Requirement for Attestation for All Airline or Other Aircraft Passengers Arriving in the United States From Any Foreign Country and Controlled Free Pratique for Airlines Confirming That Such Passengers Have Not Been in the Democratic Republic of the Congo in the Past 21 Days

Issuing agencies

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 361, 365, 368, and 369 of the Public Health Service Act, and associated implementing regulations, prohibiting the boarding of any passenger who is not otherwise subject to an exemption on any aircraft destined to the United States from a foreign country unless the passenger presents a signed attestation confirming the passenger has not been present in the Democratic Republic of the Congo (DRC) during the 21 days prior to boarding a flight to the United States. This Order was issued on October 22, 2026, to become effective at 11:59 p.m. Eastern Standard Time (EST) on November 3, 2026, and shall remain in effect through 11:59 p.m. EST on December 18, 2026. This Order may be amended or rescinded prior to that time at the discretion of the Secretary or his designee.

Full Text

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<title>Federal Register, Volume 91 Issue 206 (Tuesday, October 27, 2026)</title>
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[Federal Register Volume 91, Number 206 (Tuesday, October 27, 2026)]
[Notices]
[Pages 67582-67587]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-21828]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Requirement for Attestation for All Airline or Other Aircraft 
Passengers Arriving in the United States From Any Foreign Country and 
Controlled Free Pratique for Airlines Confirming That Such Passengers 
Have Not Been in the Democratic Republic of the Congo in the Past 21 
Days

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice of Agency Order.

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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 361, 365, 368, and 369 
of the Public Health Service Act, and associated implementing 
regulations, prohibiting the boarding of any passenger who is not 
otherwise subject to an exemption on any aircraft destined to the 
United States from a foreign country unless the passenger presents a 
signed attestation confirming the passenger has not been present in the 
Democratic Republic of the Congo (DRC) during the 21 days prior to 
boarding a flight to the United States. This Order was issued on 
October 22, 2026, to become effective at 11:59 p.m. Eastern Standard 
Time (EST) on November 3, 2026, and shall remain in effect through 
11:59 p.m. EST on December 18, 2026. This Order may be amended or 
rescinded prior to that time at the discretion of the Secretary or his 
designee.

DATES: This action will take effect November 3, 2026, at 11:59 p.m. 
EST. For individuals intending to travel to the United States by air, 
the Order will apply to flights departing at or after 11:59 p.m. EST on 
November 3, 2026.

FOR FURTHER INFORMATION CONTACT: Mina Zadeh, Acting 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#f1929592839496849d9085989e9f82b1929592df969e87"><span class="__cf_email__" data-cfemail="56353235243331233a37223f3938251635323578313920">[email&#160;protected]</span></a>.

SUPPLEMENTARY INFORMATION: On October 22, 2026, the Assistant Secretary 
for Health (ASH), HHS, signed an Order prohibiting the boarding of any 
passenger on any aircraft destined to the United States from a foreign 
country unless the passenger presents a signed attestation in paper or 
digital format confirming that the passenger has not been present in 
the Democratic Republic of the Congo (DRC) during the 21 days prior to 
boarding a flight to the United States. This includes any flight 
arriving in the United States, regardless of whether the United States 
is its final destination or the flight is connecting through the United 
States en route to another country. The airline or aircraft operator 
must retain a copy of the completed version of the signed attestation 
for at least 42 days after the passenger's flight departs for the 
United States from a foreign country and provide the attestation to the 
U.S. Government upon request.
    This Order is effective for a period of 45 days. This Order may be 
amended or rescinded prior to that time at the discretion of the 
Secretary or his designee. Any amendment or extension of this Order 
will be based on the current outbreak metrics, including case counts, 
geographic spread, community-transmission indicators, and containment 
capacity in affected countries.
    Pursuant to 42 U.S.C. 268, the U.S. customs officers and U.S. Coast 
Guard officers will assist in implementation of this Order. Other 
federal departments and agencies, including the U.S. Department of 
Homeland Security and the U.S. Department of Transportation, may also 
cooperate and assist with implementation of this Order consistent with 
their own legal authorities.
    This Order shall be enforceable through the provisions of 18 U.S.C. 
3559, 3571; 42 U.S.C. 243, 268, 270, 271; and 42 CFR 71.2. Pursuant to 
42 U.S.C. 271, CDC may request the U.S. Department of Justice seek to 
prosecute individuals who knowingly and willfully submit false 
attestations in violation of 18 U.S.C. 1001.
    This Order is not a rule within the meaning of the Administrative 
Procedure Act (``APA'') but rather is an action taken under the 
existing authority of 42 U.S.C. 264(a) and 42 CFR 71.20, 71.31(b), and 
71.32(b), which were promulgated in accordance with the APA after full 
notice and comment rulemaking and a delayed effective date. Separately, 
HHS/CDC is issuing a Paperwork Reduction Act (PRA) notice related to 
the attestation form required under this Order. The PRA notice also 
published in today's issue of the Federal Register and provides an 
opportunity for public comment through <a href="http://www.regulations.gov">www.regulations.gov</a>.
    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/attestation-order.html">https://www.cdc.gov/port-health/legal-authorities/attestation-order.html</a>.

