The seventh meeting of the Emergency Committee convened by the World Health Organization (WHO)'s director-general, Margaret Chan, MD, under the International Health Regulations (IHR) (2005) regarding the Ebola virus disease (EVD) outbreak in West Africa took place Oct. 1, 2015. As in previous meetings, the Committee’s role was to advise the WHO director-general as to whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC) and, if so,whether the current temporary recommendations should be extended or revised, and whether new temporary recommendations should be issued.
Presentations were made by representatives of Guinea, Liberia and Sierra Leone on the current epidemiological situation in those countries, response operations and exit screening.
Since the sixth meeting of the committee, Liberia has been declared free of EVD transmission for a second time (Sept. 3, 2015), the overall case incidence in Guinea and Sierra Leone has been below 10 cases per week, and the Sierra Leonean capital city of Freetown has remained free of EVD transmission for more than 42 days. The committee noted the enhanced Ebola control measures being implemented in each country and reaffirmed the importance of the community outreach, social mobilization, and other best practices.
However, two active chains of EVD transmission continue, one in Guinea and one in Sierra Leone. The committee highlighted that the continued identification (including post-mortem) of cases not previously registered as contacts, resistance to response operations in some areas, and the ongoing movement of cases and contacts to Ebola-free areas, all constitute risks to stopping all EVD transmission in the subregion. The committee noted the small number of Ebola cases in which virus from a convalescent individual could not be ruled out as the origin of infection; while viral persistence is understood to be time-limited, further investigation is needed on the nature, duration and implications of such persistence.
The committee was concerned that although some improvements have been observed in the rescinding of excessive or inappropriate travel and transport measures, 34 countries continue to enact measures that are disproportionate to the risks posed, and which negatively impact response and recovery efforts. Furthermore, a number of international airlines have yet to resume flights to the affected countries.
The committee advised that the EVD outbreak continues to constitute a Public Health Emergency of International Concern. In addition, the committee advised the director-general to consider the following temporary recommendations, which supersede and replace those issued previously:
States with Ebola transmission
1. The Head of State should continue to address the nation to provide information on the situation, the steps being taken to address the outbreak and the critical role of the community in ensuring its rapid control.
2. There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation. To minimize the risk of international spread of EVD:
Confirmed cases should immediately be isolated and treated in an Ebola Treatment Center with no national or international travel until two Ebola-specific diagnostic tests conducted at least 48 hours apart are negative;
Contacts (which do not include properly protected health workers and laboratory staff who have had no unprotected exposure) should be monitored daily, with restricted national travel and no international travel until 21 days after exposure;
Probable and suspect cases should immediately be isolated and their travel should be restricted in accordance with their classification as either a confirmed case or contact.
3. States should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused by Ebola virus. States should share exit screening data with WHO on a regular basis. Such exit screening must be maintained for at least 42 days after the last case has twice tested negative for Ebola virus; countries are encouraged to maintain exit screening until EVD transmission has stopped in the entire subregion.
4. The cross-border movement of the human remains of deceased suspect, probable or confirmed EVD cases should be prohibited unless specifically authorized on a case-by-case basis by relevant national authorities of both the exporting and receiving country.
5. There should be no general ban on international travel or trade; there should be no restrictions on the travel of EVD survivors; only those restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented.
6. Those States which currently implement excessive or inappropriate travel and transport measures that go beyond these Temporary Recommendations should terminate such measures by the end of October 2015.
7. States should provide travellers to areas of active Ebola transmission with relevant information on risks, measures to minimize those risks, and advice for managing a potential exposure.
8. States should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD and, where appropriate, the capacity to manage travellers originating from areas of active Ebola transmission who arrive at international airports or major land crossing points with unexplained febrile illness.
9. If active Ebola transmission is confirmed to be occurring in the State, the full recommendations for States with Ebola transmission should be implemented, on either a national or subnational level, depending on the epidemiologic and risk context.
Based on this advice and information, the director-general declared that the 2014-2015 Ebola outbreak in these West African countries continues to constitute a Public Health Emergency of International Concern. The director-general endorsed the committee’s advice and issued that advice as Temporary Recommendations under the IHR. These Temporary Recommendations supersede and replace all previous recommendations issued under the IHR in the context of the Ebola Outbreak in West Africa.