The Centers for Disease Control and Prevention said in a website update dated July 14 that U.S. citizens returning from the Democratic Republic of Congo must spend 21 days in a third country before attempting entry into the United States. The move is intended to limit the potential importation of Ebola cases linked to an ongoing outbreak in the region.
The restriction also applies to certain travelers from Uganda and South Sudan. Other travelers from those two countries will continue to be subject to airport screening measures that have been in place in recent months, including checks of travel history, temperature assessments and symptom reviews at selected U.S. ports of entry.
The CDC said exceptions to the 21-day third-country-stay requirement may be made on a case-by-case basis for humanitarian reasons or for law-enforcement purposes. The agency reiterated that there have been no confirmed cases in the United States tied to this outbreak and that, according to the CDC, the risk to the American public and travelers remains low.
Earlier this spring, the CDC and other federal agencies issued an order that prevented non-citizens - including some with extended legal status - from entering the United States directly from the same three countries and required a similar 21-day stay in another country prior to travel to the United States.
The updated guidance follows debate over the use of travel restrictions for outbreak control. Dr. Daniel Jernigan, a former senior CDC official who led the agency's response during the 2014-2015 Ebola outbreak in West Africa, criticized the approach of preventing U.S. citizens from boarding flights when their individual risk of infection is low. He said using a "do-not-board" policy in such circumstances is unprecedented and warned of practical consequences: "This change in policy risks shifting medical and public-health responsibility to third countries, it may encourage travelers to conceal itineraries or exposures, and it will make recruitment of American outbreak responders more difficult."
Authorities have maintained targeted screening for travelers who arrive at designated airports. Those procedures involve questions about travel history and direct health checks at arrival points. The CDC noted that, to date, all cases in the Congo outbreak are linked to the Bundibugyo strain of the Ebola virus, with official tallies showing more than 1,900 confirmed cases and over 700 deaths.
As federal agencies implement the 21-day third-country requirement for certain travelers, the guidance is intended to reduce the chance of importing cases while allowing for narrowly defined exceptions in urgent circumstances. How the policy will affect travel logistics, deployment of outbreak response personnel and third-country health systems remains a subject of concern voiced by public-health experts and observers.