The Travel Health and Vaccine Specialists

Health Alert

Ebola in Democratic Republic of the Congo

Updated October 4, 2018

Key Points
There is an outbreak of Ebola in the North Kivu (Kivu Nord) and Ituri provinces in the Democratic Republic of the Congo (DRC).
The outbreak is in a part of the country identified by the U.S. State Department as a “reconsider travel” zone because of armed group activity and major outbreaks of violence targeting civilians.
Travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or 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.
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 direct 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.

What is the current situation?
An outbreak of Ebola is occurring in the North Kivu (Kivu Nord) and Ituri provinces of the DRC, including the city of Butembo. This outbreak, in the northeastern part of DRC, is approximately 780 miles from the Ebola outbreak in western DRC that ended in July 2018 (see map of Ebola-affected health zones in the DRC). The DRC Ministry of Health declared this 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.

The North Kivu and Ituri provinces are among the most populated in DRC. These provinces share borders with other countries (Rwanda and Uganda) with frequent cross-border movement for trade activities. The provinces have been experiencing a prolonged humanitarian crisis and deteriorating security situation, which is limiting public health efforts to respond to this outbreak.

The DRC Ministry of Health, WHO, and partners are responding to this outbreak and working to establish its extent. The response includes enhanced illness surveillance and reporting, monitoring of “contacts” (people who may have been exposed to Ebola), cross-border surveillance in neighboring countries, expanded laboratory capacity, and vaccination of front-line health workers and contacts.

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 health care workers (HCWs) who do not use correct infection control precautions, are at highest risk.

What can travelers do to protect themselves?
There is no 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 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 wild animals and bushmeat.
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.
Separate yourself from others and 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 U.S. Department of State.
If you are a U.S. 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 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 become sick during 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 an appropriate medical evacuation.

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 with risk of exposure to Ebola virus.
Practice proper infection control. For more information, see “Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting.”
Discuss options for vaccination with your sponsoring organization. DRC, WHO and other partners are offering an investigational vaccine to priority populations such as frontline HCWs. A major clinical trial conducted in Guinea in 2015 showed the vaccine to be highly protective against Ebola.
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 HCWs and other responders) against Ebola. Study sites are at the NIH in Bethesda, MD, and Emory University in Atlanta, GA.
Upon leaving the outbreak area

Monitor yourself for 21 days for symptoms of Ebola infection (fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes). Contact your sponsoring organization and local health department immediately if you develop any symptoms of possible Ebola infection.
Notify your healthcare facility’s infection control professional of your recent travel and self-monitoring activities (if you will be caring for patients in a U.S. healthcare facility during your 21-day self-monitoring period).
Special Recommendations for Nongovernmental Organizations and Faith-Based Organizations Sponsoring HCWs Supporting the Ebola Response
Nongovernmental Organizations (NGOs) and Faith-Based Organizations (FBOs) are responsible for ensuring the health and safety of sponsored HCWs supporting the Ebola response, including after their return to the United States.

CDC recommends that NGOs and FBOs

Be in contact with the health department(s) in the states where sponsored HCWs will be staying during their recommended 21-day self-monitoring period
Establish mutual points of contact between your organization, state and local health departments, and the returned HCW
Work with health department contacts to agree on a process for medical evaluation of returned HCWs exhibiting signs and symptoms of Ebola virus disease
CDC works with NGOs and FBOs to

Share CDC’s recommendations for returning HCWs
Determine the extent to which U.S.-based personnel are participating in the response
Understand NGO and FBO occupational health policies for sponsored HCWs supporting the response
For more information or additional guidance, NGOs and FBOs should contact CDC at [email protected].

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: August 08, 2018
Page last updated: October 03, 2018
Page last reviewed: October 03, 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)