Guidance on Ebola disease prevention, monitoring and surveillance

Notice to reader

Ebola disease outbreak: Current situation

In May 2026, an outbreak of the Ebola disease caused by Bundibugyo virus was declared in the Democratic Republic of the Congo and Uganda. The Government of Canada has introduced temporary border measures to reduce the risk of Ebola disease entering and spreading in Canada.

Last complete revision: July 2026

This statement was reviewed by CATMAT and minor changes were made to reflect the current (2026) outbreak of Bundibugyo virus disease (BVD) in Equatorial Africa. There are no significant changes to: the methodology used to develop the guidance (narrative review); the evidence considered; or, to the recommendations.

On this page

• Preamble
• Objective
• Key points for the healthcare provider
• Recommendations
• Background
• Methods
• Epidemiology
• Recommendations for preventive measures for travellers
• Recommendations for monitoring and surveillance of travellers arriving from Ebola disease-affected areas based on exposure risk
• Treatment of Ebola disease
• Abbreviations
• Acknowledgements
• Conflict of interest
• Appendix: Assessment table for applicability of good practice statements
• References

Preamble

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada (PHAC) with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. PHAC acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers.

Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use.

Objective

This statement is intended for use during active outbreaks of Ebola Disease (EBOD, generic designation for all illnesses associated with the causative viruses), with a primary focus on areas outside Canada susceptible to or currently suffering an active outbreak. It provides recommendations on preventive measures, monitoring and surveillance for travellers returning to Canada from countries affected by Ebola disease.

It is recognized that the scale and potential impacts of EBOD outbreaks vary, and hence they may or may not evoke legislated or mandated federal, provincial, territorial (FPT) responses related to travel and travellers. The guidance provided herein must not be construed as replacement or an alternative to FPT requirements but rather is intended: to complement these requirements; or, to serve as reasonable practice in the circumstance that FPT guidance is not in place.

Key points for the healthcare provider

• Transmission of orthoebolaviruses, the agents that cause Ebola disease, occurs primarily via direct contact with infected blood, body fluids, or tissues of a symptomatic person, a deceased case, or an infected animal, or with surfaces contaminated with the body fluids of infected persons. Orthoebolaviruses are not transmitted between humans through airborne transmission.
• Transmission from casual interaction with asymptomatic returning travellers from areas suffering outbreaks has not been reported, and is not expected to occur (very low risk).
• CATMAT suggests that, while most of the currently available scientific evidence comes from experience with Ebola virus (EBOV), formerly called Zaire ebolavirus, approaches recommended for travellers to prevent EBOV also apply to other species, such as Sudan virus (SUDV), Bundibugyo virus (BDBV), and Taï Forest virus (TAFV).
• Travellers should verify any requirements (EBOD related or otherwise) in place at their destination(s) and for their return to Canada.

Recommendations

• When possible, travel to EBOD-affected areas (as identified by the WHO Disease Outbreak News webpage) should be postponed.

  (Good practice statement)

When travel to EBOD-affected areas cannot be delayed:

• Travellers should follow local public health guidelines to minimize the risk of exposure to EBOD.

  (Good practice statement)

• Travellers are advised to practice frequent hand hygiene while abroad, either with soap and water, or with an alcohol-based hand rub.

  (Good practice statement)

• Travellers are advised to avoid close contact with live or dead animals, avoid handling raw or undercooked meat and avoid consuming wild game.

  (Good practice statement)

• Condoms should be used during sexual activity with any new partners while abroad, for the prevention of common sexually transmissible infections, as well as EBOD.

  (Good practice statement)

• Healthcare providers counseling outbound travellers should discuss all standard precautions to prevent febrile illness, including the use of malaria chemoprophylaxis, the assiduous use of insect repellent, and pre-travel vaccination. These measures will help reduce the risk of non-EBOD febrile illnesses, thereby facilitating exit and entry screening procedures that travellers may be subjected to.

  (Good practice statement)

• All travellers should be cautious of exposure to ill individuals. Individuals travelling for the purpose of visiting friends and relatives should exercise additional caution, particularly of exposure to ill individuals in a household setting.

  (Good practice statement)

• Individuals travelling for the purpose of visiting friends and relatives, who may attend or participate in funeral rituals, should be aware of and adhere to burial practices that reduce EBOD transmission.

  (Good practice statement)

• Healthcare providers should prioritize screening for malaria in symptomatic returned travellers with travel history to EBOD-affected areas.

  (Good practice statement)

Background

EBOD is a severe, potentially fatal illness caused by RNA viruses of the genus Orthoebolavirus^{Footnote 1}. There are four species of Orthoebolavirus known to cause human disease (Table 1).

Table 1. Species of Orthoebolavirus known to cause human disease

Virus name (Species name, abbreviation)	Disease name
Ebola virus (Orthoebolavirus zairense, EBOV), formerly known as Zaire ebolavirus	Ebola virus disease (EVD)
Sudan virus (Orthoebolavirus sudanense, SUDV)	Sudan virus disease (SVD)
Bundibugyo virus (Orthoebolavirus bundibugyoense, BDBV)	Bundibugyo virus disease (BVD)
Taï Forest virus (Orthoebolavirus taiense, TAFV)	Taï Forest virus disease (TVD)

Species identification is important because treatments and vaccines developed against one species may not have similar effectiveness against others.

EBOV and SUDV have been most commonly implicated in outbreaks, however a large outbreak of BVD occurred in Equatorial Africa in 2026^{Footnote 2Footnote 3}.

