COMMENTARY

Ebola: The Risk to International Travelers

Phyllis Kozarsky, MD

Disclosures

August 20, 2014

Editorial Collaboration

Medscape &

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Outbreaks of Ebola can cause worry and fear among travelers. Although these outbreaks may be characterized by a high case-fatality ratio, the risk to most travelers is extremely low. I'm Dr. Phyllis Kozarsky, with the Travelers' Health Branch at the Centers for Disease Control and Prevention. I'm pleased to be speaking with you today as part of the CDC Expert Video Commentary series on Medscape.

Today I would like to discuss the 2014 Ebola outbreak in West Africa, the transmission dynamics of Ebola, and how to talk to travelers about their risk.

On March 21, 2014, the Ministry of Health of Guinea reported an outbreak of Ebola virus disease. Suspected cases in neighboring Liberia and Sierra Leone were subsequently confirmed. As of August 12, the outbreak had sickened more than 1800 people, more than 1000 of whom died, making it the largest Ebola outbreak ever documented. The outbreak has been extensively covered in the media, and travelers to Africa have expressed concern over their risk. CDC has issued travel warnings for Guinea, Liberia, and Sierra Leone, advising US residents to avoid nonessential travel to these countries. When talking with a traveler who is concerned about Ebola, it may be reassuring to discuss how the disease is transmitted and the probable risk to the traveler.

Ebola is spread from person to person through direct contact with blood or other body fluids. This happens primarily in healthcare settings, among family members caring for a sick person, or among people touching the body of a recently deceased person. Travelers on typical tourist or business itineraries are extremely unlikely to encounter a patient with symptomatic Ebola, so the risk of being infected by another person is low.

Transmission from an animal to a human is also possible. Ebola may be spread by eating meat from an infected primate and can also be spread by bats. Travelers can mitigate the risk for zoonotic transmission by avoiding nonhuman primates and bats, including bat caves, and by not eating wild game, or "bushmeat."

Even patients who aren't traveling may have concerns that travelers will import Ebola and spread it in the United States. With the speed of global travel, importation is possible; however, because Ebola is not spread by casual contact, the risk for community transmission in the United States is extremely low. The risk for nosocomial transmission is also low because of high infection control standards in US hospitals.

If you have a patient who expresses fears about an outbreak of Ebola, take his or her concerns seriously -- overwrought media coverage and reports of high mortality can keep people awake with worry. However, a little education on how Ebola is transmitted and the risk to travelers can go a long way to easing their concerns. The prevention messages -- avoid contact with blood and other body fluids -- are obvious precautions for most travelers. Urge travelers to instead focus on preventing more common -- but less newsworthy -- foodborne and vectorborne illnesses, such as dengue, chikungunya, and travelers' diarrhea.

Best wishes for safe and healthy travel!

Web Resources

Centers for Disease Control and Prevention. Ebola Viral Disease Outbreak -- West Africa, 2014. MMWR Morb Mortal Wkly Rep. 2014;63:548-551.

Ebola Hemorrhagic Fever. 2014 West Africa Outbreak

Phyllis Kozarsky, MD, is an expert travel health consultant for CDC's Travelers' Health Branch. She is the chief medical editor of CDC's Health Information for the International Traveler, also known as the "Yellow Book."

Dr. Kozarsky began her CDC career in 2001. She is also medical co-director at TravelWell, an Emory Healthcare-affiliated program aimed at providing pre-and post-travel health services to international travelers, and at Grady Memorial Hospital's Immigrant and Refugee Clinic. Her current research efforts have primarily focused on issues in clinical tropical medicine and travelers' health, including the epidemiology of travel-related infections.

She received her bachelor's degree from Hobart and William Smith Colleges in Geneva, New York. She went to the Medical College of Pennsylvania in Philadelphia and received her medical degree from Albert Einstein College of Medicine in New York.

She is the author of many peer-reviewed articles and is a member of many professional organizations, including the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene.

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