Centers for Disease Control and Prevention (CDC)

Department of Health and Human Services (HHS)

Notice and Order Under Sections 361, 365, 368, & 369 of the Public 
Health Service Act (42 U.S.C. 264, 268, 270, & 271) and 42 Code of 
Federal Regulations 71.20, 71.31(b), & 71.32(b)

Requirement for Attestation for all Airline or Other Aircraft 
Passengers Arriving in the United States From any Foreign Country and 
Controlled Free Pratique for Airlines Confirming That Such Passengers 
Have Not Been in the Democratic Republic of the Congo in the Past 21 
Days

Summary

    Pursuant to 42 CFR 71.20, 71.31(b), and 71.32(b), and as set forth 
in greater detail below, this Notice and Order prohibit the boarding of 
any passenger who is not otherwise subject to an exemption on any 
aircraft destined to the United States from a foreign country unless 
the passenger presents:
    <bullet> A signed attestation in paper or digital format confirming 
that the passenger has not been present in the Democratic Republic of 
the Congo (DRC) during the 21 days prior to boarding a flight to the 
United States.

[[Page 67583]]

    This includes any flight arriving in the United States, regardless 
of whether the United States is its final destination or the flight is 
connecting through the United States en route to another country. This 
Order does not apply to overflights that do not land at any airport in 
the United States.
    Further, pursuant to 42 CFR 71.31(b) and as set forth in greater 
detail below, this Notice and Order operates as a controlled free 
pratique requiring an airline or other aircraft operator with an 
aircraft arriving into the United States to confirm to the U.S. 
Government that every passenger onboard the aircraft has completed and 
signed an attestation confirming that the passenger has not been in the 
DRC during the 21 days prior to boarding the flight to the United 
States as a condition of the airline or aircraft operator being granted 
permission to enter a U.S. port of entry, disembark passengers, and 
begin operations with respect to arriving at a U.S. airport.
    A parent or other authorized individual may complete and sign the 
required attestation on behalf of a passenger under 18 years of age. An 
authorized individual may also act on behalf of any passenger who is 
unable to act on their own behalf (e.g., by reason of age, or physical 
or mental impairment).
    The passenger must provide the airline or aircraft operator with a 
paper or digital copy of the completed attestation reflecting that the 
passenger has not been present in the DRC in the past 21 days prior to 
boarding a flight to the United States. The airline or aircraft 
operator must retain the paper or digital copy of each passenger's 
completed and signed attestation for at least 42 days after the 
passenger's flight departs for the United States from a foreign country 
and provide the attestation to the U.S. Government upon request.
    CDC encourages airlines and aircraft operators to incorporate the 
attestation into paperless check-in processes. An airline or aircraft 
operator may use a third party (including a third-party digital 
application) to provide translations. However, an airline or aircraft 
operator has sole legal responsibility to ensure the accuracy of any 
translation and to comply with all other obligations under this Order. 
An airline or aircraft operator is responsible for any failure to 
comply with its responsibilities as set forth in this Order, including 
for actions of a third party used to help effectuate its compliance 
with this Order. As between the airline or aircraft operator and the 
U.S. Government, the airline or aircraft operator remains responsible 
for compliance with this Order regardless of the involvement of any 
third party.
    Pursuant to 42 U.S.C. 268, customs officers and U.S. Coast Guard 
officers will assist in the implementation of this Order. Other federal 
departments and agencies, including the U.S. Department of Homeland 
Security and the U.S. Department of Transportation, may also cooperate 
and assist with implementation of this Order consistent with their own 
legal authorities.
    The U.S. Department of Justice may seek to prosecute individuals 
who knowingly and willfully submit false attestations in violation of 
18 U.S.C. 1001.

