Imported Ebola cases: excerpts from ECDC strategic framework

This document summarises the health preparedness and response planning regarding the potential importation of Ebola disease published by European Centre for Disease Prevention and Control (ECDC). The severity of the disease necessitates robust preparedness. This strategy is centered on 4 critical focus areas: first point of contact, in-country transport, designated treatment facilities, and medical evacuation. The primary objectives are: early case recognition, effective isolation, safe patient management, and the protection of healthcare personnel through rigorous Infection Prevention and Control (IPC) measures. The current outbreak of Bundibugyo species of the Ebola virus (BDBV), ongoing since May 2026, presents significant challenges due to its magnitude and complex setting. Effective response relies on:

Flexibility: Adapting response plans based on the evolving international situation.

Resilient public health systems: Ensuring surge capacity for epidemiology and laboratory activities.

Leadership and Coordination: Establishing clear decision-making rules between regional and national levels.

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1. Case Definitions:

Standardized definitions are essential for identifying and managing potential cases. The following criteria are used to categorize individuals in the context of the BDBV outbreak:

Case Classification Criteria:

Patient Status Definitions:

• Person Under Investigation (PUI): Meets clinical and epidemiological criteria OR has high-risk exposure and any listed symptoms.
• Probable Case: Meets clinical and high-risk exposure criteria.
• Confirmed Case: Meets laboratory criteria.

2. Focus Areas:

A) Points of First Contact:

The health system’s first contact with an unknown Ebola case may occur via rescue services, points of entry (airports/ports), ambulance services, or primary healthcare providers. Because these settings may not be equipped for long-term management, the strategy focuses on:

• Identification: Training staff to recognize PUI or probable cases through clinical and travel history.
• Isolation: Establishing simple isolation rooms to provide initial supportive care while preventing transmission to other patients or staff.
• Information: Establishing Standard Operating Procedures (SOPs) to promptly inform regional/national public health focal points and coordinate safe transport.

B) In-Country Transport:

Once a PUI, probable, or confirmed case is identified, safe transport to a designated facility is mandatory.

• Designated Services: Use of specialized ambulance services or equivalent transport equipped with isolators.
• IPC and Safety: Strict adherence to PPE donning and doffing protocols for transport staff and established disinfection protocols for equipment and environments.
• Contact Tracing: Immediate initiation of monitoring for any staff members exposed during the transport process.

C) Designated Treatment Facilities:

Designated facilities (usually tertiary care hospitals) provide specialized care and laboratory diagnosis.

• Infrastructure Standards: Facilities must conform to high-level isolation unit standards, including filtered air (HEPA) and specialized waste/sewage management.
• Advanced Clinical Care: Ability to provide critical-care-level supportive care and facilitate the use of experimental treatments or vaccines through fast-track ethical approval.
• Post-Mortem Care: Protocols for safe and dignified burials to prevent transmission following a patient’s death.

D) Medical Evacuation (Medevac):

Medevac involves the organized evacuation of high-risk contacts or confirmed cases from affected areas:

• International Collaboration: Operations follow SOPs agreed upon
• Logistical Preparation: Countries must pre-designate specific airports for medevac arrivals, including designated parking spaces and routes for aircraft.
• Deployment Monitoring: Maintaining an overview of all nationals deployed in affected areas to ensure follow-up and contact tracing upon their return.

3. Public Health Preparedness:

Effective management of imported cases requires a systemic approach beyond immediate patient care:

Laboratory Capacity:

• Ensuring in-country diagnostic capacity for BDBV with validated methods.
• Establishing collaboration with the Reference Laboratory on Emerging, Rodent-borne and Zoonotic Viral Pathogens.
• Securing sustainable funding for reagents and staffing until the PHEIC is lifted.

Risk Communication and Community Engagement (RCCE-IM):

• Unified Voice: Disseminating consistent messages to the public and stakeholders to avoid misinformation.
• Social Listening: Monitoring online and offline channels to identify and address rumors or “infodemics.”
• Stakeholder Mapping: Integrating community stakeholders and at-risk groups (e.g., healthcare workers) into planning.

Training and Surge Capacity:

• Developing and testing surge capacity for epidemiological analysis and contact tracing.
• Tailoring training modules to the specific needs of different staff levels, from airport screening teams to intensive care unit (ICU)clinicians.
• Regularly updating clinicians on the status of the BDBV outbreak in the Democratic Republic of the Congo (DRC) and Uganda.

Credit for image: ECDC

_{Citation: European Centre for Disease Prevention and Control. Preparedness and response for imported cases of Ebola disease into an EU/EEA country – Operational checklists to support national preparedness planning. Stockholm: ECDC; 2026.}