Questions and answers about the current Ebola disease outbreak for healthcare professionals in Europe
General
What is the current situation?
An ongoing Ebola disease outbreak caused by Bundibugyo virus is affecting the Democratic Republic of the Congo (DRC) and Uganda. For the latest figures, check ECDC’s page about this outbreak.
What is Ebola disease?
Ebola disease is a rare but severe disease caused by viruses of the genus Orthoebolavirus. It occurs in countries in Africa and can often lead to death, although severity varies depending on the virus species.
Transmission usually occurs from person to person through direct contact with blood and other bodily fluids.
The first documented outbreak of Ebola disease was reported in 1976 in the area what is now in the Democratic Republic of the Congo.
What are the symptoms of Ebola disease?
In most cases, an infected person experiences:
- sudden onset of fever;
- weakness, muscle and joint pains;
- headache.
This is followed by:
- progressive weakness;
- lack of appetite;
- diarrhoea (sometimes containing blood and mucus);
- nausea and vomiting.
The initial symptoms are unspecific and similar to more common diseases, such as the common cold and malaria. The next stage is more severe, with bleeding from the nose, gums and skin, and bloody vomiting and stools.
Other symptoms include skin rash, inflamed throat and difficulty swallowing. It can take between two and 21 days from the point of infection for a person to begin to show symptoms.
Is this outbreak of concern?
Yes. While the risk of infection for people in Europe remains very low, the outbreak remains a public health emergency of international concern, mostly for DRC and other high-risk countries in the region. The number of cases continues to increase and the outbreak has expanded geographically, including to new DRC health zones and provinces.
Responding to the outbreak remains challenging, particularly in remote and difficult-to-access areas. In addition, the outbreak is caused by Bundibugyo virus, for which there are currently no licensed vaccines, post-exposure prophylaxis or specific treatments. Continued surveillance, rapid identification and isolation of cases, contact tracing, infection prevention and control, and community engagement are therefore particularly important.
Recognition and assessment of suspected cases
Should healthcare professionals be concerned about every patient returning from affected countries with a fever?
Most patients returning from the areas affected by the Bundibugyo virus disease outbreak with a fever or other non-specific symptoms will not have Ebola disease. Many other infections, including malaria and respiratory infections, can cause similar symptoms.
Healthcare professionals should assess symptoms together with the patient’s recent travel history and possible exposure to a suspected, probable or confirmed case. Ebola disease should be considered a possibility with patients who have travelled to affected areas within the previous 21 days and are showing compatible symptoms. People who have travelled to affected areas and develop symptoms such as fever, weakness and headache should not go directly to a doctor’s office or hospital emergency department without first contacting healthcare services for advice.
When should Ebola disease be suspected?
Ebola disease should be considered in a patient with compatible symptoms and a relevant travel or exposure history.
Although it is expected that imported cases of Ebola disease in Europe will be very rare, healthcare professionals should remain alert when assessing patients who have travelled to affected areas in DRC or any other country where the outbreak may be ongoing within the previous 21 days. Symptoms that may raise suspicion include sudden onset of fever, weakness, muscle and joint pain, headache, nausea, vomiting, and diarrhoea. In more severe cases, patients may present with bleeding from the nose, gums and skin, and/or bloody vomiting and stools. Other symptoms include a skin rash, sore throat and difficulty swallowing.
Patients with compatible symptoms and relevant travel or exposure history should be managed according to national infection prevention and control procedures while further assessment is undertaken.
What should be done if a traveller becomes symptomatic during travel or on arrival?
If a traveller develops symptoms compatible with Ebola disease during a flight, cabin crew should follow established procedures and inform the destination airport before arrival. On arrival, the traveller should be assessed and managed following protocols that are appropriate for highly pathogenic diseases. If infection is confirmed, public health authorities may initiate contact tracing for relevant passengers, crew and other contacts. More information is available here.
Which healthcare and support staff should be aware of the outbreak?
Staff who may have first contact with patients should be aware of the outbreak. This includes doctors, nurses, emergency department staff, urgent care staff, ambulance services, airport or port health staff, laboratory staff, and administrative or triage staff who speak to patients before clinical assessment.
