The Travel Health and Vaccine Specialists

Ebola in Democratic Republic of the Congo

Key Points

  • There is an outbreak of Ebola in the North Kivu (Kivu Nord) and Ituri provinces in the northeastern part of the Democratic Republic of the Congo (DRC).
  • Travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or other body fluids.
  • Travelers should seek medical care immediately if they develop fever, headache, body aches, sore throat, diarrhea, weakness, vomiting, stomach pain, rash, or red eyes during or after travel.
  • CDC has provided recommendations to ensure workers with potential occupational exposure to Ebola are healthy when they return to the United States.

What is the current situation?

An outbreak of Ebola is occurring in the North Kivu (Kivu Nord) and Ituri provinces of the DRC (see map of Ebola-affected health zones in the DRC). The DRC Ministry of Health declared this current outbreak on August 1, 2018. For the latest information on this outbreak, including updates on numbers of cases and deaths, see the World Health Organization’s (WHO) Ebola situation reports: Democratic Republic of the Congo.

What is Ebola?

Ebola virus disease (also known as Ebola hemorrhagic fever) is a rare and deadly disease that periodically causes outbreaks in several African countries. It is spread by contact with blood or body fluids of a person infected with Ebola virus. It is also spread by contact with contaminated objects or infected animals.

Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

North Kivu and Ituri provinces are among the most populated in DRC. These provinces share borders with other countries (Rwanda, South Sudan, and Uganda) with frequent cross-border movement for personal travel and trade. The provinces have been experiencing a prolonged humanitarian crisis and deteriorating security, which are limiting public health efforts to respond to this outbreak. The US Department of State has identified this part of the country as a “reconsider travel” zone because of armed conflict.

The DRC Ministry of Health, WHO, and partners are responding to this outbreak and working to enhance illness surveillance and reporting, monitor contacts, conduct cross-border surveillance in neighboring countries, expand laboratory capacity, and vaccinate front-line health workers and contacts of people with Ebola.

Who is at risk?

The risk of Ebola infection for most travelers to DRC is low. Only those going to the outbreak area or who otherwise have contact with a person with Ebola are at risk. Travelers could become infected if they come into contact with blood or body fluids from an infected person. Family and friends caring for people with Ebola and health care workers who do not use correct infection control precautions are at higher risk.

Although the risk for Ebola is low for most travelers to DRC, other infectious disease risks remain high, including the risk for malaria. Get recommended vaccines before travel, take medicine to prevent malaria and avoid bug bites, and follow other precautions to stay healthy and safe, such as following food and water precautions. Seek medical care if you feel ill during travel or after returning.

What can travelers do to protect themselves and others from Ebola?

There is no US Food and Drug Administration (FDA)-approved or widely available vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.

  • Take action to prevent Ebola infection.
    • Avoid contact with other people’s blood or body fluids. (See the section below for special precautions if your work puts you at risk for exposure to Ebola.)
    • Do not handle items that may have come in contact with a person’s blood or body fluids (such as clothes, bedding, needles, or medical equipment).
    • Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared from these animals (bushmeat) or meat from an unknown source.
    • Do not participate in funeral or burial rituals that require handling human remains.
    • Wash your hands often or use hand sanitizer, and avoid touching your eyes, nose, or mouth.
  • Consider travel health and medical evacuation insurance coverage.
    • If you are traveling for work, have information about your employer’s plan for medical care or evacuation during your trip.
  • Register with the US Department of State. If you are a US citizen, enroll online in the Smart Traveler Enrollment Program (STEP) to receive security updates and information about getting help in the event of an emergency.
  • For travelers to the outbreak area, pay attention to your health during travel and for 21 days after you leave the outbreak area.
  • Separate yourself from others and seek medical care immediately if you have been in an area where Ebola is spreading and develop fever or other symptoms of Ebola.
    • Before you go to a doctor’s office, urgent care center, or emergency room, call ahead and tell the doctor about your recent travel and your symptoms. Advance notice will help the doctor care for you and protect other people who may be in the office or hospital.
    • If you need help getting health care overseas, contact the nearest US embassy.
    • If you are in DRC for work and become ill, contact your employer or sponsoring organization.
    • Do not travel until cleared by health officials.
  • If you think you have been exposed to Ebola:
    • Contact the nearest US embassy (for US citizens overseas) or local health officials immediately. If you are in DRC for work, also contact your employer or sponsoring organization.
    • Do not travel until cleared by health officials.