Orthoebolaviruses are most frequently^{Footnote 4} transmitted to humans through contact with the infected blood, body fluids, and/or tissues of a person with symptomatic disease or a deceased case^{Footnote 5Footnote 6}. They can also be transmitted through:

• contact with infected animal reservoirs
• physical contact with surfaces and fomites (for example, needles, medical equipment, clothes, bedding) contaminated with infected fluids
• vertical transmission (during pregnancy or delivery)
• sexual transmission during the acute phase or, particularly for males with EBOD, during the convalescent period^{Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11Footnote 12}.

Definition of EBOD-affected areas

During an EBOD outbreak, the WHO considers areas to be affected in regions where there has been a confirmed locally acquired case of EBOD or where an individual with an infectious case of EBOD has resided. Up-to-date information on affected areas can be found through the WHO Disease Outbreak News webpage.

Methods

This statement was developed by the Committee to Advise on Tropical Medicine and Travel (CATMAT) Ebola working group (WG), a sub-group of members of CATMAT, supported by the CATMAT Secretariat.

In their review and update of this guidance, the WG determined that evaluating the pre-existing recommendations and developing new recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidance on the development and use of good practice statements (GPS) was appropriate^{Footnote 13Footnote 14}.

The recommendations were assessed against five key criteria to determine the applicability of developing GPS:

• the statement should be clear and actionable;
• the message should be necessary for actual healthcare practice;
• after considering all relevant outcomes and potential downstream consequences, implementing the GPS would result in large net positive consequences;
• collection and summary of the evidence would be a poor use of a guideline panel’s time and resources;
• a well-documented, clear and explicit rationale connecting the indirect evidence.

The final statement and recommendations were approved by CATMAT.

Epidemiology

Sustained chains of transmission of the viruses causing EBOD are typically restricted to areas of sub-Saharan Africa, with foci of epidemic disease occurring in parts of Central Africa, West Africa and East Africa^{Footnote 2}. Historically, outbreaks of EBOD have primarily been reported from the Democratic Republic of the Congo (DRC; predominantly in the Provinces of Ituri, North Kivu, and South Kivu), Guinea, Liberia, Sierra Leone, and Uganda^{Footnote 2}.

During the large-scale 2014-16 EVD outbreak affecting Sierra Leone, Liberia, and Guinea^{Footnote 15}, exportation of cases elsewhere in Africa and very few to overseas jurisdictions including to Europe and North America occurred with limited secondary transmissions^{Footnote 16Footnote 17}. No cases of EVD were imported to Canada during this outbreak^{Footnote 15}.

Given the prolonged incubation period of EBOD (that is, up to 21 days) and relative ease of international travel, EBOD manifesting once an exposed and infected traveller returns home is not unexpected^{Footnote 18}. However, recovered EBOD patients also sometimes have prolonged carriage of infectious EBOV in immune sanctuary sites (such as, testes, eyes), with reports of EBOV transmission through sexual activities or other close contact months to years after an epidemic has been declared over^{Footnote 10}.

Nevertheless, experience indicates that the risk of EBOD transmission outside of an outbreak area, by an individual traveller who returns home without symptoms, is very low.

More recent outbreaks have had significantly altered epidemiology due to the availability of EVD vaccines for healthcare workers and close contacts of EVD-infected patients. During the 2014-2016 rVSVΔG-ZEBOV-GP vaccine (Ervebo^®) trials, immediate vaccination of close contacts had a 100% effectiveness at preventing EVD and is therefore expected to improve EVD outbreak response in the future^{Footnote 19}. This vaccine is not indicated for use against other orthoebolaviruses, such as SUDV or BDBV, or related filoviruses, such as Marburg virus. Furthermore, at the time of this writing, the effectiveness of currently available vaccines against orthoebolaviruses other than EBOV is thought to be low.

Transmission

Transmission of EBOD occurs via handling, preparing or ingesting infected animals (for example, bats, wild game), or via contact with the blood, body fluids (for example, stool, vomitus, saliva, semen), or tissue of infected human cases during their symptomatic illness or soon after death, directly or via objects contaminated with such fluids^{Footnote 5Footnote 6Footnote 7Footnote 9Footnote 11}.

Those at particular risk for acquisition of EBOD include healthcare workers^{Footnote 20} and family members tending to ill relatives, as well as those involved with the burial process, including preparing the deceased for burial^{Footnote 6}.

Generally, EBOD has an incubation period of between 2 and 21 days, with most cases manifesting clinical disease within 6 to 10 days following exposure^{Footnote 21}. Risk of transmission is highest when viral load is greatest in infected individuals, such as patients who are acutely unwell with fever, vomiting, and diarrhea, or soon after their death^{Footnote 22}. Current evidence suggests that transmission does not occur prior to the onset of symptoms in the acute phase of the illness^{Footnote 5}.

Following recovery and release from isolation, the risk of sexual transmission can remain a concern for EBOD survivors^{Footnote 9Footnote 11} due to asymptomatic persistence of orthoebolaviruses in semen^{Footnote 23}. For example, viable Ebola virus (Orthoebolavirus zairense) has been shown to persist for several months and perhaps less commonly, for years in body organs that are protected from the survivor's immune system, such as the testes, eyes and central nervous system (CNS)^{Footnote 10}.

Vertical transmission of EBOD has been well documented, and nearly all cases of congenital EBOV transmission during the 2014-2016 EVD outbreak in Sierra Leone, Liberia and Guinea resulted in the death of the fetus^{Footnote 8Footnote 24}. Pregnant women and pregnant people with EBOD may also experience severe clinical outcomes, including death, more frequently than those who are not pregnant^{Footnote 25}.

