Ebola Fact Sheet and Guidance

EBOLA FACT SHEET AND GUIDANCE

ISOS Background Information The largest outbreak of Ebola virus is currently underway in West Africa. The current outbreak is spreading person to person, via bodily fluids (not an airborne virus), causing significant international concern and disrupting both the health and economy of these countries as well as neighboring nations.

This outbreak began in Guinea. The first case there occurred in December 2013, though it was not reported to the World Health Organization/identified as Ebola until March 2014. This significant delay means that control measures were not enacted for months, allowing the virus to take hold in the community. Soon after the disease was brought to international attention, cases were also reported in neighboring Liberia. This progression was upsetting but not unpredictable: borders in the affected area are often porous, with people walking from one nation to another on a daily basis.

Control measures were enacted in both countries, and seemed effective. By the beginning of April, disease activity slowed. It looked like the outbreak was heading to its end.

However, unexpectedly, cases spiked again in late May. New areas were affected. Ebola struck people in areas that had never had an Ebola infection before. The disease also intensified in places where people had previously been infected. There have been cases transported to Europe and North America.

The Ebola outbreak in West Africa is not under control, and resources and personnel are stretched in trying to handle the situation. Cultural concerns also play a role: some people in these countries do not believe Ebola is an actual disease. Others are unethically selling a counterfeit “vaccine” to protect people (there is no vaccine for Ebola). Misinformation and mistrust make it difficult to implement national and international health measures – which are critical to bringing the disease under control.

This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

Map of confirmed and suspected cases as of October 24, 2014. Check ISOS website regularly for updates.

Ebola Facts This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

Ebola belongs to a group of diseases referred to as "viral hemorrhagic fevers" (VHF). Dengue fever, yellow fever, Lassa fever, and Marburg fever are other examples of VHFs. "Hemorrhagic" means these diseases can involve bleeding, which can be one of their more alarming symptoms.

Transmission The disease spreads from person to person, or to people from animals or bats. Ebola virus is contained in the blood and body fluids of infected people (vomit, diarrhea, urine, nasal secretions, sweat, ejaculate). These fluids are contagious. If someone has contact with an infected person's body fluids, they can get Ebola. The more symptomatic a person is, the greater the risk of catching the virus from their body fluids. In addition, it is possible to become infected by touching contaminated objects (objects that have germs from an infected person on them). The germs get onto the toucher's hands, and then may accidentally be transferred into the nose, mouth or eyes, or enter the blood stream via cuts on the hands.

Clearly, family, caregivers, and medical staff are at high risk. Funeral practices that require touching, washing or kissing the dead body promote spread of the virus.

Once a human has been infected, an outbreak can occur if proper precautions are not taken. The current outbreak in West Africa is being spread person to person via bodily fluids. It is still not confirmed how the index case in Guinea was infected, but the subsequent international spread was caused by activities between people.

Symptoms Symptoms can start within two days after exposure to the virus. The incubation period is the time between infection (when a person takes in the virus) and when they start to feel ill. For Ebola, the period can range from 2 to 21 days. However, on average, it is about 7-9 days.

Usually, the person suddenly feels weak, with a fever, muscle/joint pain, headache and sore throat. Vomiting, diarrhea, rash and abdominal pain follow in most cases. Some people may develop redness of eyes and hiccups.

Organ failure and bleeding (both internally and externally) occur in some people. These lead to death. About 50% to 90% of cases are fatal. The Zaire strain is the most lethal strain of Ebola. It is responsible for the current Ebola outbreak. Prevent infection through strict hygiene measures and avoiding contact with body fluids.

Diagnosis Blood tests are the only way to firmly diagnose Ebola. Highly specialized equipment is required, and blood samples must be handled securely. Only a few laboratories are able to do this routinely. Often the specimens have to be carefully shipped to international destinations for firm diagnosis. As such, once an Ebola outbreak is underway, patients are not always firmly diagnosed with blood tests. Instead, people This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE who have symptoms and exposures that meet case definitions are considered suspected or probable cases.

Treatment There is no treatment or cure for Ebola. Sick people are given supportive therapy, which are treatments that help make them more comfortable but do not cure their illness. These often include IV fluids, supplemental oxygen, and antibiotics if the person has a bacterial infection occurring along with the Ebola virus. (Ebola itself cannot be treated with antibiotics because antibiotics do not work on viruses.)

