Notice2026-21036
Order Under Sections 362 and 365 of the Public Health Service Act Continuing the Suspension of the Right To Introduce Certain Persons From Countries Where a Quarantinable Communicable Disease Exists
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 15, 2026
Effective
October 11, 2026
Issuing agencies
Health and Human Services DepartmentCenters for Disease Control and Prevention
Abstract
The Centers for Disease Control and Prevention (CDC), a component of the Department of Health and Human Services (HHS), announces it is issuing an Order under Sections 362 and 365 of the Public Health Service Act, and associated implementing regulations, continuing the suspension of the right to introduce certain persons from countries where an outbreak of a quarantinable communicable disease exists. This Order was issued on October 11 and shall remain in effect through 4:59 p.m. Eastern Daylight Time (EDT) on Tuesday, November 10, 2026. This Order may be amended or rescinded prior to that time at the discretion of the Director.
Full Text
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<title>Federal Register, Volume 91 Issue 198 (Thursday, October 15, 2026)</title>
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[Federal Register Volume 91, Number 198 (Thursday, October 15, 2026)]
[Notices]
[Pages 65556-65562]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-21036]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Docket No. CDC-2026-0892]
Order Under Sections 362 and 365 of the Public Health Service Act
Continuing the Suspension of the Right To Introduce Certain Persons
From Countries Where a Quarantinable Communicable Disease Exists
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice with comment period.
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SUMMARY: The Centers for Disease Control and Prevention (CDC), a
component of the Department of Health and Human Services (HHS),
announces it is issuing an Order under Sections 362 and 365 of the
Public Health Service Act, and associated implementing regulations,
continuing the suspension of the right to introduce certain persons
from countries where an outbreak of a quarantinable communicable
disease exists. This Order was issued on October 11 and shall remain in
effect through 4:59 p.m. Eastern Daylight Time (EDT) on Tuesday,
November 10, 2026. This Order may be amended or rescinded prior to that
time at the discretion of the Director.
DATES: This action took effect October 11, 2026, at 5:00 p.m. EDT.
Written comments must be received on or before October 30, 2026.
ADDRESSES: You may submit comments, identified by Docket No. CDC-2026-
0892 by either of the methods listed below. Do not submit comments by
email. CDC does not accept comments by email.
<bullet> Federal eRulemaking Portal: <a href="http://www.regulations.gov">http://www.regulations.gov</a>.
Follow the instructions for submitting comments.
<bullet> Mail: Division of Global Migration Health, Centers for
Disease Control and Prevention, 1600 Clifton Road NE, MS H16-4,
Atlanta, GA 30329.
Instructions: All submissions received must include the agency name
and Docket Number. All relevant comments received will be posted
without change to <a href="http://regulations.gov">http://regulations.gov</a>, including any personal
information provided. For access to the docket to read background
documents or comments received, go to <a href="http://www.regulations.gov">http://www.regulations.gov</a>.
FOR FURTHER INFORMATION CONTACT: Jordan Faircloth, Deputy Chief of
Staff, Centers for Disease Control and Prevention, 1600 Clifton Road
NE, MS V18-2, Atlanta, GA 30329. Phone: 404-639-7000. Email:
<a href="/cdn-cgi/l/email-protection#d0b3b4b3a2b5b7a5bcb1a4b9bfbea390b3b4b3feb7bfa6"><span class="__cf_email__" data-cfemail="a2c1c6c1d0c7c5d7cec3d6cbcdccd1e2c1c6c18cc5cdd4">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: On May 18, 2026, the Acting Director of the
Centers for Disease Control and Prevention signed an Order prohibiting
the introduction of certain persons who have departed from, or were
otherwise present within, specified countries during the last 21 days.
On May 22, 2026, the Assistant Secretary for Health (ASH), HHS, signed
an Amended Order that reflected updates to 42 CFR 71.40 (f), which no
longer provides an exemption for lawful permanent residents (LPRs) from
such orders. CDC accepted comments on both the original Order and
Amended Order through June 22, 2026. On June 21, 2026, the ASH signed a
new 30-day Order continuing the previous Order, without change, and
provided a 15-day comment period. Subsequent new orders, each
continuing the previous Order without change and responding to public
comments as well as providing updates on the epidemiologic situation
and status of the outbreak, were signed by the ASH on July 13, 2026,
August 12, 2026, and September 11, 2026, respectively. During the
comment period for the September 11, 2026, Order, CDC received one
comment, which is addressed below. With this notice, CDC is announcing
the issuance of an Order that continues the suspension of the right to
introduce certain persons who have departed from, or were otherwise
present within, specified countries during the last 21 days. This Order
is effective for a period of 30 days.
