update
October 11, 2024:
For purposes of these interim recommendations, we have defined which staff are considered “U.S.-based health care personnel.” The health department added that people may choose to postpone the initial risk assessment conducted by CDC staff on people tested at a U.S. port of entry. Avoid non-essential visits to a U.S. health facility (such as elective surgery) until 21 days have passed since your last stay in a Rwandan health facility. Since your last stay in a Rwandan health facility Once the 21-day period ends, the following advisory has been added: If you have less than 21 days left after leaving Rwanda, you must continue self-monitoring during this period. Add exception to advisory
overview
On September 27, 2024, the Ministry of Health of the Republic of Rwanda reported an outbreak of MVD involving health worker illness. These are the first known cases of MVD in Rwanda. For more information, see First Marburg virus disease outbreak in the Republic of Rwanda.
At this time, the risk of exposure to Marburg virus for returning health care workers is unknown. However, given concerns about infection prevention and control practices in Rwanda’s health care facilities and the identification of MVD cases among health care workers, CDC is reducing these from currently published sources until the risks are better defined. We are taking a different approach to managing healthcare workers. An important change is that employees (including outpatients and traditional healers) who have worked at Rwandan health facilities will not be able to return to the U.S. until 21 days have passed since they last worked at a Rwandan health facility. The recommendation is that the person should be excluded from working in a medical facility. Rwanda.
For purposes of these interim recommendations, U.S.-based health care personnel include all people who work or volunteer in any capacity in a U.S. health care facility (inpatient or outpatient).
At this time, CDC is making the following recommendations for health care workers who have worked in Rwandan health facilities (including outpatient facilities, non-patient care areas, and traditional healers) in the past 21 days. Although MVD cases have only been reported in certain districts of Rwanda, the CDC applies these recommendations to the entire country.
These recommendations may be updated based on information from developments in the outbreak in Rwanda. It may also be updated if a U.S.-based health care worker is identified as having MVD while in Rwanda or after leaving the country.
Sponsoring organization
The sponsoring organization will collect all U.S.-based returning health care workers who may have been in a Rwandan health care facility (including outpatient care facilities, non-patient care areas, and traditional healers) in the past 21 days. The following measures should be taken against:
Before personnel leave Rwanda, assess the risk of exposure and signs and symptoms of MVD. This assessment should be conducted by an occupational health, infectious disease prevention and control, or other equivalent professional and should not be a self-assessment by an individual. Because of this outbreak, a modified template tool has been developed that can be used for this purpose. A copy of your completed assessment may be requested by your competent U.S. Department of Health. If a person is identified as having a potentially high-risk exposure or signs and symptoms consistent with MVD, they should consult the CDC before allowing them to travel. CDC emergency assistance is available 24 hours a day, seven days a week, by calling CDC’s Emergency Operations Center (EOC) at 770-488-7100 and requesting an on-call epidemiologist from the Virus and Special Pathogens Branch (VSPB). Masu. High-risk exposures, or persons with suspected or confirmed MVD, must be managed in accordance with CDC guidance for the public health management of viral hemorrhagic fever (VHF) or persons with suspected or confirmed high-risk exposures. Before traveling to the United States, notify the health department having jurisdiction over your final destination in the United States. Contact information for U.S. state, local, and territorial health departments is available at: 24-Hour Epi-on-Call Contact List Information provided includes the individual’s name, U.S. destination address, contact information (phone, email address), and flight itinerary. .US Department of Health
U.S. health officials are taking the following actions for all returning health care workers who have been in Rwandan health facilities (including outpatient facilities, non-patient care areas, and traditional healers) in the past 21 days: should be taken.
Conduct an exposure risk assessment. Health authorities may request a copy of the person’s pre-departure assessment. For people tested at a U.S. port of entry, health officials may choose to postpone the risk assessment conducted by CDC staff. If a high-risk exposure is confirmed, the person should be managed according to CDC guidance for public health management of VHF or people with suspected or confirmed high-risk exposures. Educate people about self-monitoring and what to do if they develop symptoms during the monitoring period, including how to contact the Department of Health, which is available 24/7 for guidance on seeking medical care. These individuals are excluded from working in a clinical or non-clinical role at a U.S. health facility until 21 days after their last stay at a Rwandan health facility. Advise these individuals to avoid non-essential visits to U.S. health care facilities (e.g., elective surgery) until 21 days after their stay in a Rwandan health care facility. These people will be monitored daily until 21 days after their last stay in a Rwandan health facility. Monitoring can be conducted by telephone, video conferencing, other electronic means (such as text messages, emails, apps, web forms, etc.), or in person, depending on the resources available in the jurisdiction. The health department, at its discretion, may choose to delegate oversight to the employment or sponsoring organization’s occupational health program. The CDC is asking health officials to provide aggregate, anonymized data on people being monitored during this outbreak. Information on how to submit these data is provided to the health department. Isolation or movement restrictions are not recommended as long as the infected person remains asymptomatic. Asymptomatic people can stay home, but should have a plan in place to isolate themselves from other people in their household in case they develop signs and symptoms consistent with MVD. If travel to another jurisdiction occurs, coordinate ongoing monitoring with the health department of the person’s destination. If an individual plans to leave the United States during the monitoring period, please notify CDC by emailing DGMHTRAMPROPTeam@cdc.gov. Please encrypt or password-protect all personally identifiable information, including, to the extent available, the following: Name Passport number Date of birth Travel dates Destination contact information (address, phone number, (email address) Date of last medical visit; In Rwanda, if 21 days have passed since your last stay in a medical facility in Rwanda, whether you have 21 days remaining since you left Rwanda; Advise travelers to continue self-monitoring.
If you develop signs or symptoms consistent with MVD, you should immediately self-isolate and contact your health department for instructions.
Health authorities should conduct a public health assessment to determine the likelihood that the traveler’s symptoms are caused by Marburg virus infection. If MVD is suspected, refer the patient for medical evaluation at a predetermined health facility with consideration for Marburg virus testing. When a diagnosis of MVD is considered, state, tribal, local, or territorial public health officials should work with CDC to ensure that appropriate precautions are taken to prevent the potential spread of Marburg virus and arrange for testing. You need to make sure that steps are taken. CDC’s VSPB can contact the CDC Emergency Operations Center (EOC) at 770-488-7100 to request a VSPB on-call epidemiologist or by emailing spather@cdc.gov. We are available 24 hours a day, 7 days a week to discuss your case. Persons with suspected or confirmed MVD should be managed according to CDC guidance for public health management of persons with suspected or confirmed VHF or high-risk exposures.
Exceptions for certain U.S.-based health care workers
CDC is issuing exceptions to the above interim recommendations for some U.S.-based health care workers who meet all of the following criteria:
Trained in nosocomial infection prevention and control precautions recommended for the clinical management of patients with suspected or confirmed VHF. Infection prevention and control of VHF in designated treatment units for the clinical management of VHF patients (e.g. Ebola and Marburg treatment units) Work only in designated Marburg treatment units in Rwanda and in other areas of health facilities in Rwanda Identify high-risk exposures to Marburg virus that were off-limits to
After arriving in the United States, these individuals are recommended to:
As long as you remain asymptomatic, you will not be excluded from working in a U.S. health care facility or in any other capacity, including clinical roles. Intermittent monitoring (eg, weekly or every few days) or as directed by the health department. The health department, at its discretion, may choose to delegate oversight to the employment or sponsoring organization’s occupational health program.
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