Ebola Recommendations for Organizations

Recommendations for organizations sending U.S.-based healthcare or emergency response workers to areas with Ebola outbreaks and predeparture assessment and post-arrival management of any workers traveling from Ebola outbreak areas to the United States

This document was updated March 9, 2021, to:

  1. Include Advisory Committee on Immunization Practices (ACIP) recommendations regarding pre-exposure prophylaxis vaccination with rVSVΔG-ZEBOV-GP (Ebola vaccine)
  2. Align with new interim CDC guidance for U.S. health departments

Key Points

  • CDC recommends that organizations sending U.S.-based workers to areas with Ebola outbreaks ensure the health and safety of those workers before, during, and after their deployment.
  • Pre-deployment recommendations include educating workers about Ebola, travel vaccines, healthy behaviors, personal protective equipment, and travel health insurance.
  • During-deployment recommendations include remaining in contact with all workers, periodically asking about any symptoms of or exposures to Ebola, and contacting in advance the U.S. state or local health departments that have jurisdiction in the areas where workers will be staying after arrival in the United States.
  • CDC recommends that all workers in an outbreak area who are traveling to the United States undergo a health and exposure assessment before their departure from the outbreak area. The scope of the assessment should be determined by the degree of potential occupational risk (see definitions below).
  • Post-deployment recommendations include staying in contact with all workers for 21 days after they leave the outbreak area (while they self-monitor for symptoms of Ebola) and conducting symptom monitoring at certain time points during the 21-day monitoring period.

Audience

Audiences for this document include:

  • Organizations such as nongovernmental, faith-based, academic, or aid organizations that send U.S.-based workers (employees, contractors, or volunteers) to areas where Ebola outbreaks are occurring.
  • Organizations whose non-U.S.-based workers, such as locally employed personnel or U.S. expatriates working in the outbreak area, intend to travel to the United States.

Definitions

For the purpose of these recommendations, workers with higher potential occupational health risk include those engaged in clinical care or laboratory work in an Ebola treatment unit (ETU), burial work, or clinical care or clinical laboratory work in non-Ebola settings in the outbreak area.

Workers with lower potential occupational risk include those whose routine activities are unlikely to result in exposure to a person sick with Ebola or to Ebola-contaminated body fluids, such as epidemiologists, contact tracers, emergency operations center workers, logisticians, and airport screeners.

Organization Responsibilities Before, During, and After Worker Travel to Ebola Outbreak Areas

Before Workers Travel to Outbreak Areas

Workers providing clinical care or testing patient specimens in non-Ebola settings in an area where Ebola is spreading may encounter patients (or specimens from patients) with undiagnosed Ebola. In such situations, workers may be at high risk of exposure to Ebola virus if they don’t recognize the potential risk and take steps, including using appropriate PPE, to protect themselves.

Remind health care workers in an Ebola outbreak area about the importance of remaining vigilant for patients with acute febrile illnesses and following appropriate procedures for isolation, testing, and notification of public health officials. Remind laboratory workers to follow routine safety protocols to avoid exposure to clinical specimens.

  • Educate all workers about exposure risks, symptoms of Ebola, and the importance of monitoring themselves for fever and other symptoms during travel and for 21 days after leaving the outbreak area. Provide information about whom a worker should contact in the event of an exposure or if symptoms develop.
  • Encourage all workers to get routine and destination-specific vaccines, including cholera and yellow fever vaccines, before travel, to follow precautions (including food and water precautions) to stay healthy and safe during travel, and to take steps to avoid malaria (including preventing mosquito bites and taking preventive medication, when indicated) and other infectious diseases.
  • The Advisory Committee on Immunization Practices (ACIP) recommends pre-exposure prophylaxis vaccination with rVSVΔG-ZEBOV-GP (Ervebo™) for adults ≥ 18 years of age in the U.S. population who are at highest risk for potential occupational exposure to Ebola virus species Zaire ebolavirus. These include personnel responding to (or planning to respond to) Ebola outbreaks.
    • rVSVΔG-ZEBOV-GP is safe and protects against Zaire ebolavirus, which has caused the largest and most deadly Ebola outbreaks to date. For prescribing information and detailed instructions on how to order rVSVΔG-ZEBOV-GP vaccine from the CDC, see Ebola Vaccine: Information for U.S. Healthcare Providers.
  • Arrange for or help all workers obtain travel health and medical evacuation insurance. Everyone traveling to the outbreak area should have full health insurance coverage, including coverage for emergency medical evacuation.
  • Ensure workers with higher potential occupational risk of exposure to Ebola virus have access to appropriate personal protective equipmentExternal Linkexternal icon (PPE). Provide training on the correct use of PPE and other infection control measuresExternal Linkexternal icon to prevent the spread of Ebola.

