At a glance
This page contains tiered interim recommendations for public health management of travelers (including U.S.-based healthcare personnel) arriving in the United States who have been in the Republic of Rwanda during the previous 21 days.
Updates
On December 6, 2024:
- Updated to reflect that CDC discontinued public health entry screening on December 4, 2024.
Overview
U.S.-based Healthcare Personnel Returning from Rwanda
In response to the outbreak of Marburg virus disease (MVD) in the Republic of Rwanda, CDC has updated its interim recommendations for public health management of travelers arriving in the United States if they have been in Rwanda in the previous 21 days. Based on the World Health Organization's announcement that the last patient with MVD in Rwanda had been discharged, CDC removed the defined outbreak area from these interim recommendations. These interim recommendations will continue to be updated as new information becomes available. MVD outbreaks are declared over if no new infections arise during the 42 days after the last confirmed case-patient tests negative.
These interim recommendations assume no high-risk exposures were identified during a public health risk assessment of the individual. Travelers with high-risk exposures to Marburg virus should be managed in accordance with CDC guidance for Public health management of people with suspected or confirmed VHF or high-risk exposures.
Note
Information about travelers
As of December 5, 2024, CDC is no longer sending contact information for travelers arriving from Rwanda to health departments.
Data request
CDC requests that health departments submit data for the number of people being monitored during this outbreak. Information for how to submit these data has been provided to health departments.
Defined outbreak area
There is currently no defined MVD outbreak area in Rwanda as there are currently no identified patients with MVD. MVD outbreaks are declared over if no new infections arise during the 42 days after the last confirmed case-patient tests negative.
Recommendations
All travelers, including U.S.-based healthcare personnel, who have been in Rwanda in the past 21 days are recommended to watch their health for symptoms of MVD following information available in Traveling to the United States from Rwanda.
- CDC will send automated text messaging to travelers whose contact information is available to CDCA reminding them to watch their health and of actions to take if they develop symptoms compatible with MVD. These reminders will end on or before December 11, 2024.
Health departments, at their discretion, may choose to exceed CDC's interim recommendations.
Symptomatic travelers
If any traveler develops signs and symptoms compatible with MVD, they should immediately self-isolate and contact their health department for guidance.
- Health departments should conduct a public health assessment to determine the likelihood that the traveler's symptoms are caused by MVD and, if MVD is suspected, refer the person for medical evaluation at a pre-determined healthcare facility with consideration of testing for Marburg virus.
- If a diagnosis of MVD is considered, state, tribal, local, or territorial public health officials should coordinate with CDC to ensure appropriate precautions are taken to help prevent potential spread of Marburg virus and to arrange for testing. CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations regarding suspected MVD cases by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 and requesting VSPB's on-call epidemiologist, or by emailing spather@cdc.gov.
- People with suspected or confirmed MVD should be managed in accordance with CDC guidance for Public health management of people with suspected or confirmed VHF or high-risk exposures.
The purpose of conducting an initial public health risk assessment of symptomatic travelers is to ensure public health officials at the state, territorial and local levels:
- Have situational awareness of ill people within their jurisdictions who have been in Rwanda within the previous 21 days before they seek care at a healthcare facility
- Can identify the appropriate type of treatment center for the person if medical care is recommended, based on whether or not MVD is suspected
- Can communicate their assessment to emergency medical services, healthcare facilities, and others as needed, in coordinating the management of symptomatic people for whom medical evaluation and care is recommended (including for diseases other than MVD)
By conducting such assessments and assuming a coordinating role in the management of symptomatic travelers, health departments will have the opportunity to:
- Address concerns of healthcare or medical transport personnel in situations where there are no known risk factors for Marburg virus infection and testing is not recommended
- Minimize potential unintended consequences of managing a symptomatic traveler as having suspected MVD if they have no known risk factors for infection, including unnecessary implementation of infection control precautions suitable for MVD or delayed recognition and management of other potentially life-threatening conditions (e.g., malaria, typhoid) while ruling out MVD
- For any patient whose illness and exposure history meet the definition of suspect case of MVD:
- Designate an appropriate healthcare facility that has capacity to provide an appropriate level of care for and safely manage a patient with suspected MVD
- Communicate in advance with emergency medical services and the healthcare facility to ensure appropriate infection control precautions are in place during transport, and at the healthcare facility
- Designate an appropriate healthcare facility that has capacity to provide an appropriate level of care for and safely manage a patient with suspected MVD
CDC does not recommend that all people who have been in Rwanda and subsequently develop symptoms compatible with MVD be tested for MVD, regardless of their risk level or recommended post-arrival monitoring strategy. Rather, such decisions should be based on the public health risk 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.
Previous updates
On November 25, 2024:
- Merged interim recommendations for U.S.-based healthcare workers and other travelers into a single page.
- Removed the defined "outbreak area" following the World Health Organization's announcement that the last patient with Marburg virus disease in Rwanda had been discharged. This change removes the recommendation for health departments to monitor travelers.
- Removed all definitions and interim recommendations that no longer apply during this outbreak.
On November 4, 2024:
- Removed all healthcare facilities listed as having known transmission risk to reflect the evolving situation
- Added items related to Marburg treatment units in the definition of “other situations with exposure potential”
On October 30, 2024:
- Clarified definitions to reflect that Rwanda currently has only one Marburg treatment unit (MTU) which is now listed as a "healthcare facility with known transmission risk." Therefore, the elements of the "other situations with exposure potential" definition that specifically relate to presence in a MTU have been temporarily removed.
On October 25, 2024:
- Aligned timing of intermittent monitoring as “weekly” for both U.S.-based healthcare personnel and other travelers
On October 23, 2024:
- Limited the interim recommendations for daily monitoring and avoidance of nonessential visits to a U.S. healthcare facility to travelers who have been present in the past 21 days in patient care areas of specified Rwandan healthcare facilities with known Marburg virus transmission risk (previously applied to all Rwandan healthcare facilities)
- Defined an outbreak area for which travelers are recommended to have intermittent monitoring if they have a history of being in certain situations with exposure potential
- Traveler contact information available to CDC includes information air passengers provide to airlines as required by a CDC Order or provide directly to CDC during the public health entry screening process.