An experimental treatment, ZMapp, has not yet been tested in people, although animal tests are promising. The drug is a combination of antibodies, created in plants. The treatment has been made available to a few healthcare workers who were infected while treating Ebola patients. Some of them have recovered although some did not and subsequently died. On 12 August, the manufacturer, Mapp Biopharmaceutical, announced that supplies had been exhausted. "Any decision to use an experimental drug in a patient would be a decision made by the treating physician under the regulatory guidelines of the FDA. Mapp and its partners are cooperating with appropriate government agencies to increase production as quickly as possible."

The experimental antiviral drug BCX-4430, manufactured by BioCryst Pharmaceuticals, has been awarded funding from the US National Institute of Allergy and Infectious Diseases (NIAID) to commence trials against Ebola in non-human primates. The trial is expected to start in September / October 2014.

Vaccine There is no Ebola vaccine to protect people from the disease, although research is underway. The US National Institutes of Health will start a safety trial of a vaccine on human volunteers in Maryland, USA. The vaccine has been developed by NIAID and the pharmaceutical company GlaxoSmithKline (GSK), and contains antigenic material from both the Zaire and Sudan strains of Ebola.

NIH is also partnered with the Jenner Institute, Oxford University, which has announced it expects to begin human trials of an experimental Ebola vaccine in September 2014. The vaccine is a monovalent type, containing only the Zaire strain, and will be administered in several countries (USA, UK, The Gambia, Mali) to healthy volunteers

The current outbreak is spreading person to person, via bodily fluids. The virus is present in fluids like blood, vomit, semen, sweat, etc. The best way to protect yourself is to avoid sick people and their secretions.

High risk activities include:  Contact with ill people  Handling bodies of people who have died from Ebola  Touching or eating sick or dead wildlife  Eating bush meat  Caring for Ebola patients, attending their funerals or burying their bodies

To avoid the virus:  Stay away from sick people. Do not touch their bodily fluids or objects contaminated with their fluids.  Pay strict attention to hygiene. Wash your hands often.  Do not go to funerals or touch dead bodies.  Do not go to hospitals, as they may be treating patients with Ebola. (Call International SOS if you need medical treatment in an Ebola-affected country.)  Do not handle animals or bats, even if they seem healthy.  Do not eat bats or "bush meat" from gorillas, monkeys and other primates.  Ensure all meat is cooked well. Do not drink raw blood.

Risk Assessment and Controls Operations management in impacted areas is closely monitoring the situation and has engaged in preventative measures since the outbreak began. For operations in country, staff and visitors have been briefed on Ebola signs and symptoms, the precautions needed to be taken and what to do if they fall sick.

The US Centers for Disease Control has established exposure risk levels intended to provide a framework for evaluating risk of exposure of persons to Ebola Virus Disease (EVD) and initiating appropriate public health responses. These interim guidelines define three levels of risk:

High Risk  Health Care Workers with percutaneous (e.g., needle stick) or mucous membrane exposure to body fluids of EVD patient  Direct care of an EVD patient or exposure to body fluids without appropriate personal protective equipment (PPE)  Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions  Participation in funeral rites which include direct exposure to human remains in the geographic area where outbreak is occurring without appropriate PPE

Some Risk of Exposure  Household member contact with an EVD patient  Other close contact with EVD patients in health care facilities or community settings

Close contact is defined as being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment or having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment. Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact.

No Known Exposure  Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no exposures. Public health authorities will now maintain daily contact with all travelers from the three affected countries for 21 days

As part of the interim guideline document, the CDC has offered additional detail on response actions and infection control procedures for healthcare workers based on each of these risk factors and the clinical presentation of the individual.

For the majority of Tetra Tech operations, general office workers do not fall under the category of high risk for infection with the Ebola virus. However, in an abundance of caution, certain infection prevention and control guidelines are to be implemented in impacted areas. These guidelines are detailed in a separate document entitled Office Guidelines for Ebola Affected Locations and posted on My.TetraTech.com.

Proposed work in affected countries must be evaluated for potential risk and controls put in place prior to mobilization. For project tasks that may present a risk of exposure, appropriate infection control measures and medical surveillance are to be assessed and implemented. Project teams will be briefed on Ebola signs and symptoms, the precautions needed to be taken and what to do if they fall sick prior to and during travel.

Some project tasks require interaction with the local populace, travel to remote areas and community workshops. These tasks will be reviewed on a case by case basis and may be restricted during the active phase of disease transmission.