During Workers’ Stay in Outbreak Areas

  • Remain in contact with all workers throughout their stay. Periodically ask about symptoms and potential exposures.
  • Ensure all workers are aware that CDC will not allow anyone with a history of high-risk exposure to Ebola virus (without use of appropriate and effective PPE) or Ebola-like symptoms to travel to the United States, unless the travel is part of a coordinated medical evacuation or until they are medically assessed and determined not to have Ebola infection.
  • Coordinate with the nearest U.S. embassy or health officials (country’s ministry of health) to facilitate timely medical evaluation and care of any symptomatic workers.
  • Contact CDC to discuss management of workers with high-risk exposures to Ebola virus and to coordinate safe return travel, if necessary, of symptomatic or exposed U.S.-based workers.

High-risk Exposure Definition

  • Percutaneous (i.e., piercing the skin), mucous membrane (e.g., eye, nose, or mouth), or skin contact with blood or body fluids1 of a person with known or suspected Ebola
  • Direct contact with person who has known or suspected Ebola
  • Providing health care to a patient with known or suspected Ebola without use of recommended personal protective equipment (PPE)2, or experiencing a breach in infection control precautions that results in the potential for percutaneous, mucous membrane, or skin contact with the blood or body fluids of a patient with Ebola while working in an Ebola treatment hospital or associated facility (e.g., laboratory) or while taking care of a patient with Ebola
  • Direct contact with or the occurrence of a breach in infection control precautions while handling a dead body in an Ebola outbreak area, the body of a person who died of Ebola or had an illness compatible with Ebola, or who died of unknown cause after any potential exposure to Ebola virus
  • Living in the same household as a person with symptomatic known or suspected Ebola

1Body fluids include but are not limited to feces, saliva, sweat, urine, vomit, sputum, breast milk, tears, and semen.
2Recommended PPE should be sufficient to prevent skin or mucous membrane exposure to blood or body fluids.

Before Workers Depart from Outbreak Areas and Travel to the United States

  • For workers with lower potential occupational risk based on assigned duties, conduct a limited pre-departure assessment that confirms the following:
    • Occupational activities did not change in a way that could increase the risk of Ebola virus exposure
    • Worker had no known exposures to Ebola virus or to a person with signs and symptoms of Ebola in the previous 21 days
    • Worker has no signs or symptoms of Ebola
  • For workers with higher occupational risk:
    • Ensure workers undergo a comprehensive exposure and health assessment before travel to the United States. Incorporate this activity into existing occupational health and safety protocols. See additional information and template tools below.
  • For all workers, contact the U.S. state or local health departmentsExternal Linkexternal icon that have jurisdiction in the areas where workers will stay during their 21-day monitoring period after leaving the outbreak area. CDC can help establish the initial contact between your organization and the health departments.
    • Establish points of contact between your organization, state and local health departments, and the returned worker.
    • Work with the health departments to develop processes for medical evaluation of workers exhibiting signs and symptoms of Ebola. Processes should include information about whom the worker should call first and expected next steps in evaluating the worker.

CDC recommends that workers self-monitor for 21 days after leaving an Ebola outbreak area with additional monitoring by their employer or sponsoring organization. However, U.S. state and local health departments have the authority to determine how they want monitoring conducted within their jurisdiction. Health departments may elect to accept risk assessment and/or monitoring by the sponsoring organization; they may also request updates from the sponsoring organization, or assume direct responsibility for risk assessment and/or monitoring of these workers. CDC has provided separate interim guidance for health departments.