[[Page 65557]]
Response to Comment on Previous Order
Comment: CDC received one comment in response to the September 11,
2026, Order. The commenter expressed support for strong evidence-based
measures to prevent Ebola from entering the United States during a
serious outbreak and stated their support for broad public-health
powers that are tied to clear scientific criteria for when restrictions
begin, narrow, and end. The commenter also recommended that CDC use a
meaningful risk-assessment approach to travel restrictions that
consider the differences between meaningful exposure and theoretical
exposure to pathogen, while recognizing uncertainty when evidence is
incomplete. The commenter observed that the epidemiological situations
described for Uganda and South Sudan are different from that of
situation in Democratic Republic of the Congo and recommended CDC
publish measurable criteria for adding and removing countries and
reassess those criteria frequently, and that if a country completes the
relevant surveillance period without cases, the public should be able
to understand what additional evidence CDC needs before restrictions
change.
The commenter also stated concern about applying restrictions to
lawful permanent residents and to people whose presence in a listed
country may have involved only transit, noting that Ebola transmission
requires meaningful exposure to an infected symptomatic person or
contaminated materials. The commenter recommended that if
individualized risk assessment is operationally impractical during this
outbreak, CDC should explain why and continue evaluating whether
targeted screening, monitoring or narrowly defined exceptions could
achieve comparable protection.
Response: Thank you for this comment. CDC recognizes that
individual risk may differamongpersons who have been present in a
designated country or place where the quarantinable communicable
disease outbreak is occurring. However, CDCalso considersthe public
health and other resourcesrequired to implement an Order issued under
Sections 362 and 365 of the Public Health Service Act and the
implementing regulation at 42 CFR 71.40. Whether an individual
transited through a covered jurisdiction or spent significant time
there does not necessarily resolve all public health considerations
relevant to that person's physical presence in the designated country
or place or potential exposure. Moreover, implementation of the
proposed limitations based on individual exposure circumstances would
be more difficult to operationalize considering the volume of travelers
at issue, as well as restraints on resources and personnel in the
highly fluid context of international air travel.
Based on such considerations, CDC hasdetermined thata generally
applicable threshold based on whether an individual was present in a
designated country or place during the relevant period is both more
protective of public health and more feasible to implement. CDC does
not agree that individualized exposure assessments, testing, symptom
screening, or monitoring can presently be feasibly implemented and
serve as a substitute for the Order for all covered persons. CDC also
notes that the status of Legal Permanent Residents (LPRs) is outside
the scope of this notice, and that travel restrictions for LPRs are
addressed at 42CFR71.40.
In regard to the commenter's recommendation that CDC monitor
evidence and revise restrictions as indicated, CDC appreciates the
comment and agrees that public health measures should be based on
current epidemiological evidence and periodically reassessed as
relevant conditions change. CDC will continue to evaluate the
epidemiological conditions underlying the Order, the risk of
international introduction, the effectiveness and availability of
public health mitigation measures, and relevant information concerning
implementation of the Order. If changing circumstances warrant
modification of the geographic scope, covered populations, exceptions,
or other provisions of the Order, CDC will consider such modifications
consistent with 42 U.S.C. 265 and 42 CFR 71.40.
The Order also is temporary and subject to continuing reassessment.
The current Order is effective for 30 days and is intended to
facilitate an ongoing public health assessment and risk profile of the
outbreak. CDC continues to evaluate epidemiological conditions, the
risk of importation, the effectiveness and availability of mitigation
measures, and other relevant public health information in determining
whether the statutory and regulatory criteria remain satisfied. If
those circumstances materially change, CDC will consider whether the
Order should be modified, narrowed, or discontinued.
CDC carefully considered the comment and determined that it did not
warrant changes to the requirements of the Order issued September 11,
2026. The new Order, issued on October 11, 2026, provides updated
information regarding the status of the Ebola disease outbreak and CDC
response efforts and maintains the previous travel restrictions. CDC
will accept comments for this Order for 15 days from the date of
publication using docket CDC-2026-0892. A copy of the Order is provided
below and a copy of the signed Order can be found at <a href="https://www.cdc.gov/port-health/legal-authorities/evdorder.html">https://www.cdc.gov/port-health/legal-authorities/evdorder.html</a>.
U.S. Department of Health and Human Services Centers for Disease
Control and Prevention (CDC)
Order Under Sections 362 & 365 of the Public Health Service Act
(42 U.S.C. 265, 268) and 42 CFR Sec. 71.40
Continuing the Suspension of the Right To Introduce Certain Persons
From Countries Where a Quarantinable Communicable Disease Exists
I. Executive Summary
The Centers for Disease Control and Prevention (CDC), a component
of the U.S. Department of Health and Human Services (HHS), issues this
Order pursuant to Sections 362 and 365 of the Public Health Service
(PHS) Act, 42 U.S.C. 265 and 268, and their implementing regulations.
This Order continues the suspension of the right to introduce ``covered
aliens,'' as defined herein, into the United States for a period of
thirty days, subject to the outcome of an ongoing comprehensive public
health risk assessment. This Order is necessary to protect public
health in the United States from the serious risk posed by the
introduction of Ebola disease into the United States by covered aliens
based on the outbreak of Ebola disease caused by the Bundibugyo virus
confirmed present in the Democratic Republic of the Congo (DRC) and,
until recently, in Uganda.
This Order applies to covered aliens who have departed from, or
were otherwise present within, DRC, Uganda, or South Sudan during the
last 21 days (regardless of their country of origin). This Order is
based on an assessment of the most recently available data and current
conditions regarding the Ebola disease outbreak.