Specific guidance from the WHO is available on the prevention of congenital and post-partum transmission of EBOD to infants. While comprehensive review of the topic is outside the scope of this document, specific recommendations include the discontinuation of breastfeeding for mothers with acute EBOD and immunization of exposed mothers^{Footnote 26}.

The likelihood of exposure to EBOD is generally very low for travellers. The routes for potential transmission are the same as for residents living in areas of risk. Certain groups, such as healthcare workers providing direct care to patients, especially if delivering care in an area suffering an outbreak, or travellers visiting friends and relatives, are at substantially increased likelihood for exposure^{Footnote 6}.

Clinical manifestations

EBOD is characterized by an abrupt onset viral syndrome consisting of fever, malaise, myalgia, pharyngitis, severe headache, and conjunctival injection^{Footnote 5}. Gastrointestinal symptoms frequently appear a few days later, with vomiting and large-volume diarrhea that can be bloody. These symptoms may be accompanied by a maculopapular or petechial rash that can progress to purpura^{Footnote 27}. Given the non-specific nature of early disease (viral prodrome), a high index of suspicion based on epidemiology is required.

In up to half of patients, some bleeding may occur from mucosa (gums, nose), from the gastrointestinal or urogenital tract, or at venipuncture sites^{Footnote 28}. As the disease progresses, dehydration leading to electrolyte abnormalities may become severe, followed by wasting and listlessness.

Severe EBOD cases with hemorrhagic symptoms usually have concurrent and significant multi-system and end-organ damage such as acute kidney injury, CNS dysfunction, bone marrow suppression (with leukopenia and thrombocytopenia), and liver failure^{Footnote 27Footnote 29}. The course of the disease can be further complicated by secondary bacterial infections. Historically, EBOD outbreaks have always occurred in malaria-endemic countries, indicating that malaria co-infection can occur and warrants screening^{Footnote 30Footnote 31}.

The average EBOD case-fatality rate is high even with optimal intensive care, and if death occurs, it is usually 7 to 10 days after symptom onset^{Footnote 5Footnote 29}. Survivors have a prolonged recovery phase and can experience a range of complications after recovery. Sequelae include: non-specific fatigue, joint pain, muscle aches, uveitis, and others^{Footnote 32}.

Monitoring of recovered cases is warranted since recurrence/relapse of EBOD can occur, although rare, and the latency period is not well established^{Footnote 33}. Follow-up testing can also be necessary to determine at what moment the body fluids (breast milk, semen) are no longer infectious^{Footnote 34Footnote 35}. Duration and frequency of follow-up testing for viral shedding after acute EBOD is not well established.

Recommendations for preventive measures for travellers

GPS 1. When possible, travel to EBOD-affected areas, as identified by the WHO Disease Outbreak News webpage, should be postponed.

During an EBOD outbreak, travellers to an affected area may experience major disruptions to their travel plans, including movement restrictions, and entry and exit requirements including quarantine; lack of access to timely and adequate medical care for both EBOD and other health issues, if needed; and limited ability to return home quickly.

Depending on their reason for travel and planned activities, a traveller may also be at an increased risk of acquiring EBOD. A systematic review found recent travel to an area with known cases of EBOD significantly increased the odds of contracting the disease by up to 40% in some cases, based on data collected during the 2007-2008 BVD outbreak in Uganda^{Footnote 6}.

Should a traveller develop symptomatic disease, there is no assurance of medical evacuation to a Western health care centre, or of access to all supportive interventions and treatments that might be available for disease management in Canada. Finally, as stated previously, case-fatality rates for individuals with EBOD are high, even with optimal intensive care practices.

Postponing travel helps protect the traveller, reduces the risk of disease transmission, and supports outbreak management efforts in the affected area.

General travel advice applicable to all travellers to EBOD-affected areas when travel cannot be delayed

Travellers should verify any requirements (EBOD related or otherwise) in place at their destination(s) and for their return to Canada.

GPS 2. Travellers should follow local public health guidelines to minimize the risk of exposure to EBOD.

Travellers in or planning a visit to an affected area should be made aware that they could become subject to local public health requirements (e.g. if they come into contact with a known or suspected case). Following mandated public health measures is effective in minimizing exposure and reducing the transmission of EBOD.

GPS 3. Travellers are advised to practice frequent hand hygiene while abroad, either with soap and water, or with an alcohol-based hand rub. This helps prevent potentially severe infections like EBOD.

Soap is used for handwashing worldwide and is generally available, familiar, and acceptable in communities that have experienced Ebola^{Footnote 36} Methods of handwashing, including with soap and water, or with an alcohol-based hand rub, are both safe and effective to prevent EBOD transmission^{Footnote 36Footnote 37}.

GPS 4. Travellers are advised to avoid close contact with live or dead animals, avoid handling raw or undercooked meat and avoid consuming wild game.

EBOD is a zoonotic disease transmitted to humans primarily via handling, preparing or ingesting infected animals (for example, bats, wild game)^{Footnote 6Footnote 7}. Travellers visiting EBOD-affected areas should avoid close contact with animals (alive, sick or dead), including handling raw or undercooked meat, and consuming wild game as any of these could result in exposure to EBOD. If this high-risk activity cannot be avoided, travellers should be made aware of the proper precautions to take. Refer to Ebola disease: Prevention and risks.

