Statement on the 8th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa

The 8th meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the Ebola Virus Disease (EVD) outbreak in West Africa took place by teleconference on Tuesday, 15 December 2015, and by electronic correspondence from 15-21 December 2015.

The Committee’s role was to provide the Director-General with views and perspectives as to whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC), whether the current Temporary Recommendations should be extended, rescinded or revised, and whether additional recommendations should be considered.

Verbal presentations or written submissions were provided by representatives of Liberia and Sierra Leone on the current epidemiological situation, exit screening, survivor care, surveillance and rapid response capacities.

The Committee noted the progress in interrupting the original chains of Ebola virus transmission, with Guinea having reported its most recent such case on 29 October 2015, Sierra Leone on 8 August 2015 and Liberia on 20 March 2015. The Committee emphasized, however, that between March and November 2015 as many as 10 new outbreaks had occurred as the result of re-introduction of Ebola virus from the convalescent population, based on epidemiologic investigations and genetic sequencing data. The most recent such outbreak had occurred in Liberia, with 3 cases reported between 19 and 20 November 2015.

While recognizing that these new outbreaks have been rapidly controlled, the Committee considers these outbreaks as constituting extraordinary events, which continue to require coordinated international action in support of the affected States. It also reemphasized that while virus persistence is understood to be time-limited, further research is needed on its nature, duration and implications. The Committee highlighted the importance of communicating to the general public that casual contact with survivors does not constitute a health risk.

The Committee remains deeply concerned that 34 countries still enact inappropriate travel and transport measures and highlights the need to immediately terminate any such measures due to their negative impact, particularly on recovery efforts.

The Committee advised that in this critical phase of transition, from stopping the original chains of transmission to managing new outbreaks most likely due to the re-introduction of the virus from survivor populations, often in densely populated areas, the EVD outbreak continues to constitute a Public Health Emergency of International Concern (PHEIC). The Committee advised the Director-General to extend the Temporary Recommendations as follows:

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 Centre with no national or international travel until 2 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.

All States

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. Given the continued progress made in interrupting the original chain of transmission, and lack of justification for excessive or inappropriate additional measures, States should terminate any travel and transport measures that go beyond these Temporary Recommendations by end-December 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.

In formulating its views and perspectives, the Committee reflected on the fact that it could advise only on the continuation or the termination of a Public Health Emergency of International Concern (PHEIC) and that the IHR do not provide for an “intermediate” level of alert. The Emergency Committee was informed that the IHR Review Committee on the Ebola Response is looking closely at this issue and is considering potential recommendations in this regard. The Committee expressed support for such consideration. Looking forward, under the IHR (2005) temporary recommendations can be extended or modified even if the PHEIC status is ended.

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.

The Director-General thanked the Committee members and advisors for their advice, noted the Committee’s support for the work of the IHR Review Committee, and requested their reassessment of this Ebola situation within 3 months.