This Order is time-limited and shall be in effect for 30 days from
the date of issuance. This Order is intended to address the serious
risk of introduction of Ebola disease into the United States, while
allowing the U.S. Government to continue an ongoing assessment of the
current and evolving conditions of the Ebola disease outbreak in
consultation with other stakeholders.
[[Page 65558]]
This Order is severable from previously issued Orders under
Sections 362 and 365 of the Public Health Service (PHS) Act, 42 U.S.C.
265 and 268, and their implementing regulations under 42 CFR part 71.
Any provision of this Order held to be invalid or unenforceable by its
terms, or as applied to any person or circumstance, shall be construed
so as to continue to give the maximum effect to the provision permitted
by law, unless such holding shall be one of utter invalidity or
unenforceability.
II. Authority, Scope, and Purpose
I issue this Order pursuant to Sections 362 and 365 of the Public
Health Service (PHS) Act, 42 U.S.C. 265 and 268, and their implementing
regulations under 42 CFR part 71,\1\ which authorize the CDC Director
to suspend the right to introduce \2\ persons into the United States
when the Director determines that the existence of a quarantinable
communicable disease in a foreign country or place creates a serious
danger of the introduction of such disease into the United States and
the danger is so increased by the introduction of persons from the
foreign country or place that a temporary suspension of the right of
such introduction is necessary to protect public health.
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\1\ Control of Communicable Diseases; Foreign Quarantine:
Suspension of the Right to Introduce and Prohibition of Introduction
of Persons into United States from Designated Foreign Countries or
Places for Public Health Purposes, 85 FR 56424 (Sept. 11, 2020), as
amended by 91 FR 31362 (May 27, 2026); 42 CFR 71.40.
\2\ Suspension of the right to introduce means to cause the
temporary cessation of the effect of any law, rule, decree, or order
pursuant to which a person might otherwise have the right to be
introduced or seek introduction into the United States. 42 CFR
71.40(b)(5).
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This Order applies to persons who have departed from, or were
otherwise present within, DRC, Uganda, and South Sudan during the last
21 days (regardless of their country of origin), including lawful
permanent residents of the United States, subject to the exceptions
detailed below. For purposes of this Order, I refer to persons covered
by the Order as ``covered aliens.''
This Order does not apply to the following:
<bullet> U.S. citizens and U.S. nationals; \3\
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\3\ 42 CFR 71.40(f).
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<bullet> Members of the armed forces of the United States and
associated personnel, U.S. government personnel serving overseas,
associated personnel, and their spouses and children, subject to
required assurances; \4\
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\4\ 42 CFR 71.40(e)(1) and (2).
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<bullet> Persons whom customs officers determine, with approval
from a supervisor, should be excepted from this Order based on the
totality of the circumstances, including consideration of significant
law enforcement, officer and public safety, humanitarian, and public
health interests. The U.S. Department of Homeland Security (DHS) will
consult with CDC regarding the standards for such exceptions to help
ensure consistency with current CDC guidance and public health
recommendations; and
<bullet> Persons who would otherwise be subject to this Order, who
are permitted to enter the United States based on an exception
provisionally granted by CDC with confirmation based on a public health
assessment at time of entry under a DHS-approved process documented and
shared with CDC which includes appropriate public health mitigation
protocols, per CDC guidance.
The purpose of this Order is twofold. First, this Order aims to
continue minimizing the number of covered aliens entering the United
States who have been within countries experiencing or that have
recently experienced a known or suspected outbreak of Ebola disease and
thereby reduce the risk of introduction of Ebola disease into the
United States. Second, this Order is intended to facilitate an ongoing
public health assessment and risk profile of the Ebola disease
outbreak. Thirty days is the amount of time necessary for CDC to
continue monitoring the situation and determine if there has been a
material change to the risk of importation and whether this Order would
remain in effect or requires modification. Such information will enable
the CDC Director to make an informed determination regarding what
restrictions are necessary going forward and provide the opportunity
for the development of a comprehensive mitigation and containment plan
in consultation with stakeholders.
III. Factual Basis
A. Ebola Disease
Viral hemorrhagic fever refers to a group of severe illnesses
caused by certain viruses that damage the body's blood vessels and
affect the ability of the blood to clot properly. Viral hemorrhagic
fevers include diseases such as Ebola, Marburg, Lassa fever, and dengue
hemorrhagic fever.
Bundibugyo virus disease (BVD) is a severe and often fatal illness
caused by one of the viruses in the Ebola family. Ebola disease
outbreaks occur mainly in parts of sub-Saharan Africa and can spread
rapidly in communities with limited healthcare resources. Ebola disease
caused by the Bundibugyo virus is a rare form of Ebola first identified
during an outbreak in Bundibugyo District, Uganda, in 2007. Bundibugyo
virus is one of several species within the orthoebolavirus family and
causes symptoms similar to other forms of Ebola, including fever,
weakness, vomiting, diarrhea, and, in severe cases, hemorrhagic
complications and organ failure. The disease spreads through direct
contact with infected bodily fluids or contaminated materials.