Operations have been asked to maintain a current roster of affected employees and dependents with names, current location, contact information, emergency contacts.

Site specific site safety and security plans must be updated to ensure they address the Ebola virus and preventative measures including an updated emergency communication matrix.

Test satellite phones and other communication devices to ensure they will be charged and operational when needed.

For all deployed staff: Avoid high risk activities and pay strict attention to hygiene.

Staff should not to go to medical facilities that are treating Ebola cases.

The status of medical facilities change frequently, should staff abroad need medical attention, call International SOS to be directed to an appropriate facility. The ISOS Paris call center is the main ISOS location handling Ebola calls and is open 24 hours a day.

Tel: +33 (0) 155 633 155 Fax: +33 (0) 155 633 156 US Telephone Number: (215) 94208226

Note that International evacuation of non-Ebola illnesses - especially if the sick person has a fever or other symptoms similar to Ebola - is more complicated and difficult than usual and may not be available. Therefore international evacuation should not be considered as feasible for patients with active clinical symptoms of Ebola.

Additional International SOS Services Tetra Tech maintains an access agreement with International SOS. Services included in this contract include:  Unrestricted access to information on the ISOS website https://www.internationalsos.com/en/  To access membership only information and sign up to receive special alerts the Tetra Tech ISOS Membership # is 11BCMA000238.  Access to security and health care professionals on call 24/7 to assist with emergencies or to provide advice and up to date information on health and safety concerns.  One-call emergency services including evacuations for medical or security situations. ISOS maintains contact information for the various Tetra Tech insurance providers and can put you in direct communication with them if necessary.

Current Outbreak Updates Access the ISOS Ebola website for most current report. Ebola

High risk activities include having contact with ill people, with the bodies of people who have died from Ebola, with sick or dead wildlife or with bush meat.

In Country Operations in Guinea, Liberia and Sierra Leone In addition to high risk activities, employees could potentially be exposed to the disease if an infected person who has symptoms is moving around the general community. Employees can reduce their risk of infection by paying strict attention to hygiene: hand washing or use of hand sanitizer, avoid touching their face, avoid close contact with someone who is obviously sick.

Tetra Tech has developed an Office Guidance Protocol for offices or project locations. This document is posted on My.TetraTech/Health and Safety/Manual.

Authorities are implementing strict screening and quarantine measures. Anyone who appears ill or has a fever may be placed in isolation. People who are identified as "contacts" of a suspected Ebola case, may be quarantined.

It is more complicated and difficult than usual to move people with non-Ebola illnesses across international borders for treatment - especially if the sick person has a fever or other symptoms similar to Ebola. Note that malaria, which is a medical emergency, has some symptoms in common with Ebola, so moving malaria patients may be more difficult than usual.

 Anyone who is sick is advised not to travel.  Some commercial airlines have suspended flights to these countries, and charter air movements are extremely limited.  In Liberia - there is almost no reliable access to medical care available. Many medical facilities, including in Monrovia, have either closed or are over capacity, are severely limited in their capability and do not have stringent infection control. The majority of Ebola cases are being cared for outside the designated treatment units.  Illnesses, including potentially life-threatening conditions, cannot be managed adequately. Less serious illnesses may become life-threatening.  International evacuation is highly challenging and may not be achievable.  Some areas have been quarantined, and the quarantine may be enforced by security.

For staff remaining in country:  Ensure employees are fully briefed on the situation, preventive measures, and what to do if they fall sick.  They should avoid high risk activities and pay strict attention to hygiene.  They should be advised not to go to medical facilities that are treating Ebola cases. This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

 Should they need medical attention while in these countries, call International SOS and they will be directed to an appropriate facility.

Travel Summary All travel to Ebola affected countries must have prior operations approval and H&S review– only essential travel will be approved. H&S Representatives in conjunction with Tetra Tech’s medical surveillance administrator will conduct a health review and briefing for traveler(s) before departure.

US employees returning from Ebola affected countries will be required to participate in the CDC /Local Health Department’s active post-arrival monitoring program for 21 days.

Upon return , if employees develop any Ebola like symptoms: fever (temperature of 101.5°F/ 38.6°C), headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding do not come to work. Immediately call your local health department unit appointed to handle Ebola. Let them know you may be infected with Ebola to ensure proper precautions, also inform your supervisor of your health status.