After Workers Depart from the Outbreak Area

  • Ensure workers self-monitor for signs and symptoms of Ebola for 21 days after leaving the outbreak area.
  • Actively monitor workers for symptoms at a minimum at the following time points:
    • After arrival in the United States,
    • Midway through their 21-day monitoring period, and
    • At the conclusion of their 21-day monitoring period.
  • Active monitoring may be conducted by phone, video conferencing, other electronic means (e.g., text message, email, app, web form), or in person, according to resources available.
  • Ensure that returned health care workers who intend to provide care to patients in U.S. health care facilities during their 21-day monitoring period first notify the facility’s infection control or occupational health professional of their recent travel and self-monitoring activities.
  • Notify the state or local health department immediately if any worker located in the United States develops symptoms during the 21-day monitoring period. Health departments are responsible for coordinating a rapid and safe medical evaluation.
  • Notify state and local health departments of a worker’s travel plans during the 21-day monitoring period, including if a worker intends to relocate to another state or leave the United States. The state or local health department of jurisdiction will decide if health departments at the new destination need notification, based on the timing within the 21-day monitoring period and duration of travel.
  • If workers intend to deploy to another country within 21 days after leaving the outbreak area for the purpose of providing humanitarian aid, notify the ministry of health of the destination country in advance of their arrival.

Comprehensive Predeparture Exposure and Health Assessment for Workers with Higher Potential Occupational Risk Traveling from Ebola Outbreak Areas to the United States

Before workers with higher potential occupational risk (as described above) travel from Ebola outbreak areas to the United States, assess them for signs and symptoms compatible with Ebola and for possible high-risk exposures to Ebola virus.

CDC recommends a predeparture exposure and health assessment for the following reasons:

  • To prevent the potential public health consequences of exporting a case of Ebola
  • To prevent workers who are symptomatic or who have had high-risk exposures to Ebola virus from traveling by commercial airline

At a minimum, the predeparture assessment should include the following:

  • Careful assessment for potential exposures to Ebola virus
  • Review of signs and symptoms compatible with Ebola
  • Determination that the worker appears well
  • Oral temperature measurement

Conduct the exposure assessment after the last possible occupational exposure, and the health assessment within 24-48 hours of departure. For ETU workers, CDC recommends the ETU’s safety officer complete the exposure assessment and the organization’s medical supervisor complete the health assessment. Workers outside health care settings can complete their own exposure assessments for review by the organization’s medical supervisor; the medical supervisor should perform the health assessment.

CDC has developed template tools (Workers in Ebola Treatment Units (print only) pdf icon[PDF – 3 pages]) and Workers in non-ETU settings (print only) pdf icon[PDF – 3 pages]) that organizations can choose to use or modify to help structure the comprehensive predeparture assessment. Organizations may also opt to develop their own forms.

While CDC does not request copies of predeparture assessment forms, it does recommend that both the sponsoring organization and the returning worker retain the documentation, in case it is requested by the state or local health department where the worker resides or is located.

Symptomatic or Exposed U.S. Workers Located Overseas

CDC is available to provide consultation to organizations that identify

  • Workers with Ebola-compatible illness
  • Workers with high-risk exposures (i.e., without the use of appropriate and effective PPE)

Ebola-compatible illness includes elevated body temperature (≥100.4°F or 38°C), subjective fever, or signs or symptoms of Ebola, including severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bruising or bleeding.

CDC prohibits travel to the United States by commercial airline of any person with symptoms compatible with Ebola and potential exposure to Ebola virus, or any person with known high-risk exposure to Ebola virus even if the person is asymptomatic. CDC will assess such situations case by case and, if necessary, may use federal public health travel restrictions to safeguard the public’s health. CDC will support organizations or workers in requesting assistance from the U.S. Department of Health and Human Services and the U.S. Department of State for noncommercial transport to the United States.

Contacting CDC

For urgent consultations regarding symptomatic or potentially exposed workers, please call the CDC Emergency Operations Center (available 24/7) at 770-488-7100 and ask to speak to the officer on call for Viral Special Pathogens.