The incubation period for Ebola disease caused by the Bundibugyo
virus is typically between 2 and 21 days, with most people developing
symptoms within 4 to 10 days after exposure. During this incubation
period, infected persons do not spread the virus until symptoms begin.
Screening for Bundibugyo virus disease focuses on identifying
symptoms and possible exposure history, such as recent travel to
affected areas or contact with infected aliens. Suspected patients are
evaluated for symptoms including fever, weakness, vomiting, diarrhea,
and bleeding, and laboratory confirmation is performed using
specialized tests such as PCR (polymerase chain reaction) to detect the
virus in blood and other body fluid samples. Health authorities also
use temperature checks, contact tracing, and isolation procedures to
prevent transmission.
There are currently no widely approved vaccines or specific
antiviral treatments for the Bundibugyo strain of Ebola disease.
Treatment mainly consists of supportive care, including intravenous
fluids, electrolyte replacement, oxygen support, pain and fever
management, and treatment of secondary infections. Early medical care
significantly improves survival chances. Robust public health measures
such as early detection, rapid isolation, strong infection prevention
measures (i.e., use of personal protective equipment [PPE]), and
monitoring of contacts are critical to controlling outbreaks and
reducing deaths. A clinical trial of monoclonal antibodies is presently
underway in DRC.\5\ However, experts expect it will be several months
before these therapeutics are potentially available for wider use.
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\5\ WHO, Patient enrolment begins in a scientific trial to
identify the first effective treatments for Bundibugyo virus
disease, <a href="https://www.who.int/news/item/02-07-2026-patient-enrolment-begins-in-a-scientific-trial-to-identify-the-first-effective-treatments-for-bundibugyo-virus-disease">https://www.who.int/news/item/02-07-2026-patient-enrolment-begins-in-a-scientific-trial-to-identify-the-first-effective-treatments-for-bundibugyo-virus-disease</a> (last accessed September 10,
2026).
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[[Page 65559]]
B. Ongoing Bundibugyo Virus Disease Outbreak
The ongoing outbreak of Ebola virus disease caused by the
Bundibugyo virus in DRC continues to escalate in intensity and expand
geographically. The outbreak is now the largest and deadliest Ebola
outbreak in DRC's history, as well as the second largest Ebola outbreak
on record.\6\ This Ebola outbreak appears to be expanding faster than
any previously documented Ebola outbreak, with seven times as many
cases observed 100 days after initial detection as experienced in the
2014 West Africa Ebola outbreak, the largest recorded outbreak
worldwide.\7\ The outbreak remains centered in eastern DRC's Ituri
Province, although cases have been identified in North Kivu, South
Kivu, Haut-U[eacute]l[eacute], Tshopo, and Bas-U[eacute]l[eacute]
provinces. Since the issuance of the last Order, the outbreak has
spread to an additional province, Sud-Ubangi.\8\ On September 9, prior
to the issuance of the last Order, DRC reported 6,779 confirmed cases
and 3,267 deaths across 61 health zones. Cases and deaths have
continued to increase and as of October 5, 2026, DRC reports 8,665
confirmed cases and 4,178 deaths across 64 health zones.
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\6\ Kabasele D, Meyer E, Kabore I, et al. Notes from the Field:
Characteristics and Monitoring of the 2026 Outbreak of Ebola Disease
Caused by Bundibugyo Virus--Democratic Republic of the Congo, August
2026. MMWR Morb Mortal Wkly Rep 2026;75:554-556. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm7535e1">http://dx.doi.org/10.15585/mmwr.mm7535e1</a>.
\7\ Rossow J, McHale TC, Fuller J, et al. Notes from the Field:
The First 100 Days of Five Ebola Outbreaks--Democratic Republic of
the Congo, Uganda, and West Africa, 2007-2026. MMWR Morb Mortal Wkly
Rep 2026;75:576-578. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm7537e1">http://dx.doi.org/10.15585/mmwr.mm7537e1</a>.
\8\ CDC, Ebola Outbreak: Current Situation <a href="https://sante.gouv.cd/documents/sitreps">https://sante.gouv.cd/documents/sitreps</a> (last accessed October 8, 2026).
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As recently as October 5, 2026, the ongoing Bundibugyo Ebola virus
outbreak in DRC continues to spread despite response efforts. This
geographic expansion is concerning, particularly given that response
efforts are still not at the scale required for outbreak containment.
Contact tracing is currently at 80%, a decrease from 87% in September
and well below the operational threshold of 95% needed to successfully
slow the spread of this outbreak.\9\ Recent assessments indicate that
the true magnitude of the outbreak may be two to four times greater
than reported surveillance data suggest. Surveillance challenges
persist in the most heavily affected areas, with conflict and
insecurity, weak health infrastructure, and relatively porous borders
in the region complicating containment efforts. These conditions
increase the likelihood that cases will remain undetected and that
infected persons may travel outside affected areas before being
identified by public health authorities.