GPS 5. Condoms should be used during sexual activity with any new partners while abroad, for the prevention of common sexually transmissible infections, as well as EBOD.

Evidence of prolonged carriage of EBOV in semen, months to years after the acute infection, raises the possibility of travellers sexually acquiring the virus from an EBOD-recovered male^{Footnote 23Footnote 38}. While not precisely known, this risk is likely considerably smaller than the risk of acquiring other sexually transmissible infections and likely mitigated through similar means such as the consistent use of barrier methods, such as condoms.

GPS 6. Healthcare providers counseling outbound travellers should discuss all standard precautions to prevent febrile illness, including the use of malaria chemoprophylaxis, the assiduous use of insect repellent, and pre-travel vaccination. These measures will help reduce the risk of non-EBOD febrile illnesses, thereby facilitating exit and entry screening procedures that travellers may be subjected to.

Among returned travellers^{Footnote 39Footnote 40}, common complaints include febrile illness with malaria, dengue, and influenza-like illness as common causes of fever, depending on the region of travel.

Outbreaks of EBOD have primarily been reported from the Democratic Republic of the Congo, Guinea, Liberia, Sierra Leone, and Uganda^{Footnote 2Footnote 30Footnote 31}; all are malaria-endemic countries.

In those who cannot avoid travelling to areas where ebolaviruses may be circulating, standard travel-related infection prevention recommendations will have even more potential benefit than usual in preventing non-EBOD febrile illness and potentially minimizing the exit and entry requirements for travellers.

Travellers to EBOD-affected areas visiting friends and relatives

People travelling to an EBOD-affected area for the purpose of visiting friends and relatives should exercise a degree of caution beyond that of typical tourist travellers, given that they often stay in local homes for a more prolonged period of time, and engage in high risk activities (e.g. consuming wild game, participating in burial rituals) which can present a risk for EBOD transmission^{Footnote 27}.

In addition to the general preventive measures listed above;

GPS 7. All travellers should be cautious of exposure to ill individuals. Individuals travelling for the purpose of visiting friends and relatives should exercise additional caution, particularly of exposure to ill individuals in a household setting.

Travellers visiting friends and relatives are more likely to be exposed to ill locals and should be cautious and made aware of the risks of potential exposure to EBOD in a household setting, where any febrile illness may be present. Travellers should avoid direct contact with ill individuals and their bodily fluids, as well as avoid contact with any surfaces, including toilets, linens, clothing, and toiletries to prevent the spread of EBOD^{Footnote 6Footnote 22}. In the event this cannot be avoided, travellers should be made aware of the recommended precautions to take. Refer to Ebola disease: Prevention and risks.

Extensive recommendations for provision of care to a family member in EBOD-affected areas are available from the WHO^{Footnote 41}. However, in an EBOD-affected area, fever and/or severe clinical illness in a local household where the traveller may be exposed should be brought to the attention of local health authorities, whose recommendations should be followed. In such a scenario, transfer to a healthcare facility for evaluation and care should occur promptly.

GPS 8. Individuals travelling for the purpose of visiting friends and relatives, who may attend or participate in funeral rituals, should be aware of and adhere to burial practices that reduce EBOD transmission.

Intimate practices associated with preparing a body for funeral and burial, such as ritual handwashing, washing and dressing a body, and direct contact with a corpse, its bodily fluids or soiled items significantly increase the risk of EBOD transmission^{Footnote 6}. Travellers who may attend or participate in funeral rituals should be aware of and adhere to burial practices that reduce EBOD transmission, as outlined by the WHO^{Footnote 42}.

Guidance on preventive measures for healthcare workers who are providing care to patients with suspected or confirmed EBOD is available elsewhere^{Footnote 20Footnote 43}, and is not otherwise addressed in this guideline.

Vaccines against EBOV

rVSVΔG-ZEBOV-GP Ebola vaccine (Ervebo^®, Merck)

The Ebola virus vaccine (Orthoebolavirus zairense), Ervebo^®, is authorized for use in Canada, however, it is not currently available or recommended for Canadians as part of routine immunizations or vaccinations prior to travel.

At the time of this writing, Ervebo^® vaccine is not approved or recommended to prevent disease caused by other orthoebolaviruses, including BDBV, SUDV, and TAFV. Due to significant antigenic differences, Ervebo^® vaccine is not expected to provide significant protection against other orthoebolaviruses.

Ervebo^® was used to vaccinate humanitarian workers and contacts in an outbreak of EVD in the DRC^{Footnote 44}. Effectiveness of immediate vaccination of close contacts against EVD occurring 10 days after vaccination approached 100%^{Footnote 19}. Vaccine efficacy is difficult to evaluate with certainty. As such, vaccinated individuals must undergo the same monitoring and surveillance measures as those who have not been vaccinated when returning from affected areas.

For more information on the Ervebo^® vaccine, refer to Ebola virus vaccine under Part 4: Immunizing agents of the Canadian Immunization Guide.

Returning travellers from EBOD-affected areas

The risk of exportation and further transmission of EBOD outside affected areas may theoretically be mitigated through the implementation of exit screening measures. Such measures are usually put into place to identify symptomatic persons and/or those who may have had a high risk of exposure to an EBOD case. They can be implemented within an affected country (for example, between areas of active transmission and areas where no transmission has been documented) as well as at international points of entry/exit (for example, air and water ports, land border crossings, etc.)^{Footnote 45}.

