Background
The ongoing outbreak of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo (DRC) and Uganda reported in May 2026 [1] has prompted ECDC to review its operational guidance relevant to air travel.
In this context, updated guidance is needed to support preparedness and public health action if a case is identified during or after a flight.
This ECDC rapid scientific advice builds on the Ebola disease content previously included in the haemorrhagic fevers chapter of the ‘Risk assessment guidelines for diseases transmitted on aircraft (RADIGA)’ [2].
In the original 2010 guidance, Ebola disease was included under haemorrhagic fevers; in 2011, the guidance was expanded to cover additional diseases.
This updated information is intended to support public health authorities and other competent national authorities in European Union/European Economic Area countries by providing actions to consider after the identification of a suspected or confirmed Ebola disease case during or after a flight.
Early recognition of the disease and risk assessment are needed to support an appropriate public health response when a potentially infectious passenger is identified during or after a flight, while avoiding unnecessary alarm or disruption to air traffic.
Methods
The methods used to develop the original operational guidance are described in the RAGIDA – Part 2 document [2].
For this rapid scientific advice, the content relevant to Ebola disease was reviewed and adapted from the haemorrhagic fevers chapter of that guidance.
The text was updated, where needed, in light of evidence and operational experience accrued since the publication of the 2011 guidance.
To produce this update, ECDC experts reviewed the peer-reviewed and grey literature for reports relevant to Ebola disease and air travel (Annex 1) and consulted additional operational and guidance documents relevant to public health management in relation to air travel (Annex 2).
Results of the literature review
The literature search did not identify any published reports describing orthoebolavirus transmission events associated with air travel.
After the 2013–2016 Ebola disease outbreak in West Africa, several publications described travellers who took commercial flights from West Africa to such countries as the United Kingdom, the United States (US) and Italy who were subsequently diagnosed with Ebola disease [3-7].
However, these reports did not describe symptoms occurring during the flight.
In one of these publications, an imported case was detected after the passenger arrived in the US.
Public health authorities carried out contact tracing of passengers and crew members who had been on the same flight, as the date of symptom onset was unclear. None of the traced contacts were later found to be positive for Ebola virus infection [5].
Ebola disease case definitions
For the purposes of this guidance, an index case is a person under investigation or a confirmed case identified during or after a flight, based on the applicable outbreak-specific case definitions in use at the time.
For the current outbreak of Ebola disease caused by Bundibugyo virus in DRC and Uganda, the relevant case definitions are available on the ECDC website [8].
In relation to air travel, the key considerations that might prompt contact tracing or other public health action are whether the person met the applicable case definition and was symptomatic during the flight.
Detection of an index case
In this guidance, an ‘index case’ is a person under investigation or a confirmed case identified in relation to a flight.
The distinction between identification during a flight or after a flight reflects when the case first comes to the attention of the crew or public health authorities.
In both situations, the key question is whether or not the person was symptomatic during the flight, because Ebola disease is not considered transmissible before symptom onset.
Symptoms compatible with Ebola disease may include fever, severe headache, muscle pain, weakness, fatigue, sore throat, vomiting, diarrhoea, abdominal pain, or unexplained bleeding or bruising.
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Suggested citation: European Centre for Disease Prevention and Control. Rapid Scientific Advice. Risk assessment guidelines for diseases transmitted on aircraft (RADIGA) – Ebola disease update. ECDC: Stockholm; 2026.
© European Centre for Disease Prevention and Control, Stockholm, 2026
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