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\9\ Ministry of Public Health, Hygiene and Social Welfare,
Situation Report on the 17th Ebola Virus Outbreak Disease/DRC--
October 6, 2026, <a href="https://insp.cd/category/activite-cousp/">https://insp.cd/category/activite-cousp/</a> (last
accessed October 8, 2026).
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Uganda completed the 42-day enhanced monitoring period--defined as
twice the maximum incubation period for Ebola (21 days) per
international guidance--on August 27, 2026.\10\ Prior to August 27,
2026, Uganda reported 20 confirmed cases of Ebola disease and two
confirmed deaths, as well as one probable case and one probable death.
The last confirmed case of the outbreak was reported on June 21, 2026.
Of the confirmed cases, 15 were imported cases and 5 were secondary
cases linked to imported cases from DRC.\11\ All cases in Uganda have
been epidemiologically linked to the ongoing outbreak in DRC, with
cross-border importations having occurred, resulting in secondary
transmission among family members and caregivers.\12\ Ugandan
authorities activated emergency response systems, expanded
surveillance, and strengthened screening at borders and health
facilities. Although the country has achieved successful containment of
the outbreak, continued overland travel from DRC poses an ongoing risk
of cross-border transmission, particularly among healthcare workers and
in western Ugandan districts that serve as points of entry for
travelers seeking medical care. For example, on October 6, 2026, the
Kenya Ministry of Health announced the country's first BVD case and
death in an individual who had traveled from DRC to Uganda, flown from
Kampala to Nairobi on October 2, and was hospitalized before dying on
October 5, 2026.\13\
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\10\ World Health Organization, Uganda ends Ebola outbreak
following completion of 42-day countdown, <a href="https://www.afro.who.int/countries/uganda/news/uganda-ends-ebola-outbreak-following-completion-42-day-countdown">https://www.afro.who.int/countries/uganda/news/uganda-ends-ebola-outbreak-following-completion-42-day-countdown</a> (last accessed October 8, 2026).
\11\ WHO, Disease Outbreak News: Ebola disease caused by
Bundibugyo virus, Democratic Republic of the Congo & Uganda, <a href="https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON613">https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON613</a>
(last accessed October 8, 2026).
\12\ CDC internal data.
\13\ World Health Organization, Kenya confirms first imported
Bundibugyo virus disease case; WHO supports control efforts, <a href="https://www.afro.who.int/countries/kenya/news/kenya-confirms-first-imported-bundibugyo-virus-disease-case-who-supports-control-efforts">https://www.afro.who.int/countries/kenya/news/kenya-confirms-first-imported-bundibugyo-virus-disease-case-who-supports-control-efforts</a>
(last accessed October 6, 2026).
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To date, South Sudan has not reported any confirmed Ebola disease
cases in the current outbreak.\14\ However, it is considered at high
risk because of its close border with affected areas in eastern DRC,
limited healthcare infrastructure, and cross-border population
movement. Regional and international agencies, including WHO and Africa
CDC, are supporting preparedness measures, surveillance, and
coordination among the three countries to prevent wider spread. Despite
these efforts, there continues to be a risk that the outbreak in DRC
could spread to South Sudan through cross-border travel by infected
individuals during the virus's incubation period, when they have been
exposed but are not yet showing symptoms.
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\14\ CDC, Ebola Outbreak: Current Situation, <a href="https://www.cdc.gov/ebola/situation-summary/index.html">https://www.cdc.gov/ebola/situation-summary/index.html</a> (last accessed
October 8, 2026).
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Travelers moving between affected countries and major international
transit hubs could unknowingly carry the Bundibugyo virus before
becoming ill. Such travelers may spread the outbreak beyond the
affected countries and ultimately reach the United States. DRC, Uganda,
and South Sudan are connected to the global aviation network through a
series of regional and international transit hubs that provide pathways
into the United States. Travelers departing from outbreak-affected
regions frequently transit through densely populated metropolitan
airports such as Addis Ababa Bole International Airport (ADD), Jomo
Kenyatta International Airport (NBO) in Nairobi, Brussels Airport
(BRU), Hamad International Airport (DOH) in Doha, Dubai International
Airport (DXB), and Istanbul Airport (IST), all of which maintain
extensive passenger connectivity to major U.S. gateway airports
including John F. Kennedy International Airport (JFK), Washington
Dulles International Airport (IAD), Hartsfield-Jackson Atlanta
International Airport (ATL), Chicago O'Hare International Airport
(ORD), and Los Angeles International Airport (LAX). These international
transportation corridors support continuous movement of travelers
between Central and East Africa and major U.S. metropolitan centers,
increasing the likelihood that aliens exposed to Ebola disease could
enter the United States before symptoms become apparent. Complex multi-
leg itineraries and the rapid pace of international travel create
substantial challenges for identifying potentially infected travelers
before arrival.