Anticipate travel disruption due to Ebola-related flight bans, health screening measures The authorities in several countries have implemented entry restrictions to curtail the spread of Ebola from countries that have Ebola cases, while air carriers have restricted flights or modified schedules. Flights serving destinations inside and outside Africa may also be subject to diversion or delay with little or no warning in order to quarantine passengers suspected or claiming to be exhibiting Ebola-like symptoms.

Health screening has also been implemented at ports of entry and departure in various countries throughout West Africa and is being introduced in Europe and North America countries as well. Specific details of restrictions such as those listed below are difficult to verify and subject to change, while the implementation of state-imposed entry conditions can vary. Similarly, flight schedules may change at short notice.

Travelers departing from countries affected by an outbreak of Ebola should seek itinerary-specific guidance from the relevant authorities on screening procedures and documentation requirements. They should also reconfirm the status of flights before setting out and allow additional time during arrival and departure to pass through enhanced medical screening.

Entry restrictions Africa  Cameroon on 17 September reopened its borders to travelers from Senegal. An 18 August ban remains in place on travel from Nigeria, Guinea, Liberia and Sierra Leone.  Cape Verde on 9 October announced that it would now deny entry to non-resident foreigners coming from countries with ‘intense Ebola transmission' – Sierra Leone, Guinea and Liberia - or who have been to those countries in the previous 30 days.  Chad on 21 August closed its land border with Nigeria at Lake Chad. The country previously reportedly banned the entry of any travelers originating or transiting through Guinea, Liberia, Nigeria or Sierra Leone, with airlines serving the country reportedly rerouting flights.  Côte d'Ivoire in early October reopened its borders with Guinea, Sierra Leone and Liberia, having closed the borders of 23 August.  Equatorial Guinea is denying entry to travelers whose journeys originated in countries affected by Ebola.  Gabon stated on 22 August that it is restricting the issuance of entry visas to travelers from Guinea, Liberia, Sierra Leone and Nigeria on a case-by-case basis.  Gambia on 1 September suspended entry of persons who have visited Guinea, Liberia, Sierra Leone or Nigeria in the 21 days prior to travel. Those travelling indirectly from any of the aforementioned countries to Gambia via another country also come under this measure.  Kenya on 10 October announced that it had closed the Suam border crossing (Trans-Nzoia county) with Uganda due to reports of an Ebola-related death in Bukwo district (Uganda). Earlier, the Kenyan authorities on 19 August suspended entry of passengers travelling from and through Guinea, Liberia and Sierra Leone, excluding health professionals supporting efforts to contain the outbreak and Kenyan citizens.  Mauritius on 8 October banned entry to all travelers who have visited Nigeria, Sierra Leone, Guinea, Liberia, Senegal and Congo (DRC) in the last two months, rather than just citizens of those countries, as was the case previously. The authorities have announced that entry restrictions for travelers from Senegal and Nigeria will be lifted on 10 October and 17 October respectively, if no further cases of Ebola infection are reported.  Namibia's foreign ministry on 11 September announced that foreigners travelling from countries affected by Ebola would be prohibited from entering the country.  Rwanda, according to the US Department of State on 22 August, has banned entry to travelers who have visited Guinea, Liberia or Sierra Leone in the 22 days prior to travel.  Senegal on 21 August closed its land border with Guinea, while the country's sea and air borders will also be closed to vessels and aircraft from Guinea, Liberia and Sierra Leone.  Seychelles on 8 October suspended entry to travelers who have visited Sierra Leone, Liberia, Guinea-Bissau, Guinea, Nigeria or Congo (DRC) 28 days prior to their journey, with the exception of Seychellois citizens.  Southern African Development Community (SADC) member states – Angola, Botswana, Democratic Republic of Congo (DRC), Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe – have stated that This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

