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Following the World Health Organization (WHO) declaration of an outbreak of Ebola virus disease as a Public Health Emergency of International Concern (PHEIC) on 17 March 2026, the Centers for Disease Control (CDC) issued a Health Advisory on 19 May: Ebola Disease Outbreak in the Democratic Republic of the Congo and Uganda. As a precaution, this Health Advisory summarizes CDC's recommendations for U.S. public health departments, clinical laboratories, and healthcare workers about potential Ebola disease case classification, testing, and biosafety considerations in clinical laboratories. The risk of this Ebola virus disease outbreak to the general public and to DON personnel not directly involved in Ebola outbreak support activities is very low. However, the U.S. (CDC) and Department of Homeland Security (DHS) have implemented targeted travel restrictions. Review of the latest official government and Department of War advisories before travel to affected regions is highly recommended.
Ebola virus disease (EVD) is a rare and deadly illness caused by one of 4 types of orthoebolaviruses that cause viral hemorrhagic fever (VHF) in humans: Ebola virus (EBOV), Sudan virus (SUDV), Bundabugyo virus (BDBV) and Tai Forest virus. Two additional orthoebolaviruses cause infections in other primates, though not in humans: Reston virus and Bombali virus. EBOV is the most common and best known of these viruses, responsible for the large, well-publicized 2014 EVD outbreak in West Africa. Consequently, it is the only one of these viruses with a vaccine, disease specific treatments and readily available tests. A large 2022 SUDV outbreak occurred in Uganda and resulted in temporary travel restrictions in both the U.S. and DoW. BDBV, a much less common virus, is driving the current outbreak and represents only the third identified outbreak of this virus.
EVD spreads through direct contact with infected blood or body fluids, objects contaminated with infected body fluids, or direct contact with infected animals (e.g., apes, monkeys). A person is not contagious and cannot spread the virus until they show symptoms. Once symptoms appear, patients become increasingly infectious as the disease progresses, with levels of virus in body fluids peaking shortly after death. EVD symptoms include fever, muscle pain, weakness, fatigue, diarrhea, vomiting and hemorrhage. Case fatality is high, ranging from 30-90%, depending on the specific virus and availability of care.
Because of the severity of EVD, international outbreak response can evolve rapidly. It is important to remain up to date with notifications provided by DoW and BUMED, as well as CDC, the State Department and the World Health Organization (WHO) to ensure awareness of the most current travel and FHP guidelines.
DON personnel in healthcare roles should be alert to EVD and other viral hemorrhagic fever outbreaks and should be familiar with screening, infection control and appropriate Personal Protective Equipment (PPE).
The risk of EVD to personnel not directly involved in operations in EVD affected areas or EVD outbreak support activities is low.
DoDI 6200.03 Public Health Emergency Management Within the DoD 28Mar2019
OPNAVINST 3500.41B Pandemic and Infectious Disease Policy_12Jul2021
OPNAVINST 6210.2B Quarantine Regulations of the Navy_8Sept2023
BUMEDINST 3500.5B Pandemic and Infectious Disease Policy_13May2026
BUMEDINST 6220.12D Medical Surveillance and Response_14May2025
BUMED 6200.17B Public Health Emergency Officers_18May2023
NTRP 4-02.10 Shipboard Communicable Disease Prevention, Mitigation and Response_Oct2021 (*CAC Required*)
Initial symptoms are non-specific and are known as “dry” symptoms. Those include fever, headache, body aches, weakness, fatigue and sore throat. The differential diagnosis at this stage includes other more common infectious diseases in the region such as malaria, typhoid fever, meningococcal disease, and influenza. After 4-5 days the “wet symptoms” may develop including nausea, vomiting, diarrhea. Diarrhea may be severe, leading to metabolic derangement. Hemorrhage and disseminated intravascular coagulation occurs in roughly 50% of patients, typically late in the course of disease. Death, when it occurs, is typically due to multisystem organ failure on day 7-10 after illness onset.