A traveler infected in outbreak regions of DRC may transit through
multiple countries and major international airports before developing
fever or other
[[Page 65560]]
clinical signs of disease. The risk of Bundibugyo virus disease
introduction into the United States is heightened by the virus's
incubation period, which can extend up to 21 days, allowing infected
persons to travel internationally while asymptomatic and therefore
unlikely to be detected through routine symptom-based screening
measures. A single infected traveler, particularly in countries with
limited public health infrastructure, can impose significant cross-
border public health response demands even without onward transmission
occurring within the United States. The interconnected nature of global
air travel presents a credible pathway for Bundibugyo virus disease
importation into the United States, underscoring the importance of
aggressive surveillance, traveler monitoring, airport public health
screening, healthcare preparedness, and rapid containment capabilities.
Travelers utilizing air transit pathways originating in or passing
through DRC, Uganda, and South Sudan include non-U.S. citizens,
including regional migrants, foreign contract workers, humanitarian
personnel, business travelers, students, refugees, and third-country
nationals moving through international aviation hubs in Africa, the
Middle East, and Europe. Many travelers entering U.S.-bound itineraries
from these pathways may do so under temporary visas, refugee or asylum
processing mechanisms, international organizational travel, or multi-
country itineraries that obscure their original point of departure. As
a result, public health screening and border security systems face
heightened operational complexity in identifying travelers with recent
exposure histories linked to Ebola-affected regions, particularly when
travelers transit through multiple jurisdictions prior to arrival at
major U.S. metropolitan airports.
CDC has issued a series of Travel Health Notices (THNs) for the
region, adjusting the THNs for individual affected provinces to reflect
current circumstances during the course of the outbreak. On August 4,
2026, CDC escalated the THN issued for Ituri and North Kivu Provinces
of DRC to a Level 4 (avoid all travel).\15\ A Level 3 THN (reconsider
nonessential travel) is currently in place for Haut-U[eacute]l[eacute],
and Tshopo Provinces of DRC.\16\ The rest of DRC and all of Uganda
remain under a Level 2 THN (practice enhanced precautions).\17\
Modifications to the THNs reflect the geographic distribution of
reported cases and do not indicate a reduced level of concern regarding
the outbreak, which continues to expand in affected areas and poses a
risk of further transmission and geographic spread.
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\15\ CDC issued a Level 2 THN (practice enhanced precautions)
for Ituri and North Kivu Provinces of DRC on May 15, 2026; this was
escalated to a Level 3 THN (reconsider nonessential travel) on May
18, 2026. The current Level 4 THN is available at <a href="https://wwwnc.cdc.gov/travel/notices/level4/ebola-drc-provinces">https://wwwnc.cdc.gov/travel/notices/level4/ebola-drc-provinces</a> (last
accessed October 6, 2026).
\16\ South Kivu was added to the Level 3 THN on May 22, 2026 but
then was moved to a Level 2 THN on July 15, 2026; Haut-
U[eacute]l[eacute] and Tshopo Provinces were added to the Level 3
THN on August 4, 2026. The current THN is available at <a href="https://wwwnc.cdc.gov/travel/notices/level3/ebola-democratic-republic-of-the-congo">https://wwwnc.cdc.gov/travel/notices/level3/ebola-democratic-republic-of-the-congo</a> (last accessed October 6, 2026).
\17\ CDC issued a Level 1 THN (practice usual precautions) for
Uganda on May 15, 2026. On May 27, 2026, the THN for Uganda was
elevated to a Level 2. On June 15, 2026, CDC issued a Level 2 THN
for the remainder of DRC and Uganda. The current THN is available at
<a href="https://wwwnc.cdc.gov/travel/notices/level2/ebola-drc-uganda">https://wwwnc.cdc.gov/travel/notices/level2/ebola-drc-uganda</a> (last
accessed October 6, 2026).
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CDC modeling indicates that, absent rapid and sustained public
health interventions, the outbreak could become one of the largest
Ebola epidemics ever recorded.\18\ The analysis further demonstrates
that early identification of cases, contact tracing, isolation and
treatment of symptomatic persons, community engagement, and safe burial
practices are critical to reducing transmission and mitigating outbreak
growth.\19\ CDC has concluded that the current outbreak is already the
largest known outbreak of Bundibugyo virus disease and that large-
scale, sustained public health measures are necessary to prevent
further international spread of the disease and to reduce the risk of
introduction of infected persons into the United States.\20\
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\18\ Mooring EQ, Koval WT, Routledge I, et al. Modeled Scenario
Projections for the Ebola Disease Outbreak Caused by Bundibugyo
Virus, 2026. MMWR Morb Mortal Wkly Rep 2026;75:285-289. DOI: <a href="http://dx.doi.org/10.15585/mmwr.mm7522e1">http://dx.doi.org/10.15585/mmwr.mm7522e1</a>.
\19\ Id.
\20\ Id.
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Restricting entry of covered aliens into the United States reduces
the volume of higher-risk international arrivals requiring public
health monitoring and follow-up. By limiting the number of potentially
exposed travelers entering through major U.S. ports of entry, federal,
state, and local public health authorities have concentrated finite
surveillance, screening, contact tracing, quarantine management, and
medical monitoring resources on returning U.S. citizens and U.S.
nationals, including those who have worked in the outbreak areas.