In response to EBOD outbreaks, the Government of Canada may introduce temporary border measures to reduce the risk of Ebola disease entering and spreading within Canada. Returning travellers are encouraged to consult the Public Health Agency of Canada webpage on Ebola disease: Health advice for travelling abroad to verify regulatory requirements under the Quarantine Act prior to their return to Canada.

GPS 9. Healthcare providers should prioritize screening for malaria in symptomatic returned travellers with travel history to EBOD-affected areas.

Some entry and exit screening measures, such as temperature checks, may be implemented in some countries^{Footnote 46}, however pre-symptomatic or sub-clinical cases will generally not be identified, and fever is a non-specific sign that can be seen in numerous non-EBOD travel-related illnesses, particularly malaria^{Footnote 47}.

Data from the global GeoSentinel Surveillance Network indicate that among returned travellers and new immigrants from Sierra Leone, Liberia, or Guinea during the period inclusive of the 2014 EVD outbreak in West Africa, the most common diagnosis was malaria^{Footnote 48}.

Malaria remains a common diagnosis among travellers from Africa. Data collected by the Canadian Travel Medicine Network (CanTravNet) and the Canadian Malaria Network (CMN) from 2014 to 2023 indicate the vast majority of malaria cases in returned travellers to Canada are acquired in Africa. This is consistent with global trends in malaria, with 94% of all cases globally in 2024 estimated to have occurred in the WHO African Region^{Footnote 49}. Among cases with known exposure data in both CanTravNet and the CMN, countries that have experienced outbreaks of EBOD are included among the top African countries accounting for over 50% of malaria cases: Nigeria, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo, Uganda, Guinea, Ghana and the United Republic of Tanzania.

Timely screening of returned travellers for malaria and other commonly encountered infectious diseases associated with fever and other non-specific symptoms, and empiric malaria treatment if screening is delayed, are critical to limiting morbidity and mortality.

Definitions of exposure risk to travellers

Any of the following are considered as having no known exposure of concern:

• they are not a household contact, a sexual contact or have not had any known direct contact with a symptomatic EBOD case or their body fluids, their dead body or materials or surfaces contaminated with their body or body fluids within the previous 21 days
• they are only a contact of a contact, for example, even if they have interacted with an asymptomatic person who has been providing care or living in the same household as an EBOD case
• they have not travelled in the previous 21 days to an EBOD-affected area even if they have travelled to a country reporting EBOD cases
• any possible exposure occurred over 21 days prior to arrival in Canada

Any of the following are considered as a low risk of exposure:

• direct contact with the following, while adhering to recommended Infection prevention and control (IPC) measures for Ebola disease in acute care settings and no known breach in IPC precautions:
  • a symptomatic EBOD case, their body fluids, their corpse, or any other known source of orthoebolaviruses (for example, an infected animal or positive laboratory specimen)
  • objects or surfaces that may be contaminated with orthoebolaviruses from the body fluids of a patient, including bedding, clothing, and/or medical instruments
• had only casual interactions, and no direct contact, with an EBOD case or their body fluids (examples of casual interactions include sharing a seating area on public transportation or sitting in the same waiting room)
• stayed in a community where there is active transmission of EBOD, but does not meet any of the criteria for a high-risk exposure

Any of the following are considered as a high risk of exposure^{Footnote 6Footnote 32} :

• direct contact with the following without adhering to recommended IPC precautions, or due to a breach in IPC precautions:
  • a symptomatic EBOD case, their body fluids, their corpse, or any other known source of orthoebolaviruses (for example, an infected animal or positive laboratory specimen)
  • objects or surfaces that may be contaminated with orthoebolaviruses from the body fluids of a patient, including bedding, clothing, and/or medical instruments
• any household or sexual contact with a case
• unprotected sexual contact with a person recovering from EBOD, since the virus can persist for months in the semen of infected males^{Footnote 34}
  • while possible, female to male transmission through vaginal secretions of recovered females has not been described^{Footnote 32}

Healthcare and humanitarian aid workers are considered differently in terms of assessment of their exposure risk from other travellers due to the nature of their potential risk of exposure. Some healthcare and humanitarian workers may elect to have a 21-day pre-travel quarantine to decrease their risk of travelling while ill, however, if they plan to arrive in Canada within 21 days of working in an affected area, healthcare and humanitarian aid workers should:

• consult the Public Health Agency of Canada webpage on Ebola disease: Health advice for travelling abroad to verify regulatory requirements under the Quarantine Act that may be in place prior to returning to Canada.   

In the absence of regulatory requirements:

• self-identify to the appropriate public health authority following their arrival, even if they have no known exposures or only a low risk of exposure
• self-identify immediately to a Canadian Border Services Agent or Quarantine Officer at the airport, if they have a high risk of exposure or have EBOD-compatible symptoms

It should be noted that travellers who are symptomatic or who have a high risk of exposure are unlikely to present at a point of entry into Canada as EBOD-affected areas usually implement exit screening. However, in the early stages of an outbreak, there is a possibility that travellers could exit an EBOD-affected area via public conveyance, either due to inadequate exit screening or due to the unknown/unrecognized nature of an exposure.

Recommendations for monitoring and surveillance of travellers arriving from Ebola disease-affected areas based on exposure risk

Specific recommendations for monitoring and surveillance, including quarantine or isolation, of returning travellers may be established by the Quarantine Act  and/or by provincial and territorial public health authorities. The recommendations herein are intended as guidance for healthcare professionals and individuals and not intended to replace specific requirements set by the Quarantine Act or provincial or territorial public health authorities.

These recommendations apply only to individuals returning from, defined as specific sub-national regions where cases are documented.