Relationship to Other Orders

    This Order operates in addition to, and does not supersede, modify, 
or replace, other CDC orders currently in effect concerning Ebola 
disease caused by the Bundibugyo virus, including the Order Suspending 
the Right to Introduce Certain Persons from Countries Where a 
Quarantinable Communicable Disease Exists issued pursuant to 42 U.S.C. 
265, 268 and 42 CFR 71.40, as most recently continued. Nothing in this 
Order limits the authority of CDC, the Department of State, the 
Department of Homeland Security, the Department of Transportation, or 
any other federal department or agency to take additional measures 
under their own separate legal authority.

Statement of Intent

    This Order shall be interpreted and implemented to achieve the 
following paramount objectives:
    <bullet> Preservation of human life;
    <bullet> Preventing the introduction, transmission, and spread of 
the Ebola virus into the United States; and
    <bullet> Preserving the health and safety of crew members, 
passengers, airport personnel, and communities.

Definitions

    21 days for purposes of the passenger attestation means a 21-day 
waiting period based on calendar days. Day 0 is the day the individual 
departed the DRC. Day 1 is the first full calendar day the individual 
is outside the DRC. An individual who was present in the DRC may board 
a flight to the United States on day 22.
    Aircraft shall have the same definition as under 49 U.S.C. 
40102(a)(6). ``Aircraft'' includes, but is not limited to, commercial, 
general aviation, and private aircraft destined for the United States 
from a foreign country.
    Aircraft Operator means an individual or organization causing or 
authorizing the operation of an aircraft.
    Airline shall have the same definition as under 42 CFR 71.1(b).
    Attest/Attestation means completion and signature of the 
attestation in Attachment A. Such attestation may be completed and 
signed in paper or digital form, including through electronic 
signature. The attestation is a statement, writing, entry, or other 
representation made under 18 U.S.C. 1001.
    Foreign country means anywhere that is not a state, territory, or 
possession of the United States.
    Present/Presence in the DRC means any physical presence, including 
entering or traveling through the country by air (excluding 
overflights), land, or sea. Presence also includes connecting through 
an airport in the DRC, even if the passenger did not disembark the 
plane or leave the airport.
    United States has the same definition as ``United States'' in 42 
CFR 71.1(b), meaning ``the 50 States, District of Columbia, and the 
territories (also known as possessions) of the United States, including 
American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of 
Puerto Rico, and the U.S. Virgin Islands.''

Exemptions

    The following are exempt from the requirements of this Order:
    <bullet> Aircraft operators transporting passengers with Ebola 
disease pursuant to U.S. Government authorization and in accordance 
with CDC guidance.
    <bullet> Individuals for whom the CDC has issued an exemption based 
on humanitarian or other important government considerations, e.g., 
emergency medical evacuations. Additional conditions may be placed on 
individuals granted such exemptions, including but not limited to, 
observing precautions during travel, providing consent to post-arrival 
monitoring, and/or self-quarantine after arrival in the United States, 
as may be directed by federal, state, territorial, tribal or local 
public health authorities to reduce the risk of disease transmission.

Background

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, and Lassa fever.
    Bundibugyo virus disease (BVD) is a severe and often fatal illness 
caused by

[[Page 67584]]