Care is largely supportive, although two FDA-approved monoclonal antibody products are available for EBOV. Details may be found at:
CDC Clinical Guidance for Ebola Disease
WHO Clinical Management SOP for EVD Supportive Care
Because EVD infections are most likely to occur in individuals traveling from AFRICOM, it is essential to remember that there are other, far more common illnesses that can cause a febrile illness with similar initial presentation, even when returning from an area where an active EVD outbreak is occurring or where EVD is endemic. Malaria (in particular), typhoid fever, meningococcemia, dengue and many other bacterial or viral infections must be considered in the differential. Additionally, patients may present with concurrent infections. Diagnostic testing for malaria and other causes of illness should not be overlooked. CDC and WHO have published guidance for clinical evaluation and diagnostic testing of potential cases:
CDC Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease
CDC Guidance on Performing Routine Diagnostic Testing for Patients with Suspected VHFs or Other High-Consequence Disease
CDC Decision Tree for Clinicians Evaluating an Ill Person for a Special Pathogen
WHO Guidance for testing Ebola and Marburg Viruses-Dec2024
Note: the Biofire Global Fever Special Pathogen Panel includes tests for several Ebolavirus spp, including both EBOV and BDBV.
EVD is a nationally notifiable disease and must also be urgently reported within DoW. In accordance with DODI 6200.03 and BUMEDINST 6220.12D, all persons under investigation for EVD should be reported immediately to the local Public Health Emergency Officer (PHEO), local Preventive Medicine authorities and nearest Navy Environmental and Preventive Medicine Unit (NEPMU).
Cases should also be reported in the Disease Reporting System internet (DRSi) in accordance with case classification details in the Armed Forces Medical Reportable Events Guide. Note that EVD is reported as “Hemorrhagic Fever, Viral”. DCPH-A has also put together a Flowchart for Case Definition. Detailed information on reporting in DRSi can be found on NMCFHPC’s Medical Surveillance and Reporting page. Overseas locations should coordinate with their commands to adhere to host country reporting requirements.
As part of the response activities to the 2026 Bundibugyo virus outbreak, CDC has published interim guidance for public health departments, with recommendations for assessment, education, and monitoring of travelers after they arrive in the U.S.:
CDC Interim Guidance: Public Health Assessment and Management of Travelers Arriving from the Affected Countries during the 2026 Ebola Outbreak
The CDC has also published a sample exposure screening tool to assist in initial patient assessments.
For public health management of travelers with high-risk exposures and those identified as having suspected or confirmed EVD, CDC has published the following guidance:
CDC Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures
The incubation period of Ebola viruses is between 2-21 days, with symptoms appearing on average 8-10 days after exposure. During the incubation period, the infected person is asymptomatic and cannot transmit the virus.
Individuals with high-risk exposures should be quarantined, monitored daily and restricted from commercial transport for the duration of the incubation period (21 days).
The animal reservoir of EVD is believed to be bats. Non-human primates are susceptible to EVD, and human contact with these animals has been identified as the source of several outbreaks. Contact with and consumption of “bush-meat” (raw/uncooked wild animal meat, especially monkey meat) has also been implicated.
Person-to-person transmission of the virus occurs through direct contact with the body fluids of a person who is infected or has died of EVD. Viruses causing EVD can be detected in all body fluids including urine, blood, saliva, sweat, feces, vomitus, semen, vaginal secretions, and breast milk. The virus can also be transmitted indirectly through contact with surfaces and objects contaminated with the body fluids of a person who is infected or has died of EVD.
In survivors, EBOV has been shown to persist in the eye, testes, placenta and central nervous system after recovery. Semen can contain transmissible EBOV for long periods of time after EVD recovery, with documented outbreaks occurring after sexual transmission over a year after infection. Male EVD survivors should be counseled on the risk of continued EBV transmission through sex, and safer sex practices should be followed until either two consecutive monthly tests are negative, or for 12 months in the absence of semen testing.