travelers coming from Ebola-affected countries (according to the World Health Organization, WHO) would be monitored for 21 days and that travel to member countries for any gatherings would be discouraged. The SADC provided no details as to how member countries will carry out the associated screening and follow-up and it is likely that countries will have individual processes. There are also reports that some countries require health documentation for entry. Travelers are advised to contact the embassy or health ministry of their destination country to clarify their individual circumstances and prepare their trips accordingly.  South Africa on 21 August restricted entry for all non-citizens travelling from Guinea, Liberia and Sierra Leone. The government subsequently clarified that this was not a blanket ban and could be waived for 'absolutely essential travel'.  South Sudan has placed a ban on travelers coming from Guinea, Sierra Leone, Liberia or Congo (DRC), or those who have travelled to those countries in the preceding 21 days. According to the health ministry, entry of travelers from Nigeria depends on their travel history in that country and whether they have visited Ebola-affected areas. Americas  Antigua and Barbuda on 17 October imposed an entry ban on nationals of Guinea, Liberia and Sierra Leone. The ban will also apply on anyone who travels to the country within 21 days of visiting any of the aforementioned nations.  Belize announced on 18 October that it will stop issuing visas for nationals of Guinea, Liberia and Nigeria. Sierra Leone nationals, who do not need visas to enter Belize, will also be banned. In addition, travelers who have visited any of the aforementioned countries in the past 30 days will be prohibited from entering the country.  Colombia imposed an entry ban from 14 October on any traveler who has visited Guinea, Liberia, Nigeria, Senegal or Sierra Leone in the past four weeks. The restriction would also reportedly apply to Colombian nationals.  The Dominican Republic has banned entry to travelers who have been in the following countries in the past 30 days: Sierra Leone, Senegal, Liberia, Guinea, and Nigeria, as well as any countries that the World Health Organization has deemed to be affected by the Ebola virus.  Guyana announced on 16 October that visas will not be issued to nationals from Guinea, Liberia, Sierra Leone and Nigeria. Furthermore, health officials will screen travelers who have visited these countries in the six weeks prior to their arrival in Guyana.  Haiti has banned entry to travelers who have been to Guinea, Liberia or Sierra Leone in the past 28 days. Travelers who have been to these countries more than 28 days before travel to Haiti must present a government-certified health certificate and the results of a blood test for the Ebola virus upon arrival. It is uncertain at this time how these measures will be carried out or enforced. International SOS is monitoring the situation.  Jamaica imposed an entry ban from 16 October for travelers arriving from Guinea, Liberia and Sierra Leone, as well as those who have visited these countries within the four weeks prior to their arrival. In addition, any Jamaican national who travels to the aforementioned countries will be quarantined for 28 days on return.

 Panama on 22 October banned the entry of travelers who have visited Guinea, Liberia and Sierra Leone in the past 21 days. The ban will remain in place until the three countries are declared Ebola-free.  St Kitts and Nevis have restricted the entry of nationals from Guinea, Liberia and Sierra Leone. Similar measures will also be applied to travelers who have visited these countries in the 21 days prior to arrival.  St Lucia has banned visitors from Guinea, Liberia and Sierra Leone. The government has also announced that, in addition to a visa, visitors from Nigeria will be required to present a recent medical certificate clearing them of the virus. No further details are available at this stage, though we are investigating further.  St Vincent and the Grenadines has banned visitors from Guinea, Nigeria and Sierra Leone.  Suriname has banned entry to foreign travelers who have been to Guinea, Liberia and Sierra Leone in the past 21 days, unless they can present an ‘internationally recognized health certificate’ clearing them of the virus. No further details are available at this time.  Trinidad and Tobago announced on 16 October that it would deny entry to nationals of Congo (DRC), Guinea, Liberia, Nigeria and Sierra Leone. In addition, travelers who have visited any of the aforementioned countries in the past six weeks will be quarantined for 21 days upon arrival.  The United States announced that beginning 22 October, any passengers beginning their travels in Liberia, Sierra Leone or Guinea will only be able to enter the country through the following airports: JFK International Airport (JFK, New York state), Newark International Airport (EWR, New Jersey), Dulles International Airport (IAD, Washington, DC), Hartsfield-Jackson International Airport (ATL, Georgia) or Chicago O'Hare International Airport (ORD, Illinois). Others  North Korea has banned foreign tourists since 24 October over fears of Ebola; the ban applies to all entry points and border crossings.

Flights and other transport Countries that have implemented Ebola-related travel restrictions:  Gambia has banned the entry of flights from Guinea, Liberia, Nigeria and Sierra Leone.  Gabon has banned the entry of flights and ships from countries affected by Ebola.  Senegal has banned flights from Guinea, Liberia and Sierra Leone.  Cameroon has banned flights to and from Nigeria. Chad has suspended all flights from Nigeria.  Nigeria has suspended flights to the country operated by Gambian national carrier Gambia Bird.  Côte d'Ivoire has now lifted the ban on passenger flights from Guinea, Liberia and Sierra Leone.