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. BVD 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 BVD is typically between 2 and 21 days, 
with most people developing symptoms within 4 to 10 days after 
exposure. During this incubation period, infected individuals do not 
spread BVD until symptoms begin.
    Screening for BVD focuses on identifying symptoms and possible 
exposure history, such as recent travel to affected areas or contact 
with infected individuals. Patients with suspected BVD 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 and contact tracing to identify suspected cases, and 
quarantine and isolation procedures, as applicable, to prevent 
transmission.
    There are currently no widely approved vaccines or specific 
antiviral treatments for BVD. 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. Clinical trials of 
monoclonal antibodies and of an existing vaccine approved for use to 
prevent disease caused by the Ebola Zaire virus are presently underway 
in the DRC.<SUP>1 2</SUP> However, experts expect it will be several 
months before these therapeutics are potentially available for wider 
use.
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    \1\ World Health Organization. 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 October 13, 2026).
    \2\ United Nations. Ebola vaccine research programme begins in 
DR Congo, <a href="https://news.un.org/en/story/2026/09/1168381">https://news.un.org/en/story/2026/09/1168381</a> (last 
accessed October 13, 2026).
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B. Ongoing Bundibugyo Virus Disease Outbreak

    The confirmed ongoing outbreak of BVD in the DRC continues to 
escalate in intensity. 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], Bas-U[eacute]l[eacute], Tshopo, 
North Ubangi, and South Ubangi provinces. This geographic expansion is 
concerning, particularly given that response efforts are still not at 
the scale required for outbreak containment. As of October 18, 2026, 
the DRC reports 9,455 confirmed cases and 4,561 deaths in 66 health 
zones across eight provinces.
    The World Health Organization has reported substantial under-
ascertainment of cases and persistent challenges with contact tracing. 
As of its most recent assessment, only approximately 20 percent of BVD 
cases were identified through follow-up of listed contacts, and 
approximately 40 percent were ultimately linked to a known chain of 
transmission, indicating substantial undetected transmission.\3\ 
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. Although contact tracing efforts are underway, they remain 
insufficient and the daily follow-up necessary to rapidly detect 
symptomatic individuals and ensure their prompt isolation has not been 
achieved.
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    \3\ Second meeting of the IHR Emergency Committee on the 
epidemic of Ebola Bundibugyo virus disease in the Democratic 
Republic of the Congo--Meeting report https://www.who.int/news/item/
28-08-2026-second-meeting-of-the-ihr-emergency-committee-on-the-
epidemic-of-ebola-bundibugyo-virus-disease-in-the-democratic-
republic-of-the-congo--meeting-report (last accessed October 13, 
2026).
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    Travelers who have unknowingly been infected with BVD may travel 
before becoming symptomatic. Such travelers may spread the virus beyond 
DRC and ultimately reach the United States. The DRC is connected to the 
global aviation network through a series of regional and international 
transit hubs that provide pathways into the United States. These 
international transportation corridors support continuous movement of 
travelers between Central and East Africa and major U.S. metropolitan 
centers, increasing the likelihood that travelers 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.
    The risk of BVD 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. The current outbreak has demonstrated this risk: 
for example, a physician infected while providing patient care in the 
DRC traveled internationally before becoming ill and was diagnosed only 
after arriving in France.\4\ That case required extensive public health 
coordination, including federal, state, and local government efforts to 
identify, notify, and monitor potentially exposed U.S. citizens, 
demonstrating that a single infected traveler can impose significant 
cross-border public health response demands even without onward 
transmission occurring within the United States. Additionally, 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.\5\ By October 19, 2026, 
Kenya had announced another seven cases had been confirmed in 
previously identified close contacts, reaching a total of eight BVD 
cases in Kenya, including the initial case that resulted in a death.\6\ 
The interconnected nature of global air travel presents a credible 
pathway for BVD importation into the United States, underscoring the 
importance of aggressive surveillance, traveler monitoring, airport 
public health screening, healthcare preparedness, and rapid containment 
capabilities.
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    \4\ World Health Organization, WHO Director-General's opening 
remarks at the media briefing--24 June 2026, available at <a href="https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---24-june-2026">https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---24-june-2026</a> (last accessed October 
13, 2026).
    \5\ 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 13, 2026).
    \6\ Ebola cases in Kenya rise to 8 after another person tests 
positive, <a href="https://apnews.com/article/kenya-ebola-congo-uganda-0b23b5ff00d39345037f2d298e92e24f">https://apnews.com/article/kenya-ebola-congo-uganda-0b23b5ff00d39345037f2d298e92e24f</a>.

