Ebola in West Africa and the Importance of Local Health Departments to Global Health Security

????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????The current Ebola outbreak in West Africa is receiving intense national and international media attention. This is the largest outbreak of Ebola ever and impacts a region of Africa that has not previously reported cases. It has spread to four countries (Liberia, Guinea, Sierra Leone and Nigeria) and sickened 1,848 people (suspected and confirmed cases as of August 12), 1013 of whom have died (nearly 55 percent).[1] After an American physician and another American aid worker serving with a missionary group in Liberia contracted Ebola, the Centers for Disease Control and Prevention (CDC) arranged for their transports back to the United States. They are now being treated at Emory University Hospital in Atlanta.[2]

The Ebola outbreak highlights the need for more robust global health security and the critical activities that support that agenda.[3] Media reports have noted that with the speed of modern travel, Ebola is only a plane ride away from anywhere in the world. However, while Ebola is frightening, the chance of a U.S. outbreak remains small.[4] The public health and healthcare infrastructures in the United States allow officials to quickly identify and isolate potential cases and discover any individuals who may have been exposed. Major hospitals are equipped with isolation rooms and practice in infection control.

What is Ebola?

Ebola is a highly virulent virus that causes Ebola Virus Disease. Ebola is not transmitted through the air; rather it requires contact with bodily fluids (blood, sweat, saliva, vomit, diarrhea, urine) of a patient symptomatic with the disease. Patients who are not symptomatic do not transmit the virus. Ebola can survive for several days on surfaces that have been contaminated with bodily fluids from an infected patient, making it possible to become infected after touching an inanimate object.[5]

Symptoms of Ebola can appear between two and 21 days after exposure. Symptoms often resemble those of other infectious diseases and can include fever, weakness, headache, muscle pain, and sore throat. Later symptoms include vomiting, diarrhea, rash, and impaired kidney and liver functions. Patients may also exhibit internal and external bleeding. When diagnosing Ebola, other diseases should be ruled out including malaria, meningitis, and hepatitis.

Current U.S. Response

CDC is on alert and actively responding to the current outbreak. It has sent over 50 experts to the impacted countries to assist in tracking and controlling the outbreak.[6] One key issue is working with countries to identify and isolate any individuals exhibiting symptoms that may be trying to leave the country. This will help prevent the spread of the disease beyond the region. Other nations worldwide are also working to identify and isolate symptomatic travelers from the impacted region as they enter other countries.

In the United States, CDC has issued advisories through the Health Alert Network (HAN). The advisories note that the current risk of Ebola reaching the United States remains low; however, they advise healthcare providers to be on alert for those with signs and symptoms of Ebola that report travel to the impacted region within 21 days of becoming symptomatic.[7,8] Quarantine officers at major points of entry into the United States remain on alert for any travelers from the region who are exhibiting signs and symptoms.

CDC has also issued several guidance documents to help health departments, clinicians, and laboratorians understand how to handle individuals who may be infected or specimens from those individuals, including the following:

CDC has also issued a travel advisory for the region (Liberia, Guinea, and Sierra Leone), recommending against all non-essential travel.[9]  While the risk of coming into contact with Ebola while in the region remains low, any injury or illness requiring a traveler to seek care at a healthcare facility adds to the strain on an already overburdened healthcare infrastructure and increases the chances an individual will be exposed to Ebola. CDC also remains engaged with the media to provide updated reports on the outbreak response and to relieve concerns related to the two infected Americans returning to the United States.

What Can Local Health Departments Do?

Local health departments are on the front lines of protecting communities from disease outbreaks. The Ebola outbreak provides an important opportunity for local health departments to review current preparedness plans and ensure procedures are in place to contain any potential outbreaks that may occur now or in the future. In addition, local health departments can ensure that their communities have accurate information about Ebola and healthcare providers and public health entities are aware of the CDC HAN advisories, recommendations, and other resources. This will ensure that any case in the United States is quickly identified and isolated. Local health departments also help their communities and the media understand the low level of risk posed by Ebola by helping to disseminate key messages and other resources from the CDC’s digital press kit.

Local health departments can also share their questions and experiences with NACCHO by emailing infectiousdiseases@naccho.org. This information helps NACCHO work with CDC and other national partners to better understand and address needs at the local level.

Other resources:

About Chris Aldridge
Chris Aldridge is the Senior Director for Infectious Diseases at NACCHO. His work includes oversight of the Epidemiology, HIV/STI, Immunization and Infectious Disease projects, as well as coordinating those with Emergency Preparedness, Environmental Health, Food Safety, and Disability initiatives. Email: caldridge@naccho.org


  1. CDC (2014, August 3) Outbreak of Ebola in Guinea, Liberia, and Sierra Leone. Retrieved from:  http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html
  2. Binder, A (2014, August 5) Atlanta Hospital Admits Second American with Ebola. The New York Times.  Retrieved from: http://www.nytimes.com/2014/08/06/us/nancy-writebol-kent-brantly-ebola-atlanta.html
  3. Rubin, S (2014, February 18) A New Agenda for Global Health Security. NACCHO Preparedness Brief. Retrieved from: http://nacchopreparedness.org/?p=1381
  4. CDC (2014, August 1) Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease.  Health Alert Network. Retrieved from: http://emergency.cdc.gov/han/han00364.asp
  5. WHO (2014, July 8) Frequently Asked Questions on Ebola Virus Disease. Retrieved from:  http://www.who.int/csr/disease/ebola/faq-ebola/en/
  6. Karimi, F and Fantz, A (2014, August 4) Nigerian Doctor has Ebola, Officials Say.  CNN.  Retrieved from:  http://www.cnn.com/2014/08/04/health/west-africa-ebola-outbreak/index.html?iref=allsearch
  7. CDC (2014, July 28) Ebola Virus Disease Confirmed in a Traveler to Nigeria, Two U.S. Healthcare Workers in Liberia. Health Alert Network. Retrieved from http:// http://emergency.cdc.gov/han/han00363.asp
  8. CDC (2014, August 1) Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease. Health Alert Network. Retrieved from: http://emergency.cdc.gov/han/han00364.asp
  9. CDC (2014, August 3) Ebola Hemorrhagic Fever. Retrieved from: http://www.cdc.gov/vhf/ebola/index.html

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