Purpose
- This page contains interim guidance for U.S. health departments in conducting post-arrival public health assessments and management of travelers to their jurisdictions from the countries affected by the 2026 Ebola outbreak.
- This guidance reflects current evidence as of May 21, 2026, and may be updated as new information becomes available.
Overview
An outbreak of Bundibugyo virus disease (BVD) is occurring in certain countries. BVD is a type of Ebola disease (a viral hemorrhagic fever [VHF]) caused by infection with the Bundibugyo virus. BVD is a serious and often deadly disease. No vaccines or specific treatments have been approved to prevent or treat BVD. Early supportive care improves the chance of survival. Local health authorities in the affected countries are conducting investigations to identify infected people and their contacts to prevent further transmission and educating communities and the public about the risks of BVD and protective actions. As part of domestic response to the BVD outbreak in the affected countries, CDC is providing this interim guidance to health departments with recommendations for exposure assessment, education, and monitoring of travelers after they arrive in the United States.
Consistent with principles of federalism, state, tribal, local, and territorial jurisdictions may choose to make decisions about the use of public health measures that provide a greater level of public health protection than is recommended in federal guidance.
Important
This interim guidance addresses public health management of travelers who have no identified high-risk exposures. For public health management of travelers with high-risk exposures and those identified as having suspected or confirmed BVD, see Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures.
CDC has previously issued guidance specifically for organizations sending US-based personnel to areas with VHF outbreaks. However, during this outbreak, health departments and organizations should follow this interim guidance for post-arrival management of all travelers from affected countries.
Definitions
Affected countries
- DRC
- South Sudan
- Uganda
Specific areas of concern for the purpose of this response
- DRC: Entire country
- South Sudan: No specific area of concern identified. However, travelers from South Sudan are included in this interim guidance because it neighbors DRC with a high-volume of travel across a porous shared border.
- Uganda: Kampala
High-risk exposures
Refer to detailed definition in Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures
Situations with exposure potential
The following situations have potential for other or unrecognized exposure to BVD and should be considered in the assessment of people without reported high-risk exposures but who have been in an area of concern in the previous 21 days.
Nonoccupational
- Exposure to a person with acute febrile illness
- Visiting a health care facility or traditional healer
- Attending a funeral or burial
- Contact with bats, bat urine or droppings, or non-human primates; contact with blood, fluids, or raw meat from these animals; or entry into areas known to be inhabited by bats (e.g., caves, mines)
Occupational
- Providing health care, performing environmental cleaning, or handling of waste in an Ebola treatment unit (ETU), or for patients with BVD in any clinical setting
- Entry into a patient care area of an ETU for any reason
- Providing health care to an acutely ill patient not known to have BVD
- Environmental cleaning or handling of waste in a regular healthcare facility
- Clinical laboratory work associated with a treatment unit or other health care setting
- Burial work
Traveler assessment and education
CDC staff will conduct an initial assessment for air passengers arriving from affected countries who are redirected to a U.S. airport designated for public health entry screening. Health departments should establish communication with travelers arriving in their jurisdictions from an affected country to conduct an initial assessment, provide health education, conduct symptom monitoring if recommended (as described below), and track overall success in monitoring incoming travelers, according to resources available in the jurisdiction. The initial communication should occur as soon as feasible, ideally within 24 hours of receiving CDC's notification of the traveler's arrival. Priority should be given to travelers reporting situations with exposure potential and others who have been in an area of concern. For travelers who were screened by CDC staff at a U.S. port of entry, health departments may choose to defer the exposure assessment to CDC's assessment which will be provided in CDC's One CDC Data Platform (1CDP) for travelers whose final destinations are in their jurisdiction; however, health departments should still interact with travelers shortly after their arrival to conduct education as described below.
A summary of these recommendations is provided in the table below.
Traveler contact information
CDC will provide contact information for travelers arriving from an affected country electronically to health departments on a daily basis through established secure mechanisms in (1CDP).
Initial assessment
If a jurisdiction chooses to conduct its own exposure assessment, it should include whether the traveler:
- had any potential high-risk exposures
- was present (other than just transiting en route to airport) in an area of concern
- had any epidemiologic risk factors for exposure to Bundibugyo virus or any physical contact with a person with BVD or their body fluids, e.g., as a caregiver, healthcare provider, laboratory worker, or burial worker
- used personal protective equipment and other recommended infection control measures during any potential exposure to BVD
- had any potential zoonotic exposures (as described above)
Refer to the definitions above for high-risk exposures and situations with other exposure potential and to help guide traveler assessment, including decisions regarding testing should a traveler develop any signs and symptoms compatible with BVD within 21 days after leaving the affected country.
A sample exposure screening and assessment tool is available here.
Travelers should also be assessed for signs and symptoms compatible with BVD during the initial assessment.
Health education
Health departments should help all travelers from an affected country understand:
- the signs and symptoms of BVD and how to self-monitor
- the need to self-isolate immediately and contact the health department of jurisdiction if symptoms develop
- Health departments should assist travelers in identifying a suitable location within their homes to self-isolate, ideally with access to a dedicated private bathroom
- whom to contact (e.g., public health officials, healthcare professionals) if symptoms develop, based on individual exposure risk assessment
- Health departments should provide travelers instructions for how to reach the health department 24/7 for this purpose
- the need for advance notification to health department if travel outside the jurisdiction is planned
CDC has posted after-travel recommendations for travelers from affected countries. Health departments may choose to use this resource as part of their health education activities.
Monitoring and other public health interventions
Symptom monitoring can be conducted by phone, video conferencing, other electronic means (e.g., text message, email, app, web form), or in person, according to resources available in that jurisdiction, while they are in the United States. The frequency of monitoring should be guided by the results of the exposure assessment, as specified below.