Details of airlines that have restricted flights to Ebola-affected countries:  Air France suspended flights to Sierra Leone from 28 August.  The Togo-based carrier Asky Airlines has suspended flights to and from Guinea, Liberia and Sierra Leone.  Arik Air (Nigeria), Gambia Bird and Kenya Airways have suspended services to Liberia and Sierra Leone. This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

 British Airways has extended their suspension of flights to Liberia and Sierra Leone until 31 December.  Emirates Airlines has suspended flights to Guinea.  Korean Air suspended flights to and from Kenya from 20 August.  Senegal Airlines has suspended flights to and from Conakry (Guinea) until further notice.

Other airlines have modified their routes but are still operating regular scheduled services. These include:  Royal Air Maroc  Brussels Airlines.

Medical screening Entry and exit health screening is now in place in numerous countries throughout West Africa and is being introduced in Europe and North America countries as well; related measures can include the partial closure of land borders, ports and river crossings in an effort to restrict cross-border travel. Travelers should allow additional time to pass through medical screening and not travel if they are sick. Staff should continue to monitor local media and the ISOS website for developments.

Travel Advice Summary  The situation is continuing to evolve and not stable  While the risk of infection with Ebola is generally low if you avoid high risk activities, in some heavily impacted areas people who have or may have Ebola are being cared for outside the designated facilities.  Some regular medical facilities are closed or unable to operate at normal capacity and there is a possibility that non-Ebola illnesses cannot be managed (Liberia)  Certain areas have been quarantined.  Entry and exit screening is in place. Persons with fever or other Ebola-like symptoms, or those who have had contact with them, may be taken to designated centers. Entry /exit may be denied.  Travelers flying from countries affected by Ebola should enquire with the relevant embassies or health ministries about any requirements conditioning entry at their destination, and prepare accordingly.  Reconfirm bookings on all regional routes as increased demand is likely. We do not hold information on specific flights.  If your flight is disrupted because of suspected Ebola cases, contact the ISOS Assistance Center for additional advice and support with onward travel.  Allow additional time during arrival and departure to pass through enhanced medical screening.  Do not travel if you are sick. Persons with fever or other Ebola-like symptoms may be taken to designated centers or have entry/exit denied.

For staff in Guinea: This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE

Hospital response and isolation/treatment centers (ETCs)  Conakry: Medecins Sans Frontieres (MSF) is running the 85-bed ETC in Donka Hospital. A new site in Koloma is being cleared for the Donka Hospital facility to move to.  Gueckedou: MSF treatment center with 85 beds in Guinee forestiere.  Macenta: The World Health Organization (WHO) and Ministry of Health (MOH) have a 35-bed "transit centre". Patients are transferred to Conakry or Guekedou for treatment. (The MSF ETC was closed in July.) A new MSF ETC with 30 beds is under construction in Macenta and will be ready for patients in mid-November.  Telimele: The MSF treatment centre in Basse-Guinee was closed in July after no new cases had been seen for 21 days. Gueckedou is part of a "unified sector" area heavily affected by Ebola. The sector also includes the neighboring areas of Kenema (Sierra Leona) and Foya (Liberia). There are public health measures in place restricting movement in and out of the sector. For more information on Screening and Closures click here.

For staff in Liberia: Hospital response and isolation/treatment centers Lofa, Margibi, Bong and Nimba, all have isolation facilities established. As at 5 September, the country has 314 treatment beds, and WHO estimates many more are required (additional 760 beds required in Monrovia).  Foya, Lofa county: Borma Hospital Ebola Treatment Unit (ETU) has a capacity of 100 beds. A "mid-level isolation unit" has been established in Telewowan Hospital, Voinjama, managed by Medecins Sans Frontieres (MSF). The centre has 40 beds.  Monrovia: ELWA hospital ETU is being run by MSF. It opened on 17 August with 120 beds with plans to expand to 300 beds. As of 20 October it has 250 beds. The facility in JFK Hospital is functioning as a full ETU. WHO advised on 5 September an additional 40 beds had been opened in Monrovia. There is a Holding Unit at Redemption Hospital. A 150-bed unit has been opened in the western suburb of Duala. A 120-bed Ebola Treatment Centre run by the MoH and WHO opened on 22 September at the Old Island Clinic on the Bushrod Island, it has an operational US Navy mobile laboratory as at 6 October. A 200-bed ETU is due to open soon after 20 October at the Ministry of Defense in Oldest Congo Town.  Montserrado: West Point holding unit has been established.  Nimba: Renovation of the holding facilities at G. W. Harley is underway as at 20 August. Ganta Hospital is functioning.  Bong: A 70-bed Ebola Treatment Unit is functional as at 25 September, it has an operational US Navy mobile laboratory unit, as at 6 October. A 7-bed Isolation Centre has been added to the Phebe Hospital in Suakoko.  Bomi: Bomi County Health Team (CHT) opened three, two-room quarantine units with a 12-bed capacity for Ebola patients. There is a holding centre in Tubmanburg. Construction of a 100-bed ETU began in Tubmanburg 3 October.