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[[Page 67585]]

    The ongoing outbreak has also demonstrated that substantial U.S. 
public health resources may be required to respond to an Ebola exposure 
or infection in any U.S. citizen. On July 10, 2026, CDC announced that 
an additional U.S. citizen working for a humanitarian organization in 
the DRC had tested positive for BVD.\7\ The individual, who was not 
involved in direct patient care,\8\ prompted an extensive U.S. public 
health response. CDC, in coordination with the humanitarian 
organization, initiated contact tracing, exposure risk assessments, and 
monitoring activities to identify high-risk contacts and evaluate 
potential exposures among humanitarian personnel who had recently 
returned to, or are planning to return to, the United States. The 
Department of State arranged medical evacuation outside of the DRC for 
treatment. This incident demonstrates that even when an infected U.S. 
citizen remains overseas, the outbreak can require substantial U.S. 
public health resources to identify, assess, and monitor potentially 
exposed individuals associated with international humanitarian 
operations.
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    \7\ CDC, CDC Statement on Ebola Outbreak in the Democratic 
Republic of Congo and Uganda: 7/10/26, <a href="https://www.cdc.gov/media/releases/2026/cdc-ebola-outbreak-in-democratic-republic-of-congo-and-uganda.html">https://www.cdc.gov/media/releases/2026/cdc-ebola-outbreak-in-democratic-republic-of-congo-and-uganda.html</a> (last accessed October 13, 2026).
    \8\ Walsh, D. and Yoon, J., U.S. Citizen Tests Positive for 
Ebola in Democratic Republic of Congo, <a href="https://www.nytimes.com/2026/07/11/world/africa/dr-congo-ebola-american-us-citizen.html?unlocked_article_code=1.w1A.A4kv.spNPZlf8jap6&smid=url-share">https://www.nytimes.com/2026/07/11/world/africa/dr-congo-ebola-american-us-citizen.html?unlocked_article_code=1.w1A.A4kv.spNPZlf8jap6&smid=url-share</a> (last accessed October 13, 2026).
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    Travelers utilizing air transit pathways originating in the DRC 
include U.S. and non-U.S. citizens, 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 Travel Health Notices (THN) for affected countries 
and regions. Currently, there is a Level 4 THN for Ituri and Nord-Kivu 
Provinces of DRC (avoid all travel); a Level 3 THN for Haut-
U[eacute]l[eacute] and Tshopo Provinces of DRC (reconsider nonessential 
travel); a Level 2 THN (practice enhanced precautions) for the 
remainder of the DRC and Uganda; and a Level 1 THN (practice usual 
precautions) for Nairobi, Kenya.\9\ CDC modeling indicates that, absent 
rapid and sustained public health interventions, the outbreak could 
become one of the largest Ebola epidemics ever recorded.\10\ 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.\11\ CDC has 
concluded that the current outbreak is already the largest known 
outbreak of BVD and that large-scale, temporary 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.\12\ Commensurate with the deterioration of the 
epidemiological situation in the DRC, CDC escalated its response to the 
outbreak to a Level 1, the highest level within the agency's Graduated 
Response Framework.\13\
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    \9\ CDC Travel Health Notices, <a href="https://wwwnc.cdc.gov/travel/notices">https://wwwnc.cdc.gov/travel/notices</a>.
    \10\ 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>.
    \11\ Id.
    \12\ Id.
    \13\ CDC, Internal Decision Memo, June 26, 2026.
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    CDC has determined that the risk profile presented by the DRC is 
materially distinct from that of other affected countries. The DRC 
remains the epicenter of the outbreak, with an estimated 80 percent of 
newly confirmed cases in Ituri Province not linked to known contacts, 
indicating substantial undetected community transmission. Contact 
tracing, surveillance, and containment capacity in the DRC are impaired 
by conflict, insecurity, weak health infrastructure, and porous 
borders. CDC has therefore determined that a categorical temporary 
measure directed at travelers with recent presence in the DRC is 
appropriately tailored to the elevated importation risk presented by 
that country. CDC will continue to monitor conditions in the DRC and 
other affected countries and may modify the scope of this Order 
accordingly.