For more information, see WHO recommendations for international travelers related to the Ebola virus disease outbreak in the DRC.

What should travelers be aware of when leaving the outbreak area in DRC?

Travelers who may have been exposed to Ebola or who become sick during or after travel should postpone further travel and get immediate medical attention. Any person with possible exposure or Ebola-like symptoms will not be allowed to travel unless the travel is part of a coordinated medical evacuation.

Travelers leaving the outbreak area may be subject to travel restrictions or monitoring by ministries of health in other countries and should check in advance for any requirements

Special recommendations for health care workers and Ebola response workers in the outbreak area

IIf your work puts you at risk of exposure to Ebola (such as general health care in a hospital, Ebola treatment unit work, burial work, or laboratory work in the outbreak area), you should:

  • Wear protective clothing, including masks, gloves, gowns, and eye protection whenever you are at risk of exposure to Ebola virus.
  • Practice proper infection control (more information).
  • Discuss options for vaccination against Ebola with your employer or sponsoring organization. DRC’s Ministry of Health, WHO, and other partners are offering an investigational vaccine to priority populations such as frontline workers in Ebola response activities.
    • If you choose to be vaccinated against Ebola, get the vaccine before travel, if possible.
    • The National Institutes of Health (NIH) has an open-label clinical trial, entitled “Pre-Exposure Prophylaxis in Individuals at Potential Occupational Risk for Ebola Virus Exposure” or “PREPARE,” to vaccinate adult volunteers (including deploying health care workers and other responders) against Ebola. Study sites are at the NIH in Bethesda, MD, and Emory University in Atlanta, GA.

Upon returning to the United States, notify your health care facility’s infection control professional of your recent travel and self-monitoring activities (if you will be caring for patients in a US health care facility during your 21-day self-monitoring period).

Special recommendations for organizations sending workers to the outbreak area

Aid organizations and employers sending workers to the outbreak area are responsible for ensuring the health and safety of all sponsored workers, including their safe return to the United States.

For all workers in the outbreak area, including those not directly involved in Ebola response activities, sponsoring organizations should:

  • Educate personnel about exposure risk, symptoms of Ebola, the importance of monitoring themselves for fever and other symptoms during and after travel, and whom to contact in the event of an exposure or if symptoms develop.
  • Encourage employees to get recommended vaccines before travel and take medicine to prevent malaria.
  • Make arrangements for travel health insurance and, if necessary, medical evacuation. Everyone traveling to the outbreak area should have full health insurance coverage, including coverage for emergency medical evacuation.
  • Remain in contact with personnel throughout their stay, including periodic checks for symptoms and potential exposures.
  • Check in with workers before they depart the outbreak area to make sure they do not have symptoms of Ebola.
  • For any symptomatic or potentially exposed workers located overseas, coordinate with health officials (CDC or country’s ministry of health) or the nearest US Embassy to facilitate timely medical evaluation and safe travel, if necessary. For workers who develop symptoms after return to the United States, contact the state or local health department in the area where the worker is located.

For health care workers and Ebola response workers, sponsoring organizations should take these additional steps:

  • Incorporate predeparture health and exposure assessment into existing occupational health and safety protocols. This guidance applies to all returning US-based personnel with potential occupational exposure to Ebola virus in the outbreak area. See additional information below.
  • Before workers’ return to the United States, contact the state or local health departments in the states where workers will stay during their recommended 21-day self-monitoring period.
  • Establish points of contact between the organization, state and local health departments, and the returned worker.
  • Work with the health departments to agree on a process for medical evaluation of returned workers exhibiting signs and symptoms of Ebola, including whom the worker should call first and expected next steps in evaluating the worker.

CDC recommends that sponsoring organizations assess workers with potential exposure to Ebola for signs and symptoms compatible with Ebola and for possible exposures to Ebola virus before they leave DRC. These recommendations apply to US health care workers and laboratory personnel in Ebola treatment units or any other clinical settings in health zones in the outbreak area, members of burial or contact tracing teams, laboratory workers, and anyone else whose duties place them at risk of exposure to Ebola virus. CDC has developed interim recommendations and template tools to help organizations assess their workers before their departure from DRC.  State or local health departments may request copies of workers’ assessment forms.  

For more information, or to request copies of CDC’s interim recommendations and template tools for predeparture assessment, sponsoring organizations should email CDC at eocdgmqopschief@cdc.gov. To contact CDC regarding a person with potential exposure to or symptoms of Ebola, call the Emergency Operations Center at 770-488-7100.

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