These staff should be familiar with national procedures for identifying, assessing, isolating, and referring suspected Ebola disease cases. They should know which symptoms and travel histories can raise suspicion, how and to whom a suspected or probable case should be reported according to local or national procedures, and what infection prevention and control measures should be implemented to protect themselves, colleagues, and other patients.
Healthcare facilities should ensure that relevant staff have access to up-to-date national or local guidance, including clear instructions on who to contact if Ebola disease is suspected.
What should healthcare professionals do if they suspect a case of Ebola disease?
Rapid identification of suspected cases is important because it allows infection prevention and control measures to be implemented quickly, reduces the risk of exposure for healthcare workers and other patients, and enables public health authorities to coordinate testing, transfer, contact tracing, and other public health measures.
If Ebola disease is suspected, healthcare professionals should initiate national procedures immediately. Contact with the patient should be limited to essential staff trained in the use of appropriate personal protective equipment. If possible, the patient should be isolated from other patients and staff and asked to wear a fluid-resistant surgical mask (type IIR), if tolerated. Public health authorities or the relevant emergency coordination service should be contacted promptly to support further assessment, testing, referral, and management. More information is available here.
How limited should contact with a suspected case be?
Limiting the number of people exposed to a suspected case reduces the risk of transmission and simplifies contact tracing if the patient is later confirmed to have Ebola disease. Contact with suspected cases should be limited to the healthcare workers necessary for patient care, particularly those who are trained and experienced in the use of personal protective equipment and other infection control measures.
Infection prevention and control
Should healthcare facilities screen patients before direct contact?
Healthcare facilities should have systems in place to identify possible Ebola disease cases before direct patient contact whenever feasible. This may include telephone triage, referral services, emergency dispatch systems, or screening upon admittance to healthcare facilities. Early identification allows appropriate infection prevention and control measures to be implemented before exposure occurs. More information is available here.
Will all hospitals manage confirmed Ebola disease cases?
No. National preparedness plans usually identify designated facilities with the capacity to safely assess and manage suspected or confirmed Ebola disease patients. Public health authorities coordinate referral and transfer arrangements when required. More information is available here.
What should healthcare professionals consider when managing a suspected case?
Suspected cases should be identified and isolated as early as possible. Contact with the patient should be limited to the healthcare workers necessary for patient care, and appropriate personal protective equipment should be used according to national procedures.
Healthcare professionals should follow established national protocols for testing, safe handling of samples, patient transport, and referral to designated facilities where required. Close coordination with infection prevention and control teams and public health authorities is important throughout the assessment and management process. More information is available here.
What infection prevention and control measures are recommended?
Healthcare facilities should have procedures in place for the early identification, isolation, testing, referral, and management of suspected or confirmed Ebola disease cases, as defined by national protocols. Patients should be isolated promptly, contact with staff should be limited to those providing patient care, and appropriate personal protective equipment should be used based on the level of risk.
Facilities should also have established procedures for patient transport, environmental cleaning and disinfection, waste management, safe handling of samples, and the management of human remains. Staff involved in the care of suspected or confirmed cases should be trained and experienced in infection prevention and control procedures and the correct use of personal protective equipment. More information is available here.
How can healthcare workers protect themselves?
Healthcare workers should perform a risk assessment before having direct contact with patients and limit exposure to blood, bodily fluids, and contaminated materials. Direct care should be provided by the minimum number of staff necessary, using appropriate personal protective equipment according to national procedures and the level of risk.
Staff should be trained in the correct procedure for donning and doffing personal protective equipment and follow strict hand hygiene practices. Whenever possible, personal protective equipment removal should be supervised by a trained observer or ‘buddy’ to reduce the risk of accidental contamination. More information is available here.
What is the role of the ‘buddy’ system when using personal protective equipment?
A trained observer, or ‘buddy’, can help healthcare workers correctly put on (‘don’) and remove (‘doff’) personal protective equipment and monitor infection prevention and control procedures. This helps reduce the risk of accidental contamination, particularly during the removal of personal protective equipment. More information is available here.