Travellers returning from countries where EBOD cases have been reported, but without travel to the affected area(s) of the country (whether symptomatic or not), should be evaluated as returning travellers with no exposure to EBOD.

1. Travellers from an EBOD-affected area with no known exposure of concern

• We suggest that returning travellers with no symptoms should be encouraged to check the Public Health Agency of Canada's website Ebola disease: Symptoms and treatment for information on what to do if they develop symptoms in the 21 days following their departure from the affected area.
• It is recommended that these travellers follow the Group 1 recommendations regarding monitoring and surveillance provided in Table 2.

Physicians seeing travellers with symptoms and with no known exposure should contact their appropriate public health authority for further guidance.

2. Travellers from an EBOD-affected area with low risk of exposure and without symptoms

Upon arrival in Canada, it is recommended that these travellers:

• self-identify to the appropriate public health authority during the first business day following arrival in Canada for counselling regarding processes and procedures in the event that EBOD-compatible symptoms develop over the potential incubation period
• follow the Group 2 recommendations regarding monitoring and surveillance provided in Table 2 for the remaining balance of the 21-day period following the last potential exposure to EBOD

3. Travellers from an EBOD-affected area with high risk of exposure and without symptoms

In the event that a traveller learns of their high risk of exposure while in transit to Canada, it is recommended that these travellers:

• self-identify to a Canadian Border Services Agent who will contact a Quarantine Officer who will perform an individual risk assessment and determine what actions will be required to support the traveller and protect those around them
• follow the Group 3 recommendations regarding monitoring and surveillance provided in Table 2 for the remaining balance of the 21-day period following the last potential exposure to EBOD

In the event that a traveller learns of their high risk of exposure, after entering Canada, it is recommended that these travellers:

• self-identify to the appropriate public health authority who will perform an individual risk assessment and determine what actions will be required to support the traveller and protect those around them.
• follow the Group 3 recommendations regarding monitoring and surveillance provided in Table 2 for the remaining balance of the 21-day period following the last potential exposure to EBOD

Humanitarian aid workers should follow the guidance provided by their organization in addition to the guidance provided in this document.

4. Travellers from an EBOD-affected area who have developed EBOD-compatible symptoms

If a traveller from an EBOD-affected area is found to have EBOD-compatible symptoms upon arrival at a point of entry in Canada, the traveller should:

• self-identify to a Canadian Border Services Agent who will contact a Quarantine Officer. As per the Quarantine Act the Quarantine Officer will immediately conduct a health assessment and make any necessary arrangements (including issuing any necessary orders) for medical and/or appropriate public health authority follow-up^{Footnote 50}
• follow the Group 4 recommendations regarding monitoring and surveillance provided in Table 2 for the remaining balance of the 21-day period following the last potential exposure to EBOD

If a traveller from an EBOD-affected area develops EBOD-compatible symptoms after entering Canada, during the 21-day period following the last potential exposure to EBOD, the traveller should:

• immediately self-isolate (stay home until they seek health care and maintain a 2-metre distance and no physical contact with people or pets/animals)
• wash hands, especially after bleeding, vomiting or toileting
• ensure that others do not come into contact with their blood or body fluids (including urine, feces, emesis, saliva, sweat, and semen) or anything that may have come in contact with their blood or body fluid (for example, linens, clothing, toilet, toiletries). Refer to Measures for the management of Ebola virus disease-associated waste and linen in Home settings for management of EBOD-associated waste
• if seen by a health care practitioner, be triaged for screening and assessment in accordance with Infection prevention and control measures for Ebola disease in acute care settings
• follow instructions provided by the appropriate public health authority

If the traveller's symptoms require immediate medical intervention, the appropriate public health authority should be notified to ensure that all paramedic, emergency medical services and health care providers the patient may interact with are prepared to take appropriate IPC precautions. The public health authority will aid with:

• arranging for the individual to have a medical assessment at an acute care facility (where appropriate IPC measures can be implemented, if located in close proximity to the individual), to confirm or rule out EVD, SVD or other EBOD
• recommending appropriate transport to hospital. Usually this is via ambulance unless the public health authority permits travel to the medical facility by private vehicle. Individuals under investigation for EBOD should not take public conveyances (that is, do not take a bus, train, taxi, rideshare) to the hospital or healthcare facility
• ensuring the paramedic or emergency medical services (if involved) and the receiving acute care facility are informed of the status of the traveller with EBOD-compatible symptoms in advance to help ensure that appropriate IPC measures are in place during transport and before their arrival at the acute care facility

Table 2: Monitoring and surveillance of travellers arriving from EBOD-affected areas^{Footnote a}

