The Travel Health and Vaccine Specialists

Health Alert


LEVEL 1 - PRACTICE USUAL PRECAUTIONS

Ebola in Democratic Republic of the Congo

Updated June 8, 2018

Key Points
An outbreak of Ebola is occurring in the Bikoro area, Equateur province in the northwest corner of the Democratic Republic of the Congo (DRC). Cases have also been found in nearby Iboko and the large city of Mbandaka.
Travelers could be infected if they come into contact with an infected person’s blood or body fluids.
Travelers should seek medical care immediately if they develop symptoms of fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes during or after travel.
What is the current situation?
An outbreak of Ebola is occurring in the Bikoro area, Equateur province in the northwest corner of the Democratic Republic of the Congo (DRC). As of May 20, 2018, cases of Ebola, including some deaths, have been confirmed in the Bikoro and Iboko health zones and in the Wangata health zone in the large city of Mbandaka. Additional suspected cases of Ebola, including some deaths, have been reported but not confirmed. See map of Ebola-affected health zones in the Democratic Republic of the Congo (DRC).

Ebola DRC map
Map of Ebola-Affected Health Zones in DRC

A comprehensive public health response led by the DRC government and supported by the World Health Organization (WHO and other partners) has been launched to control the spread of this outbreak. Efforts have included enhanced illness surveillance and reporting, monitoring of “contacts” (people who may have been exposed to Ebola), and improved laboratory capacity. The DRC has also begun exit screening at airports and key borders to help prevent the spread of Ebola to other areas. Exit screening may include checking travelers for signs and symptoms of Ebola-like illness and identifying people who may have been exposed to Ebola.

In its statement on the May 18, 2018, Emergency Committee meeting, WHO noted several factors of concern with this Ebola outbreak in DRC:

there is a risk of Ebola spreading more quickly since it has been found in an urban area (Mbandaka), where crowding occurs and people have more access to long-distance travel;
there are several outbreaks in remote areas that are hard for public health personnel to reach; and
health care staff have been infected, which may be a risk for further spread.
There is a risk of Ebola spreading to other countries in the region since Mbandaka is near the Congo River, which is used as a main source of travel for people across the region. However, the WHO committee noted factors that may help control the spread of the outbreak, including:

the timely and comprehensive public health response; and
use of an investigational vaccine.
The WHO Committee also advised against the application of travel or trade restrictions. CDC and WHO continue to monitor the situation closely.

Who is at risk?
The risk to most travelers to DRC is low. Travelers could be infected if they come into contact with infected blood or body fluids. Family and friends caring for people with Ebola, and healthcare workers who do not use correctd infection control precautions, are at highest risk.

What can travelers do to protect themselves?
There is no 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 steps to prevent 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, and medical equipment).
Avoid contact with wild animals and raw bush meat.
Avoid participating in burial rituals that require handling a dead body.
Pay attention to your health during travel and for 21 days after you leave DRC.
Monitor yourself for fever and other symptoms.
Seek medical care immediately if you have been in an area where Ebola is spreading and develop fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.
Before you go to a doctor’s office or emergency room, 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.
Although the risk for Ebola is low in travelers to DRC, other infectious disease risks remain high, including the risk for malaria. Seek medical care and proper treatment if you feel ill during travel or after returning.
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 assistance in an emergency.
For more information, see WHO recommendations for international travelers related to the Ebola virus disease outbreak in the DRC.

What can travelers do to protect others when leaving DRC?
Travelers who may have been exposed to Ebola or who are sick should postpone international 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 an appropriate medical evacuation.
Travelers should be prepared for airport exit screening before departing DRC:
Plan to arrive early and expect delays related to public health screening.
You might be required to complete a Traveler Public Health Declaration (questionnaire), which will be reviewed before you can be cleared to board your flight.
Health authorities might take your temperature, in addition to normal security provisions.
You may be denied boarding based on public health criteria.
Special Recommendations for Health Care Workers in the Outbreak Area
If your work puts you at risk of exposure to Ebola, you should :

Wear protective clothing, including masks, gloves, gowns, and eye protection whenever you are working.
Discuss options for vaccination with your sponsoring organization. DRC, WHO and other partners are offering an investigational vaccine to priority populations such as frontline health care workers. A major clinical trial conducted in Guinea (2015) showed the vaccine to be highly protective against Ebola.
If you choose to get 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 located at the NIH in Bethesda, MD, and Emory University in Atlanta, GA.
Practice proper infection control and sterilization measures. For more information, see “Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting.”
Traveler Information
Health Information for Travelers to DRC
CDC Ebola Website
CDC Ebola Factsheets
CDC Division of High Consequence Pathogens and Pathology Website
WHO Ebola in Democratic Republic of the Congo updates
WHO Guidance for Travelers
Clinician Information
Health Information for Travelers to DRC
Viral Hemorrhagic Fevers in CDC Health Information for International Travel (“Yellow Book”)
Information for Airline Personnel
Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew
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Page created: May 15, 2018
Page last updated: June 07, 2018
Page last reviewed: June 07, 2018
Content source: Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)