In what type of room should patients be kept?
Suspected cases should be placed in a single-occupancy room designated for the management of Ebola disease. The room should have a dedicated toilet or commode and, where possible, an anteroom.
Confirmed cases should ideally be managed in a specialised high-level isolation unit, if available, taking into account feasibility, and the safety of transfer. If high-risk procedures are anticipated that may generate aerosols, rooms with negative pressure are recommended. More information is available here.
How should samples and waste be handled safely?
Samples from suspected or confirmed cases should only be collected and handled by trained personnel using appropriate personal protective equipment and following national biosafety procedures.
Laboratories should apply a risk-based approach and use validated procedures for the safe handling and testing of specimens.
Clinical waste from suspected or confirmed cases should be managed as Category A infectious waste in accordance with national procedures. Areas and equipment contaminated with blood or other bodily fluids should be cleaned promptly and disinfected using hospital disinfectants effective against viruses. More information is available here.
When can isolation measures be reduced or stopped?
The duration of isolation and other transmission-based precautions should be determined on a case-by-case basis. Decisions should take into account the patient's clinical improvement or resolution of symptoms, together with laboratory findings – e.g. from nucleic acid testing of blood samples. Consultation with infectious disease, infection prevention and control, clinical microbiology, and public health specialists is recommended when considering the reduction or discontinuation of isolation measures. More information is available here.
Laboratory diagnosis and testing
How is Bundibugyo virus disease diagnosed?
Laboratory confirmation of Bundibugyo virus disease involves the use of nucleic acid amplification tests (NAATs). The recommended sample types are whole blood or plasma from living patients and oral swabs from deceased individuals. Laboratories should ensure that the tests used can detect Bundibugyo virus and are not limited to other orthoebolaviruses. If a test does not distinguish between different orthoebolaviruses, positive results should be confirmed by sequencing, or additional laboratory testing specific for Bundibugyo virus. More information is available here.
Can an early laboratory test be negative even if a person is infected?
A negative test result does not always exclude infection if the sample was collected immediately after symptoms began. If a suspected case tests negative and the blood sample was collected less than 72 hours after symptom onset, a second sample should be collected and tested later than 72 hours after symptoms began. More information is available here.
When should potentially exposed healthcare workers be tested?
Healthcare workers with symptoms of Bundibugyo virus infection who have been exposed to the virus should be tested. ECDC offers guidance for classifying high- versus low-risk occupational exposures with corresponding proposed measures here.
Testing healthcare workers who do not have symptoms is not recommended. Healthcare workers who have occupational exposure to the virus should self-monitor for symptoms and get tested if they develop symptoms.
How should samples be transported?
Samples from suspected cases should be packaged, labelled, and transported according to international and national requirements for infectious substances. Laboratories should coordinate with the receiving facility in advance to ensure safe and secure transport and appropriate testing arrangements. More information is available here.
What laboratory support is available if diagnostic capacity is limited?
The European Union Reference Laboratory for Public Health on Emerging, Rodent-borne and Zoonotic Viral Pathogens (EURL-PH-ERZV) supports European Union/European Economic Area (EU/EEA) countries by providing diagnostic support, updated testing protocols, and technical advice on laboratory biosafety and procedures. It also offers diagnostic services to countries that do not have the capability to diagnose Bundibugyo virus infection locally.
Public health follow-up
What happens after a suspected or confirmed case is identified?
The patient is isolated and tested, and public health authorities coordinate further action. If Ebola disease is confirmed, close contacts are identified and followed up to detect possible symptoms early and prevent further transmission of the virus.
What happens to exposed healthcare workers?
A record should be kept of those healthcare workers who provided direct care to a suspected case and, if the patient is subsequently confirmed to have Ebola disease, they should be assessed for possible exposure to blood or other bodily fluids. If an unprotected exposure has occurred, public health authorities should be consulted for risk assessment and advice on appropriate follow-up and management.
How are healthcare workers and airport staff protected from exposure during a medical evacuation?