	Group 1: Travellers with no known exposureFootnote b without symptoms	Group 2: Travellers with low risk of exposureFootnote c without symptoms	Group 3: Travellers with high risk of exposureFootnote d without symptoms	Group 4: Travellers with EBOD compatible symptomsFootnote e
Proposed actions
Action upon arrival in Canada	Travellers should check the Public Health Agency of Canada's website Ebola disease: Symptoms and treatment for information on what to do if they develop symptoms in the 21 days following their return to Canada.	Travellers should self-identify to appropriate public health authority the first business day following their arrival in Canada for counselling regarding processes and procedures in the event that EBOD-compatible symptoms develop over the potential incubation period.	Travellers should self-identify to a Canadian Border Services Agent who will contact a Quarantine Officer. The Quarantine Officer will conduct an immediate risk assessment and determine what actions will be required.	Travellers should self-identify to a Canadian Border Services Agent who will contact a Quarantine Officer. Quarantine Officer will conduct an immediate health assessment and make any necessary arrangements for medical and/or public health follow-up.
Operational guidance (for the balance of the 21-day period since the last possible exposure)
Onward domestic travel permitted?	Yes	Yes	To be determined by Quarantine Officer or Medical Officer assessment.	No
Monitoring	No	Travellers should immediately start self-monitoring for symptoms of EBODFootnote f	Public health authority determines plan for monitoring for symptoms of EBODFootnote f	Yes (in hospital and then according to exposure risk if EBOD is ruled out at time of assessment)
Contingency planning	Not applicable	Travellers should: prepare to immediately self -isolate and contact the relevant appropriate public health authority should EBOD-compatible symptoms developFootnote g report any travel intentions to public health authority to acquire contact information for the destination's public health authority	Travellers should: prepare to immediately self-isolate and contact the appropriate public health authority should EBOD-compatible symptoms developFootnote g develop a plan to readily access healthcare if it becomes necessary, including remaining near appropriate acute care facility (within one hour's drive, if possible)Footnote h report any travel intentions to the public health authority to acquire contact information for the destination's public health authority	Not applicable
Attendance at Work	Yes	Yes (following assessment by the public health authority)Footnote i	NoFootnote j	No (until EBOD ruled out)Footnote j
Going out in public places	Yes	Yes (following assessment by the public health authority)Footnote i	NoFootnote j	No (until EBOD ruled out)Footnote j
Use of public conveyances	Yes	Yes (following assessment by the public health authority)Footnote i	NoFootnote j	No (until EBOD ruled out)Footnote j
Other precautions	Not applicable	Travellers should: try to avoid medications that are known to lower feverFootnote k, if these must be taken, advise public health authority advise all healthcare providers that they encounter, including paramedic services, of their potential exposure to EBOD postpone elective medical visits and other elective procedures (for example, elective dental visits, elective blood tests) not donate blood or any other body fluid or tissues maintain good respiratory and hand hygiene practicesFootnote l	Travellers should: try to avoid medications that are known to lower a feverFootnote k, if these must be taken, advise public health authority advise all healthcare providers that they encounter, including paramedic services, of their potential exposure to EBOD postpone elective medical visits and other elective procedures (for example, elective dental visits, elective blood tests) not donate blood or any other body fluid or tissues abstain from sexual contact or observe safe sex practices for 21 days further limit contact with others (for example, quarantine) if appropriate based on the individual's risk assessment as per public health authority assessment maintain good respiratory and hand hygiene practicesFootnote l Staying at home with family could be considered; visiting family elsewhere should not be permitted. Humanitarian aid workers should: follow guidance provided by their organization	Not applicable
Explanations: Footnote a EBOD-affected areas include specific sub-national regions where active cases are reported and recognized as outbreak areas. Travelling to an affected country without travel to affected subnational regions should generally not require monitoring or surveillance. Return to footnote a referrer Footnote b Have not had direct contact with a symptomatic EBOD case or their body fluids; or may have interacted with an asymptomatic person who has been providing care or living in the same household as an EBOD case. Return to footnote b referrer Footnote c Direct contact with a symptomatic EBOD case, their body fluids, their corpse, or any other known source of orthoebolavirus while adhering to recommended IPC precautions and no known breach in IPC precautions; or living in the same household but did not have direct contact with a symptomatic case or their body fluids (for example, through contaminated surfaces); or having only casual interactions and no direct contact with an EBOD case or their body fluids. Examples of casual interactions include sharing a seating area on public transportation or sitting in the same waiting room. Return to footnote c referrer Footnote d Direct contact with a symptomatic EBOD case, their body fluids, their corpse, or any other known source of orthoebolavirus without adhering to recommended IPC precautions; or due to a breach in IPC precautions; or unprotected sexual contact with an acute or convalescent EBOD case. Return to footnote d referrer Footnote e EBOD symptoms at point of entry. Return to footnote e referrer Footnote f Monitoring includes checking and documenting oral temperature twice daily. Refer to the Temperature Recording Form for Contacts of Ebola Disease (PDF). Return to footnote f referrer Footnote g Self-isolating includes maintaining a 2-meter distance and no physical contact with others. Return to footnote g referrer Footnote h The public health authority will indicate whether an appropriate acute care facility has been identified in the area for this purpose, where appropriate infection prevention and control measures can be implemented. Return to footnote h referrer Footnote i In general, essential activities can be maintained (for example, work, grocery shopping), but unnecessary direct contact beyond household members should be avoided. Return to footnote i referrer Footnote j Assessments could be made by the public health authority on a case-by-case basis. For example, a jog or a bike ride in a non-urban setting could be considered. Attending a community or religious gathering should be avoided. The operating principle is that the appropriate public health authority must be able to satisfy itself, and the general public, that the objectives of quarantine or isolation are being achieved on a sustained basis throughout the 21-day period. Return to footnote j referrer Footnote k Medications that are known to lower fever (for example, acetaminophen, ibuprofen, acetylsalicylic acid) should be avoided as these medications could mask an early symptom of EBOD; if these must be taken, advise public health authority. Return to footnote k referrer Footnote l Refer to hand washing and staying healthy for more information. Return to footnote l referrer

Treatment of Ebola disease

The treatment of EBOD remains aggressive supportive care, often in the intensive care setting with availability of appropriate personal protective equipment and isolation facilities.

