 2.1.
3.2    Those that do not show symptoms will be cleared to follow the normal immigration procedures.

4. If any of the travellers referred to the Point of Entry clinic are found to fit the case definition for the Ebola virus disease (EVD), the necessary infection control measures should be implemented while awaiting evacuation of the traveller to the designated health facility.

5. Those without symptoms or signs will be provided with information on Ebola and followed up for 21 days. Information will also be provided on phone numbers to call in case of development of fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash or red eyes.

What can travelers 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 nonessential travel to Liberia, Guinea, and Sierra Leone. If you must travel to these countries, please make sure to do the following:

• Practice careful hygiene. Avoid contact with blood and body fluids of sick persons.
• Do not handle items that may have come in contact with an infected person's blood or body fluids.
• Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
• Avoid contact with wild animals or with bush meat.
• Avoid hospitals where Ebola patients are being treated.
• The South African Embassy or consulate is often able to provide advice on facilities that are suitable for your needs.
• Seek medical care immediately if you develop fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, or red eyes.
• Limit your contact with other people when you travel to the doctor. Do not travel anywhere else.
• Pay attention to your health after you return to South Africa, by doing the following:
  • Inform the Port Health official of your occupation and travel history on arrival in South Africa.
  • 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.
  • 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

Special recommendation for health care workers

Health care workers who may be exposed to people with the disease should follow these steps:

• Wear protective clothing, including masks, gloves, gowns, and eye protection.
• Practice proper infection control and sterilization measures. For more information, see "Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting."
• Isolate Ebola patients from unprotected people.
• Avoid direct contact with the bodies of people who have died from Ebola.
  • Notify health officials if you have been exposed to someone with Ebola.
  • Inform the Port Health official of your occupation and travel history on arrival in South Africa.

Issued by Department of Health, August 21 2014

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