Via Eurosurveillance: First secondary case of Ebola outside Africa: Epidemiological characteristics and contact monitoring, Spain, September to November 2014. Excerpt from the discussion section:
The experience with the repatriated cases in several non-epidemic countries and the secondary transmissions identified in Spain and in the US have resulted in proposals to modify existing protocols. These proposals  include increased sensitivity of the case definitions for persons under investigation in order to detect possible cases in the initial phases of the disease, particularly for contacts of confirmed cases, and a revision of contact classification and monitoring measures.
The Spanish experience highlights that the generation of secondary cases among HCW caring for repatriated EVD patients represents the currently main risk for Europe as has happened also in US [8,13-15]. The risk is very low, however it can not be excluded .
Despite the existence of preparedness and response plans, trained professional teams, 24/7 alert systems and contingency plans for control and response of communicable diseases in both hospitals, the number of exposed contacts among HCW was high. After the secondary case was diagnosed, training and assessment was reinforced for all healthcare professionals involved in the treatment and care of EVD and a committee was set up to classify incidents.
This alert shows the need for constant updating and training of professionals in the use of PPE and strict application of donning and doffing procedures in order to minimise the risks. Hence it is necessary to provide adequate risk communication and create awareness in HCW who care for these patients.
Despite the rapid activation of the protocols and control measures, this first case of secondary transmission of EVD outside Africa has represented an unprecedented challenge for the health services and public health authorities in Spain [9,12-14] and has highlighted the need to strengthen continuous preparation and training in order to respond properly to this type of emergency.