Medical evacuation may be arranged when a patient needs to be transferred from an affected area to a facility with the specialised care and isolation capacity required to manage Ebola disease. Such transfers are carefully planned and coordinated between public health authorities, specialised medical teams, transport providers, and the receiving healthcare facility.
Medically evacuated patients are transported by trained teams using strict infection prevention and control procedures, dedicated equipment and appropriate isolation measures. These measures are maintained throughout the transfer to minimise potential exposure and protect the teams directly involved, other healthcare and airport personnel, and the public.
What advice should be given to returning travellers?
Returning travellers should be informed about symptoms, how the virus spreads, and what to do if symptoms develop. This information should be made clearly visible and accessible to travellers, including at relevant points of entry.
If travellers develop symptoms within 21 days of leaving an affected area, they should self-isolate, contact healthcare services as soon as possible, and inform healthcare professionals about their travel history and possible exposure. They should not go directly to a doctor’s office or emergency department without first contacting healthcare services by phone for advice. More information for returning travellers is available here.
Communication and reassurance
Cases of Ebola disease in Europe are expected to remain rare. However, an imported or suspected case can generate considerable concern among patients, healthcare workers and the wider public. Clear, factual and empathetic communication is therefore important to help address concerns, prevent misunderstandings, and reduce stigma.
What is the role of healthcare professionals in communicating about Ebola disease?
For many people Ebola is a frightening disease, and misinformation and misconceptions can contribute to fear and stigmatising attitudes. Even though the risk to the general public in Europe is classified as very low, people may perceive their risk as much higher. As a healthcare professional, it is important to acknowledge the fears, listen to concerns and try to correct misconceptions.
Why is communication with patients and families important?
Clear and empathetic communication can help patients and families understand why isolation, personal protective equipment and testing may be needed. This can reduce fear, confusion and, in the long term, build trust, and support cooperation with public health measures when needed.
Should patients, visitors and hospital staff be concerned about being exposed to Ebola disease in a healthcare setting?
No, but it is important to acknowledge that people might be concerned. Suspected or confirmed cases of Ebola disease should be promptly isolated and managed using appropriate infection prevention and control measures. Healthcare facilities should have procedures in place to safely manage suspected cases, including trained staff, appropriate personal protective equipment (PPE), and arrangements for isolation and, where necessary, transfer to a specialised facility.
Healthcare professionals also play an important role in addressing concerns among patients, visitors and staff. Clear communication about how Ebola virus spreads, the measures being taken to prevent exposure, and what people should do if they have concerns can help reduce fear, misinformation and stigma. Open and transparent communication can address concerns, reduce confusion, and strengthen trust in the healthcare response.
Should healthcare professionals be concerned about stigma or discrimination?
Fear and misunderstanding can lead to stigmatising attitudes towards patients, travellers, healthcare workers, or communities linked to affected areas. Healthcare professionals should base risk assessments on symptoms, travel history, and exposure, rather than nationality or origin, and communicate clearly and respectfully.
Healthcare workers involved in caring for suspected or confirmed Ebola disease patients may themselves experience stigma, including avoidance or discrimination from members of the public because of concerns that they could transmit the virus. It is important to underline that Ebola disease does not spread through casual contact, and healthcare workers who follow recommended infection prevention and control measures are at very low risk of infection and do not pose a risk to others.
Healthcare organisations and public health authorities can help prevent stigma by explaining how Ebola virus is transmitted, how healthcare workers are protected, and the infection prevention and control measures used when caring for patients. They should also support healthcare workers who experience stigma or discrimination.
How should healthcare professionals address misinformation and rumours?
Healthcare professionals should respond calmly and respectfully, using clear, evidence-based information.
They should listen to concerns and acknowledge worries and fears. If healthcare professionals are confronted with false claims, they should explain why these claims are incorrect and refer to accurate information. It is important to explain what is known, what remains uncertain, and what actions are being taken to protect patients, staff, and the public.
Explaining how Ebola disease is transmitted and how infection can be prevented can help reduce fear and stigma, and build trust.