Statement of Good Cause Under the Administrative Procedure Act

    This Order is not a rule within the meaning of the Administrative 
Procedure Act (``APA'') but rather is an action taken under the 
existing authority of 42 U.S.C. 264(a) and 42 CFR 71.20, 71.31(b), and 
71.32(b), which were promulgated in accordance with the APA after full 
notice and comment rulemaking and a delayed effective date. If this 
Order qualifies as a new rule under the APA, notice and comment and a 
delayed effective date are not required because there is good cause to 
dispense with prior public notice and comment and a delay in effective 
date. See 5 U.S.C. 553(b)(B), (d)(3).
    Based on the foregoing, I have determined that Ebola disease caused 
by the Bundibugyo virus, a highly transmissible quarantinable 
communicable disease designated as such by Executive Order 13295, as 
amended, is confirmed present in the DRC. I have also determined that 
Ebola disease if introduced into the United States would constitute a 
public health emergency. I have considered other alternatives, 
including reliance on airport-based public health screening, voluntary 
questioning, and expansion of the existing federal public health travel 
restrictions process, and have determined that these alternatives, 
standing alone or in combination, would not adequately address the 
identified risk given the disease's incubation period of up to 21 days, 
the substantial proportion of asymptomatic transmission-window travel, 
and the demonstrated capacity of a single infected traveler to consume 
substantial U.S. public health resources. Finally, I determine that 
requiring airline passengers to submit an attestation confirming that 
they have not been present in the DRC during the 21 days prior to 
boarding a flight to the United States, combined with a conditioning of 
controlled free pratique on airline confirmation of such attestations, 
is a necessary public health measure to protect the public health and 
prevent the introduction, transmission, and spread of Ebola disease 
into the United States. In making these determinations I have 
considered the prevalence of Ebola disease in the DRC, that country's 
limited ability to screen for the disease and engage in other 
mitigation measures, and the potential for spread in the United States. 
Accordingly, I find that any delay in issuing this Order beyond the 
minimum necessary for operationally feasible implementation would be 
contrary to the public's health

[[Page 67586]]

in the United States and therefore the public's interest.
    Any delay in the effective date, would be impracticable and 
contrary to the public interest for the additional reason that the 
outbreak in the DRC continues to expand, the 21-day incubation period 
of Ebola disease means that each additional day of pre-effective delay 
materially increases the risk that infected persons will board flights 
bound for the United States while asymptomatic, and public notice of a 
forthcoming attestation requirement could prompt individuals presently 
in the DRC to accelerate their travel to the United States before the 
requirement takes effect, defeating the purpose of this Order.
    If any provision of this Order, or the application of any provision 
to any carriers, persons, or circumstances, shall be held invalid, the 
remainder of the provisions, or the application of such provisions to 
any carriers, persons, or circumstances other than those to which it is 
held invalid, shall remain valid and in effect.
    Pursuant to 5 U.S.C. 553(b)(B), and for the reasons stated above, I 
hereby conclude that notice-and-comment rulemaking would defeat the 
purpose of the Order and endanger the public health, and is, therefore, 
impracticable and contrary to the public interest. For the same 
reasons, I have determined, consistent with 5 U.S.C. 553(d)(3), that 
there is good cause to make this Order effective immediately following 
the minimum delay necessary for the Order's implementation to be 
operationally feasible.

Action

    For the reasons outlined above, I hereby determine that passengers 
covered by this Order are at risk of transmitting Ebola disease and 
requiring passengers to attest that they have not been present in the 
DRC during the 21 days prior to boarding a flight to the United States 
is needed as a public health measure to protect the health of other 
travelers and U.S. communities.
    This Order shall remain in effect until rescinded or modified based 
on specific public health or other considerations, or until December 
17, 2026, whichever occurs first. Any amendment or extension of this 
Order will be based on a review of then-current outbreak metrics, 
including case counts, geographic spread, community-transmission 
indicators, and containment capacity in affected countries.