Paired with the DHS arrival restrictions redirecting travelers to
specific U.S. airports,\21\ this approach has reduced operational
strain on airport screening systems, CDC port health stations, public
health laboratories, and healthcare facilities responsible for
evaluating suspected Bundibugyo virus disease cases. It also has
improved the ability of authorities to conduct detailed exposure
assessments, ensure compliance with monitoring requirements during the
21-day incubation period, rapidly identify symptomatic travelers, and
allocate specialized isolation and treatment capacity more effectively.
In the context of a rapidly evolving Bundibugyo virus disease outbreak
with significant cross-border mobility, prioritizing surveillance
efforts toward a smaller and more traceable traveler population has
strengthened the overall effectiveness of U.S. disease containment and
border health security operations.
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\21\ DHS, Arrival Restrictions Applicable to Flights Carrying
Persons Who Have Recently Traveled From or Were Otherwise Present
Within the Democratic Republic of the Congo, Uganda, or South Sudan,
91 FR 29896 (May 21, 2026).
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IV. Legal Basis for This Order Under Sections 362 and 365 of the Public
Health Service Act and 42 CFR 71.40
CDC is issuing this Order pursuant to sections 362 and 365 of the
Public Health Service Act (42 U.S.C. 265, 268) and the implementing
regulation at 42 CFR 71.40. In accordance with these authorities, the
CDC Director is permitted to prohibit, in whole or in part, the
introduction into the United States of persons from designated foreign
countries (or one or more political subdivisions or regions thereof) or
places, only for such period of time that the Director deems necessary
to avert the serious danger of the introduction of a quarantinable
communicable disease,\22\ by issuing an Order in which the Director
determines that:
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\22\ See Exec. Order No. 13,295, Revised List of Quarantinable
Communicable Diseases (April 2, 2003) (adding viral hemorrhagic
fevers, including Ebola, to the U.S. federal list of quarantinable
communicable diseases).
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(1) By reason of the existence of any quarantinable communicable
disease in a foreign country (or one or more political subdivisions or
regions thereof) or place there is serious danger of the introduction
of such quarantinable communicable disease into the United States; and
(2) This danger is so increased by the introduction of persons from
such country (or one or more political subdivisions or regions thereof)
or place that a suspension of the right to introduce such persons into
the United
[[Page 65561]]
States is required in the interest of public health.\23\
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\23\ 42 U.S.C. 265; 42 CFR 71.40.
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Section 362 and the implementing regulation provide the Director
with a public health tool to suspend introduction of persons not only
to prevent the introduction of a quarantinable communicable disease,
but also to aid in continued efforts to mitigate spread of that
disease.\24\
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\24\ 85 FR 56424 at 56425-26.
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The term ``introduction into the United States'' is defined in 42
CFR 71.40 as ``the movement of a person from a foreign country (or one
or more political subdivisions or regions thereof) or place, or series
of foreign countries or places, into the United States so as to bring
the person into contact with persons or property in the United States,
in a manner that the Director determines to present a risk of
transmission of a quarantinable communicable disease to persons, or a
risk of contamination of property with a quarantinable communicable
disease.'' 42 CFR 71.40(b)(1). Similarly, the term ``serious danger of
the introduction of such quarantinable communicable disease into the
United States'' is defined as, ``the probable introduction of one or
more persons capable of transmitting the quarantinable communicable
disease into the United States, even if persons or property in the
United States are already infected or contaminated with the
quarantinable communicable disease.'' 42 CFR 71.40(b)(3).
Section 71.40(b)(2) defines ``[p]rohibit, in whole or in part, the
introduction into the United States of persons'' in Section 362 to mean
``to prevent the introduction of persons into the United States by
suspending any right to introduce into the United States, physically
stopping or restricting movement into the United States.'' See also 42
U.S.C. 265 (authorizing the prohibition when the danger posed by the
communicable disease ``is so increased by the introduction of persons .
. . from such country . . . that a suspension of the right to introduce
such persons . . . is required in the interest of public health'').
As stated in the Final Rule for 42 CFR 71.40, CDC ``may, in its
discretion, consider a wide array of facts and circumstances when
determining what is required in the interest of public health in a
particular situation . . . includ[ing] . . . [t]he overall number of
cases of disease; any large increase in the number of cases over a
short period of time; the geographic distribution of cases; any
sustained (generational) transmission; the method of disease
transmission; morbidity and mortality associated with the disease; the
effectiveness of contact tracing; the adequacy of state and local
health care systems; and the effectiveness of state and local public
health systems and control measures.'' \25\
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\25\ Id. at 56444.
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As stated in 42 CFR 71.40, this Order does not apply to U.S.
citizens, U.S. nationals, members of the armed forces of the United
States and associated personnel if the Secretary of War provides
assurance to the Director that the Secretary of War has taken or will
take measures such as quarantine or isolation, or other measures
maintaining control over such individuals, to prevent the risk of
transmission of the quarantinable communicable disease into the United
States, or United States government employees or contractors on orders
abroad, or their accompanying family members who are on their orders or
are members of their household, if the Director receives assurances
from the relevant head of agency and determines that the head of the
agency or department has taken or will take measures such as quarantine
or isolation, to prevent the risk of transmission of a quarantinable
communicable disease into the United States.\26\
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\26\ 42 CFR 71.40(e) and (f).