Travelers with reported high-risk exposure
Refer to guidance available in Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures.
Travelers who were in an area of concern but had no high-risk exposures
All travelers who have been in an area of concern should be advised to self-monitor (including daily temperature measurement) and notify their health department if they develop symptoms within 21 days after leaving the area of concern. See below for information on health department monitoring based on reported situations with exposure potential.
If these individuals intend to travel outside the jurisdiction, they should notify the health department of jurisdiction for their current location, and the health department should notify and coordinate with the receiving jurisdiction in advance of travel. If travel is international, CDC can assist with making notifications to destination authorities.
Travelers who report situations with exposure potential
Health departments should monitor these travelers regularly during the 21-day period after the person left the area of concern.
For guidance on healthcare workers' return to work in the United States after caring for a patient with suspected or confirmed BVD, visit Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals. For healthcare workers who return to work in a U.S. healthcare facility, health departments may opt to defer monitoring to the facility's occupational health program; these workers should check their temperature prior to each work shift during the 21-day period.
Travelers who do not report situations with exposure potential
Following the initial encounter, health departments should check-in with these travelers at least once during the 21-day period.
Travelers who were present in an affected country but not in an area of concern
Health departments should conduct a single check-in during the 21-day period in addition to the initial encounter. These travelers should be advised to watch their health until 21 days after departing the affected country. If they develop symptoms, they should take their temperature and notify the health department. If these individuals intend to travel outside the jurisdiction, they should notify the health department of jurisdiction for their current location; for domestic travel, the health department could choose to coordinate with the receiving jurisdiction or retain responsibility for the traveler. CDC does not make a recommendation for international notification for this group of travelers if they depart the United States.
Asymptomatic travelers
Summary Table—Asymptomatic Travelers
Post-arrival management of asymptomatic travelers1 with NO HIGH-RISK EXPOSURES2
| Intervention | Present in an area of concern | In affected country but not in area of concern 4 | |
|---|---|---|---|
| Situations with exposure potential 3 | No situations with exposure potential | ||
| Initial assessment 5 | Yes | Yes | Yes |
| Health education | Yes | Yes | Yes |
| Symptom monitoring | Regular monitoring by health department plus self-monitoring (with daily temperature measurement) | At least one check-in by the health department following the initial encounter, plus self-monitoring (with daily temperature measurement) | A single check-in by the health department following the initial encounter, plus traveler should watch their health |
| Movement restrictions | None | None | None |
| Travel outside of jurisdiction | Advance notification to monitoring health department and coordination with destination health department, based on agreement | Advance notification to monitoring health department and coordination with destination health department, based on agreement | Advance notification to monitoring health department |
1 See section below for assessment and management of symptomatic travelers
2 For high-risk exposures, refer to Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures
3 Refer to definition of situations with exposure potential
4 Given the potential for unrecognized cases outside of a defined area of concern, particularly in countries with inadequate public health infrastructure and surveillance systems, these situations could also be taken into consideration when assessing people who were present in an affected country outside of the area of concern
5 Health departments can defer to CDC's initial assessment at port of entry or choose to conduct their own initial assessment
Symptomatic travelers
Important
Recent travel from an endemic area or an area with active transmission should be considered when evaluating reports of suspected BVD or other VHF. However, travel is not by itself an epidemiologic risk factor.
CDC does not necessarily recommend BVD testing for all people who have been in an affected country or area of concern and subsequently develop symptoms compatible with BVD. Rather, such decisions should be based on the public health exposure assessment, taking into account the person's clinical presentation and reported exposure risk factors, and be made in consultation with CDC subject matter experts. CDC has resources around the world that can be leveraged to provide context and additional clarity on a patient's travel, activities, and other epidemiological risk factors.
If a traveler is identified as being symptomatic within 21 days after arriving from an affected country, health department personnel should reassess the person's travel and potential exposure history in the context of their reported signs/symptoms to determine the likelihood that their illness is caused by BVD (i.e., whether the clinical case definition for a suspected case is met), in consultation with CDC subject matter experts.
The purpose of having health departments reassess symptomatic travelers is so that public health officials at the state, territorial and local levels can:
- Have immediate situational awareness if a traveler from an affected country develops symptoms and avoid symptomatic travelers' presenting at a healthcare facility without advance notification
- Make recommendations, in consultation with CDC, regarding the need to seek medical evaluation and care immediately versus careful observation and in-home isolation
- Identify the appropriate type of treatment center for the person if medical evaluation and care are recommended, based on whether or not BVD is suspected
- Communicate their assessment to emergency medical services, healthcare facilities, and others, as needed, in coordinating the transport and management of symptomatic people for whom medical evaluation and care are recommended
By assuming a coordinating role in the management of symptomatic travelers, health departments will have the opportunity to:
- Avoid unnecessary testing of people whose signs/symptoms and exposure history do not meet the definition for suspected case of BVD
- Address potential concerns of healthcare or medical transport personnel in situations where symptomatic travelers have no known epidemiologic risk factors and testing is not recommended
- Minimize potential unintended consequences in managing a symptomatic traveler with no known epidemiologic risk factors as a suspected case-patient, including unnecessary implementation of infection prevention and control precautions suitable for VHF or delayed recognition and management of other more common and potentially life-threatening conditions (e.g., malaria, typhoid) while ruling out BVD (see Guidance on Performing Routine Diagnostic Testing for Patients with Suspected VHFs or Other High-Consequence Disease)
- For any patient whose illness and exposure history meet the definition of suspected case of BVD:
- Designate an appropriate healthcare facility that has capacity to provide an appropriate level of care for and safely manage a patient with suspected VHF
- Communicate in advance with emergency medical services and the healthcare facility to allow appropriate infection control precautions to be in place during transport and at the healthcare facility