1. Requirements for Airlines & Other Aircraft Operators

    This Order conditions the grant of controlled free pratique on the 
airline compliance measures specified below. This Order does not 
regulate landing rights, airspace access, or aircraft certification, 
which remain within the jurisdiction of the Department of 
Transportation, the Federal Aviation Administration, and other agencies 
exercising their respective legal authorities.
    Any airline or other aircraft operator with passengers who are not 
otherwise exempt from the requirements of this Order boarding a flight 
to the United States from a foreign country, shall:
    A. Confirm to the U.S. Government, at or before the time of 
boarding, that all passengers boarding or onboard the aircraft have 
completed and signed an attestation in paper or digital format 
confirming that they have not been present in the Democratic Republic 
of the Congo (DRC) during the 21 days preceding their boarding a flight 
to the United States. For purposes of this requirement, ``confirm'' 
means that the airline or aircraft operator has reviewed the completed 
attestation from each covered passenger prior to boarding and has 
determined, based on the face of the attestation, that the attestation 
is complete and signed; and
    B. Not board any passenger who has failed to complete and present 
such an attestation.
    C. Retain a paper or digital copy each passenger's completed and 
signed attestation for at least 42 days after the passenger's flight 
departs for the United States from a foreign country and provide the 
attestation to the U.S. Government on request.
    Any airline or other aircraft operator that fails to comply with 
section 1, ``Requirements for Airlines & Other Aircraft Operators,'' 
may be subject to criminal penalties under, inter alia, 42 U.S.C. 270 
and 271 and 42 CFR 71.2, in conjunction with 18 U.S.C. 3559 and 3571 
(providing for fines of up to $100,000 for individuals and $200,000 for 
organizations, and/or imprisonment of up to one year). CDC anticipates 
that separate compliance mechanisms may be established by the 
Transportation Security Administration pursuant to its own statutory 
authorities.
    Any airline or other aircraft operator that fails to provide the 
U.S. Government the confirmation of completed attestations of all 
passengers as outlined above will not receive controlled free pratique 
to enter a U.S. port of entry, disembark passengers, and begin 
operation with respect to arriving at an airport in the United States.

2. Requirements for Aircraft Passengers Who Are Not Otherwise Exempt

    A. Complete and sign the attestation under penalty of law as 
provided by 18 U.S.C. 1001 which provides criminal penalties for 
knowingly and willfully submitting false statements to the U.S. 
government; and
    B. Provide for confirmation the completed and signed attestation to 
the airline or other aircraft operator confirming that they have not 
been present in the Democratic Republic of the Congo (DRC) during the 
21 days preceding their boarding a flight to the United States.
    The required attestation text is attached to this Order as 
Attachment A. Unless otherwise permitted by law, a parent or other 
authorized individual may present the required documentation on behalf 
of a passenger under 18 years of age. An authorized individual may act 
on behalf of any passenger who is unable to act on their own behalf 
(e.g., by reason of age, or physical or mental impairment).
    Any passenger who fails to provide this attestation, or submits 
false or misleading information, may face a delay of travel, denial of 
boarding, or denial of boarding on future travel.
    Any passenger who fails to comply with the requirements of section 
2, ``Requirements for Aircraft Passengers,'' may be subject to criminal 
penalties under, inter alia, 42 U.S.C. 271 and 42 CFR 71.2, in 
conjunction with 18 U.S.C. 3559 and 3571. Willfully giving false or 
misleading information to the government may result in criminal 
penalties under, inter alia, 18 U.S.C. 1001. This Order shall be 
enforceable through the provisions of 18 U.S.C. 3559, 3571; 42 U.S.C. 
243, 268, 270, 271; and 42 CFR 71.2. The U.S. Department of Justice in 
its discretion may prosecute any individual who knowingly and willfully 
submits a false statement in violation of 18 U.S.C. 1001.

Effective Date

    This Order takes effect at 11:59 p.m. Eastern Standard Time on 
November 3, 2026. For individuals intending to travel to the United 
States by air, the Order will apply to flights departing at or after 
11:59 p.m. Eastern Standard Time on November 3, 2026.
    In testimony whereof, the Assistant Secretary for Health, U.S. 
Department of Health and Human Services, has hereunto set his hand at 
___, this October 22, 2026.
    Admiral Brian Christine, MD, Assistant Secretary for Health (ASH)

[[Page 67587]]

and Head of the United States Public Health Service (USPHS) 
Commissioned Corps, Department of Health and Human Services.

Authority

    The authority for this order is Sections 361, 365, 368, and 369 of 
the Public Health Service Act (42 U.S.C. 264, 268, 270, and 271), as 
amended.

Brian Christine,
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. 2026-21828 Filed 10-26-26; 8:45 am]
BILLING CODE 4163-18-P


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