 Margibi: The United States military has begun construction of a 25-bed hospital for infected healthcare workers.

The Ministry of Health and Social Welfare has established hotlines that the public can call to get basic Ebola information: 1333, 4455, 0886229641, 0886397381, and 0776547437. Foya is part of a "unified sector", together with Kenema, Sierra Leona, and Gueckedou, Guinea. Public health measures restricting movement in and out of the sector. (The nation has also placed Bomi, Grand Cape Mount and Lofa counties under quarantine.

For staff in Sierra Leone: ISOLATION / TREATMENT CENTRES  Kenema: The isolation facility in Kenema Government Hospital is to be re-located outside the township of Kenema, a few miles from Hanga. The Red Cross facility is functional as at 12 September.  Kailahun: There is a 96-bed treatment facility, operated by MSF. The villages of Koindu and Buedu have "referral units", where patients who have symptoms of Ebola are isolated and evaluated. If they are determined to have Ebola they are then transferred to the isolation facility.  Freetown: An isolation unit has been established at Connaught Hospital, with assistance from a medical team from King's Health Partners, UK. Rokupa Hospital Isolation Unit is due to open in mid-October.  Bo: MSF Ebola Treatment Centre with 35 beds opened 19 September. A transit centre in Gondama is run by MSF. An isolation ward is being constructed at Bo Government Hospital.  Port Loko: a holding centre has been established and as at 12 September is expected to be "operational anytime." The Ebola Care Units under construction are nearing completion as of 13 October.  Western Area: The Lakka holding facility is currently being used as a treatment centre. The 92- bed treatment facility in Kerry Town is in the final stages of construction as of 21 October. Maculy Street Hospital treatment centre opened on 15 September. Newton and Hasting police (50-bed) isolation centers are open. Rokupa Isolation Centre with 20 beds opened on 23 October. Additional beds in holding facilities are urgently required.  Bombali: A holding centre is under construction with assistance from Addax Bio Energy Sierra Leone and is expected to be finished in the first week of October. Holding centers at Paramedical School, Arab Hospital and Regional Government Hospital have been receiving patients since 21 September. Three isolation centers opened at the start of October.

Kenema is part of a "unified sector", together with Foya, Liberia, and Gueckedou, Guinea. Public health measures restricting movement in and out of the sector.

For staff in the Democratic Republic of the Congo (DRC):

There is an outbreak of Ebola in Equateur province. It appears that this outbreak is unrelated to the one in Western Africa (in Guinea, Liberia and Sierra Leone) or in Nigeria. TREATING FACILITIES: There are 2 treatment centers in Boende health zone run by Medecins Sans Frontieres (MSF)  Boende: 10 bed unit  Lokolia: 40 bed unit The Ministry of Health has established two dedicated phone numbers for the public to call for information and to report suspected cases: (+243) 999 971 005 and (+243) 810 800 020.

For travel to Nigeria: STATUS: Declared Ebola Free 20 October All contacts completed 21 days monitoring 1 October with no further cases identified. Last confirmed cases reported in early September (Lagos - 5 September, Port Harcourt - 1 September).

For travel to Senegal: STATUS: Declared Ebola Free 17 October Single imported case from Guinea in late August. All contacts of the country's lone case, which was reported on 28 August, have completed 21 days monitoring with no further cases identified.

CDC Travel Warnings The US Centers for Disease Control (CDC) has adopted a classification system to address international travel when impacted by global health events. This system identifies levels of risk for the traveler and recommended preventive measures to take at each level. Currently areas impacted with active Ebola cases (Sierra Leone, Liberia and Guinea) are at a Level 3– avoid non-essential travel. DRC is at Level2 – Practice Enhanced Precautions, Nigeria has been downgraded to Level 1 – practice usual precautions.

If you must travel, protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are ill with Ebola. For more information, visit Outbreak of Ebola in Guinea, Liberia, and Sierra Leone on the CDC Ebola website.