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In addition, this Order does not apply to additional classes of
persons excepted by the CDC Director. Creating exceptions in the Order
is consistent with Section 362 and 42 CFR 71.40. Section 362 explicitly
states that the prohibition of introduction into the United States may
be ``in whole or in part.'' This phrase is also included in section
71.40(a) and, as explained in the Final Rule, is intended to allow the
Director to narrowly tailor the use of the authority to what is
required in the interest of public health.\27\ As noted in the Final
Rule for 42 CFR 71.40, the CDC Director may also take into account
international obligations and humanitarian concerns.\28\ Pursuant to
this capability, CDC is therefore excepting certain categories of
persons, as described herein.
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\27\ 85 FR 56424 at 56444.
\28\ Id. at 56447.
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This Order will be in effect for 30 days to avert the serious
danger of the introduction, transmission, and spread of Ebola disease
into the United States. Finally, as directed by 42 CFR 71.40(c), this
Order sets out the following:
(1) The foreign countries (or one or more political subdivisions or
regions thereof) or places from which the introduction of persons is
being prohibited;
(2) The period of time or circumstances under which the
introduction of any persons or class of persons into the United States
is being prohibited;
(3) The conditions under which that prohibition on introduction
will be effective, in whole or in part, including any relevant
exceptions that the Director determines are appropriate;
(4) The means by which the prohibition will be implemented; and
(5) The serious danger posed by the introduction of the
quarantinable communicable disease in the foreign country or countries
(or one or more political subdivisions or regions thereof) or places
from which the introduction of persons is being prohibited.
V. Determination and Implementation
Based on the foregoing, I hereby determine that Ebola disease, a
highly transmissible quarantinable communicable disease, is confirmed
currently present in DRC and recently present in Uganda. There is a
material risk that the outbreak will spread to South Sudan and again to
Uganda. I also determine that the prevalence of Ebola disease in these
foreign countries constitutes a serious danger of the introduction of
this disease into the United States due to the limited screening and
testing and mitigation measures currently available. Finally, I
determine that a temporary 30-day suspension of the right to introduce
covered aliens is necessary to protect the public health from the
serious danger of the introduction of Ebola disease into the United
States, pending an ongoing public health assessment of the Ebola
disease outbreak.
I consulted with the Department of State, DHS, and other federal
departments as needed before I issued this Order and requested that DHS
aid in the enforcement of this Order because CDC does not have the
capability, resources, or personnel needed to do so.\29\ As part of the
consultation, DHS developed operational plans for implementing this
Order. These plans are consistent with the language of this Order.
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\29\ 42 U.S.C. 268; 42 CFR 71.40(d).
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Although this Order is not a rule subject to notice and comment
under the Administrative Procedure Act (APA) and is issued with
immediate effect, in order to ensure that the forthcoming public health
risk assessment is informed by public input, the Order is being issued
with a simultaneous 15-day comment period.
[[Page 65562]]
This Order takes effect at 5:00 p.m. Eastern Daylight Time on
Sunday, October 11, 2026. For individuals intending to travel to the
United States by air, the Order will apply to flights departing after
4:59 p.m. Eastern Daylight Time on Sunday, October 11, 2026.
* * * * *
In testimony whereof, the Assistant Secretary for Health, U.S.
Department of Health and Human Services, has hereunto set his hand at
Washington, DC this 9th day of October, 2026.
Dated:
Admiral Brian Christine, MD,
Assistant Secretary for Health (ASH) and Head of the United States
Public Health Service (USPHS) Commissioned Corps, Department of
Health and Human Services.
Public Participation
Interested persons or organizations are invited to participate by
submitting written views, recommendations, and data so that the public
can provide input that may inform the forthcoming public health risk
assessment and whether any subsequent exercise of this authority is
necessary.
Please note that comments received, including attachments and other
supporting materials, are part of the public record and are subject to
public disclosure. Comments will be posted on <a href="https://www.regulations.gov">https://www.regulations.gov</a>. Therefore, do not include any information in your
comment or supporting materials that you consider confidential or
inappropriate for public disclosure. If you include your name, contact
information, or other information that identifies you in the body of
your comments, that information will be on public display. CDC will
review all submissions and may choose to redact, or withhold,
submissions containing private or proprietary information such as
Social Security numbers, medical information, inappropriate language,
or duplicate/near duplicate examples of a mass-mail campaign. Do not
submit comments by email. CDC does not accept comment by email.
Authority
The authority for this order is Sections 362 and 365 of the Public
Health Service Act (42 U.S.C. 265, 268), as amended.
Brian Christine,
Admiral, Assistant Secretary for Health (ASH) and Head of the United
States Public Health Service (USPHS) Commissioned Corps, Department of
Health and Human Services.
[FR Doc. 2026-21036 Filed 10-14-26; 8:45 am]
BILLING CODE 4163-18-P
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</html>Indexed from Federal Register on October 15, 2026.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.