WHO Guidance on Sexual Transmission of the Ebola Virus
Spontaneous relapses of EVD have also been reported, which can be both fatal and the source of future outbreaks.
Vaccines: There is an EBOV vaccine, but there is no vaccine for Bundibugyo or the other viruses that cause EVD.
Environmental Controls:
Infection Control: CDC has published specific infection control guidance for EVD in Healthcare Facilities: Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers
Environmental cleaning of surfaces for Non-Healthcare/Non-laboratory Settings are provided by OSHA: OSHA Fact Sheet for Cleaning and Decontamination of Ebola on Surfaces
Safe Handling, Treatment, Transport and Disposal of EVD Contaminated Waste
Quarantine: Per OPNAVINST 6210.2B, viral hemorrhagic fevers, such as EVD, may be quarantinable. NTRP 4-02.10 outlines shipboard quarantine and isolation measures that can be instituted to protect staff and maintain mission readiness. Commanders should consult the nearest NEPMU and PHEO when instituting quarantine or isolation measures.
Safe and Dignified Burial: Bodies of EVD victims remain highly infectious, and unsafe funeral practices have been strongly associated with EVD transmission. WHO and the Red Cross have promoted Safe and Dignified Burial (SDB) protocols, which focus on cultural sensitivity and use trained burial teams working alongside religious leaders and community elders to modify rituals in a way that respects the family's beliefs while maintaining biosafety.
WHO Safe and Dignified Burial Protocol
CDC Safe Handling of Human Remains of VHF Patients in U.S. Facilities
Education and awareness: When possible, travelers to outbreak affected areas should consult with a travel medicine clinic prior to travel. Travelers should avoid close physical contact with dead bodies or people who are ill and should seek immediate medical attention at the onset of any EVD-like symptoms during or after travel.
Community education programs in areas routinely at risk for EVD outbreaks should provide regular education about the risk of wildlife-to-human transmission from contact with infected bats or monkeys/apes and the consumption of their raw meat to reduce spillover events from animals to humans. During an EVD outbreak, community education programs should stress the risk of close physical contact with persons who appear ill or are known to have EVD, the need for isolation of patients in treatment centers, and the need for safe burials.
Force Health Protection:
FHP briefs for units deploying to high threat areas can be obtained from the nearest Navy Environmental and Preventive Medicine Unit (NEPMU).
CDC has published Recommendations for Organizations Sending U.S.-based Personnel to Areas with VHF Outbreaks.
CDC Main Ebola Disease Site
WHO Main Ebola Site
National Emerging Special Pathogens Training and Education Center- Ebola
NETEC Health Care Facility Viral Hemorrhagic Fever (VHF) Preparedness Checklist
NETEC PPE Matrix for High-Consequence Infectious Diseases
Cardile AP, Murray CK, Littell CT, et al. Monitoring Exposure to Ebola and Health of U.S. Military Personnel Deployed in Support of Ebola Control Efforts - Liberia, October 25, 2014-February 27, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(25):690-694.
Choi MJ, Cossaboom CM, Whitesell AN, et al. Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2021;70(1):1-12. Published 2021 Jan 8. doi:10.15585/mmwr.rr7001a1
Malenfant JH, Joyce A, Choi MJ, et al. Use of Ebola Vaccine: Expansion of Recommendations of the Advisory Committee on Immunization Practices To Include Two Additional Populations — United States, 2021. MMWR Morb Mortal Wkly Rep 2022;71:290–292. DOI: http://dx.doi.org/10.15585/mmwr.mm7108a2
Sipos ML, Kim PY, Thomas SJ, Adler AB. U.S. Service Member Deployment in Response to the Ebola Crisis: The Psychological Perspective. Mil Med. 2018;183(3-4):e171-e178. doi:10.1093/milmed/usx042
Tsagarliotis I, Rachaniotis NP. Assessing the Role of Military Units in Epidemic Response: A Scoping Review of Key Issues. Mil Med. Published online November 17, 2025. doi:10.1093/milmed/usaf548
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