Public Health Advisory - Ebola (5/19/2026)

Health Advisory Distribution: Clinicians, emergency departments, urgent care providers, infection control officers, Marin County healthcare facilities Issued by: Melanie Thompson, DO, MPH, Deputy Public Health Officer Date: May 19, 2026

Summary

An Ebola disease outbreak is active in Ituri Province, eastern Democratic Republic of the Congo (DRC), with 390 suspected cases and 100 deaths as of May 18, 2026. One Ebola-related death has been reported across the border in Uganda. Preliminary reports suggest the causative virus may be Bundibugyo virus, which is clinically significant because FDA-approved therapeutics and vaccine exist only for the Zaire virus. The risk to Marin County is very low, but clinicians should be alert to patients with compatible illness and relevant travel or exposure history. 2026 FIFA World Cup — Increased International Travel to the Bay Area The FIFA World Cup opens June 11, 2026, with matches hosted at Levi’s Stadium in Santa Clara through the group stage (June 11–27). Significant international travel to and from the Bay Area is expected through July 19. Clinicians should ask about transit countries, not only final destinations, when evaluating febrile illness in international visitors.

Actions Requested of Clinicians

1. Ask patients with acute febrile or infectious illness about recent international travel and potential exposures.
2. Consider Ebola disease in patients with compatible symptoms and travel to an active outbreak area within the prior 21 days.
3. Isolate immediately in a single room with private bathroom; apply standard, contact, and droplet precautions; limit personnel entering the room.
4. Notify Marin County Public Health immediately before collecting or submitting specimens for Ebola testing.
5. Review your facility's infection prevention and control plans.

Report Immediately: Ebola Disease is a Medical and Public Health Emergency Marin County Public Health: 415-473-4163 After hours: 415-479-5305

Background

As of May 18, 2026, Africa CDC has reported 390 suspected cases and 100 deaths in Ituri Province, DRC, concentrated in the Mongwalu and Rwampara health zones. One Ebola-related death has been reported in Uganda in a Congolese patient, raising concern for regional spread. The current outbreak is suspected to be caused by Bundibugyo virus, one of four ebolaviruses that cause disease in humans. The others are Ebola virus (Zaire species), Sudan virus, and Taï Forest virus.

In response, the CDC issued a Title 42 order on May 18 restricting entry to the United States for non-U.S. citizens who have been in the Democratic Republic of Congo, South Sudan, or Uganda within the previous 21 days. The order remains in effect for 30 days. The ban does not restrict U.S. citizens or military personnel, and evidence from past outbreaks shows that travel bans delay rather than prevent the spread of disease.

Critical limitation: FDA-approved therapeutics and vaccines are available only for Ebola virus disease caused by the Zaire species. There are no approved treatments or vaccines for Bundibugyo.

Clinical Guidance

When to consider Ebola disease

Compatible illness plus travel to, residence in, or epidemiologic exposure involving an area with active Ebola transmission within the 21 days before symptom onset. High-risk exposures include:

• Direct contact with a sick person
• Funeral or burial exposure
• Healthcare or laboratory exposure
• Contact with potentially infected animals or body fluids

Note: Most ill returning travelers are more likely to have malaria, influenza, COVID-19, or other travel-associated illnesses. Rule these out first while maintaining appropriate precautions.

Symptoms

Early symptoms are nonspecific:

• Fever or chills, myalgias, malaise, headache, fatigue
• Loss of appetite
• Gastrointestinal symptoms: nausea, vomiting, diarrhea, abdominal pain
• Severe illness: unexplained bleeding, shock, or multi-organ dysfunction
   

Infection control

• Single room with private bathroom
• Standard, contact, and droplet precautions; appropriate PPE based on clinical status
• Limit number of healthcare personnel entering the room
• Notify facility infection control program immediately
   

Testing

• Test for common causes first: malaria, COVID-19, influenza, other travel-associated diagnoses
• Coordinate with Marin County Public Health before collecting or submitting specimens for Ebola testing
• Ebola testing is coordinated through public health authorities and CDPH — not routine lab channels
   

Management

• Supportive care and early recognition are critical
• Notify facility infection control and Marin County Public Health immediately
• Emergency transfers: advance notification to receiving facility and Public Health required
• Treatment decisions should be coordinated with CDPH and CDC given potential Bundibugyo etiology

Resources

CDPH — Ebola Disease
CDPH — For Health Professionals
Africa CDC — Ebola Updates