In addition, two monoclonal antibody treatments have been shown to be effective in reducing mortality in EBOV-infected patients with lower viral loads during the 2018 North Kivu outbreak^{Footnote 5}. Atoltivimab, maftivimab, and odesivimab (REGN-EB3, sold as Inmazeb), and ansuvimab (mAb114, sold as Ebanga) are monoclonal antibody treatments which have been shown to be moderately effective at reducing mortality in EVD patients with lower serum viral loads (defined as a cycle threshold of >22.0 on RT-PCR)^{Footnote 51}. At the time of this writing, neither of these therapeutics are licensed for use in Canada. As these monoclonal antibody treatments have been formulated against EBOV, they are not expected to be effective for the treatment of other orthoebolaviruses.

In May 2026, the WHO convened the Strategic Advisory Group of Experts on Immunization (SAGE), its Ebola vaccine working group, and WHO R&D Blueprint technical advisory groups to advise on candidate vaccines and therapeutics for BVD. At the time of this writing, there are no licensed therapeutics or vaccines specifically approved for the prevention and treatment of BVD.

The Association of Medical Microbiology and Infectious Diseases of Canada (AMMI Canada) along with the Canadian Critical Care Society and Canadian Association of Emergency Physicians have published guidelines pertaining to the care of patients with suspected and confirmed EBOD^{Footnote 52Footnote 53}. In addition, supportive treatment guidelines are available from the WHO^{Footnote 54}. Treatment of patients with confirmed EBOD in Canada will occur at a designated treatment centre, as directed by federal and provincial protocols.

Abbreviations

ACS

Advisory Committee Statement

AMMI Canada

Association of Medical Microbiology and Infectious Diseases of Canada

BVD

Bundibugyo virus disease

BDBV

Bundibugyo virus

CATMAT

Committee to Advise on Tropical Medicine and Travel

CanTravNet

Canadian Travel Medicine Network

CMN

Canadian Malaria Network

CNS

Central nervous system

DRC

Democratic Republic of the Congo

EBOD

Ebola disease

EBOV

Ebola virus

EVD

Ebola virus disease

FPT

Federal, provincial and territorial

GRADE

Grading of Recommendations, Assessment, Development, and Evaluation

GPS

Good practice statement

IPC

Infection prevention and control

PHAC

Public Health Agency of Canada

REGN-EB3

Odesivimab, Inmazeb

RNA

Ribonucleic acid

RT-PCR

Reverse transcription polymerase chain reaction

rVSVΔG-ZEBOV-GP

Ervebo^® vaccine

SUDV

Sudan virus

SVD

Sudan virus disease

TVD

Taï Forest virus disease

TAFV

Taï Forest virus

USA

United States of America

WHO

World Health Organization

WG

Working group

Acknowledgements

This statement was prepared by the CATMAT Ebola Working Group: P Lagacé-Wiens (Lead), YG Bui, M Libman, J Pernica, S Schofield, M Desroches and T Nguyen (CATMAT Secretariat) and approved by CATMAT.

CATMAT acknowledges and appreciates the contributions of AK Boggild, A McCarthy, M Crockett, S Vaughn, J Geduld, J Sciberras, T Piggott, N Pachal and E Payne to earlier versions of the statement.

CATMAT members: M Libman (Chair), YG Bui (Vice-Chair), K Plewes (Malaria Sub-Committee Chair), I Bogoch, C Hogan, K Kazmi, A Khatib, P Lagacé-Wiens, J Lee and C Yansouni.

Liaison representatives: K O’Laughlin (Centers for Disease Control and Prevention) and J Pernica (Association of Medical Microbiology and Infectious Disease Canada).

Former liaison: I Viel-Thériault (Canadian Pediatric Society).

Ex officio representatives: V Donici (National Defence and the Canadian Armed Forces [DND-CAF]), C Jensen (National Advisory Committee on Immunization [NACI] Secretariat, PHAC), D Marion (DND-CAF), S Schofield (DND-CAF), M Tunis (NACI Secretariat, PHAC), and R Zimmer (Biologic and Radiopharmaceutical Drugs Directorate, Health Canada).

Conflict of interest

None declared.

Appendix: Assessment table for applicability of good practice statements

Table 3. Assessment of applicability of good practice statement for EBOD prevention recommendations

Criteria	Supporting information	Verification
Population and intervention components are clear	Preventative measures for Canadians, including those who may be at higher risk of exposure (e.g. those visiting friends and family), travelling to EBOD-affected areas	Yes
Message is really necessary in regard to actual health care practice	EBOD prevention strategies are important for reducing individual risks as well as alleviating public health-related concerns.	Yes
Implementing the GPS results in a large net positive consequence	Yes, practicing EBOD prevention strategies lowers the risk of exposure to EBOD-causing viruses and may simplify monitoring requirements when returning from an affected area.  Furthermore, the strategies support outbreak management efforts in the affected area.	Yes
Collecting and summarizing the evidence is a poor use of a guideline panel's limited time, energy or resources. The opportunity cost of collecting and summarizing the evidence is large and can be avoided.	Yes, this recommendation is about advising travellers about EBOD prevention strategies. The advice is based on well-established principles of public health and risk mitigation, and the time and resources required to collect and summarize additional evidence would detract from addressing other priorities.	Yes
There is a well-documented clear and explicit rationale connecting the indirect evidence	Given the likelihood of major travel disruptions and potentially higher risk of exposure with travel to an EBOD-affected areas where there are confirmed cases, good practice statements for protective measures against exposure to EBOD are appropriate.	Yes
Clear and actionable	Not applicable	Yes

Final judgement: development of GPS is appropriate.

References