New US Ebola Travel Restrictions: What Infection Preventionists Need to Know About the 21-Day Return Policy

As the Ebola cases in the Democratic Republic of the Congo (DRC) continue to grow, so does the need for international support (Figure 1). More of us now know a front-line responder who has deployed, or who is considering it. Working in public health as an infection preventionist (IP), I see these as our friends, colleagues, and community members. We understand the risk they are taking on. We understand the time away from their families.

However, there have been some changes in how the US is handling how and when frontline staff deploying to the DRC come home.

Changing How US Citizens Return Home from the DRC

Two different measures are in play, and both will impact returning to the US (Figure 2).

The first measure is a border order, issued on May 18, 2026, suspending the right to introduce certain persons who were present in the DRC, Uganda, or South Sudan within the previous 21 days. It has been continued on a rolling 30-day basis, most recently on July 13, and runs through August 12.¹ That order is the one that has been in the news since May. It exempts US citizens and nationals outright, as well as military and US government personnel serving overseas.¹

The second measure is one our front-line teams were not anticipating when they deployed. In mid-July, the CDC and the Department of Homeland Security (DHS) applied a Do Not Board process to travel from the DRC.^2,4 The guidance is unambiguous. Anyone who has been in the DRC within 21 days of their flight will not be permitted to board a commercial flight to the US. That includes citizens. They should plan to remain outside the DRC for 21 days first.³ Travelers coming from Uganda or South Sudan, and not the DRC, still enter through designated airports for enhanced screening.²

Read that carefully because it is not what it sounds like. The Do Not Board list is a travel mechanism, not a CDC-mandated quarantine order. The federal measure does not require health monitoring, a symptom log, clinical clearance, or sign-off by an authorized health provider at the end. It sets one condition for boarding a plane to any US airport: 21 days in a country other than the DRC.

Where Do People Spend 21 Extra Days?

US citizens were caught off guard when the Do Not Board process took effect. No federal guidance describes what they are supposed to do next.

There is no published return protocol. There is no list of approved isolation locations. The State Department has not responded to press inquiries about whether Americans are being quarantined abroad.⁶ What I can share comes from news accounts of 2 recent incidents.

The first involves a humanitarian aid organization. Seven asymptomatic American staff were moved from the DRC to an isolation facility in Kenya for a 21-day quarantine, under US Public Health Service observation.⁵ A State Department official described the move as voluntary.⁵

A second account, reported on July 22, shows how uneven this is. Fourteen Americans returning from the DRC by way of Canada, none of them responders and none symptomatic, were stopped attempting to reenter by land at 2 different ports of entry in Vermont and New York. They were ultimately taken to an Army base 30 miles from the border, held under CDC observation for 4 days, and released.¹³ The Do Not Board process reaches commercial flights. It does not reach the land border, and no order required their detention. Fourteen people at low risk were quarantined anyway; 7 asymptomatic aid workers in Kenya were left to a 21-day stay. Same outbreak, same risk profile, 2 entirely different answers.

This inconsistency directly contradicts the CDC's own guidelines for US personnel deployed to viral hemorrhagic fever outbreaks. Under CDC guidance, a 21-day travel restriction only applies after a high-risk exposure, such as a needle stick, unprotected contact with an infected patient or body, or a breach in personal protective equipment.¹⁴ While the CDC bases its rules on the specific actions and risks an individual worker faced, the Do Not Board order applies blanket restrictions based solely on where they were geographically located.

Who Pays for the Extra 21 Days?

The government has answered this question: the traveler.

The US Embassy in Kinshasa put it in writing on July 11, alongside a Level 4 Do Not Travel advisory. Americans who go may have to quarantine outside the US at their own expense for up to 21 days. The costs may be very significant, and insurance may not cover them.⁷ The embassy's July 24 alert states the restriction in the same terms. It drops the language about expense and insurance, telling Americans instead to contact the nearest embassy for financial assistance.⁸ CDC's guidance aligns with this, stating that the agency does not reimburse travelers for expenses incurred because of redirection. CDC's alternative is trip cancellation insurance, which it notes may cover an itinerary change due to an infectious disease outbreak.²

Follow the embassy referral for what is offered; it is a repatriation loan. It covers transportation, temporary food, and lodging. The published terms are explicit: the borrower's passport is restricted until the loan is repaid.⁹

For staff sent by a large organization, the employer absorbs the cost. Samaritan's Purse has said the requirement raises its costs for moving people to a third country and keeping them there.⁴ For contractors, per diem clinicians, academic volunteers, and short-term teams, it lands on the individual: 3 weeks of lodging, meals, and rebooked airfare, with lost income running underneath it.

What Happens to the Deployment Period?

Deployment periods vary, with active field rotations lasting approximately 4 to 6 weeks before being replaced by the next team. Now, add 21 days to the end of a deployment. A 6-week assignment becomes a 9-week absence.

Those 3 weeks come out of the employees' time away from their regular jobs and families. The commitment will impact who is willing to volunteer and how many clinicians’ humanitarian organizations can afford to send. That is not speculation. Samaritan's Purse reports that they have deployed roughly 80 US citizens to treatment centers in the DRC. As a result of the Do Not Board policy, they will need to curtail their work.⁴ This new requirement will further complicate recruiting efforts for clinicians who may or may not be able to take additional extended leave.

The international community does not agree that this measure is necessary. WHO issued temporary recommendations under the International Health Regulations on May 22. It placed the US in the lowest of 3 risk tiers. Neither flight suspensions nor denial of entry to travelers from affected countries was recommended.¹⁰ Africa CDC aligns with the WHO on this and does not advise travel bans. It has submitted requests to the US health secretary asking that the restrictions on Uganda be lifted, since Uganda has gone roughly a month without a new infection.¹¹

However, the federal stance is that the policy change is valid and based on recent events. On July 10, the CDC reported that a US citizen working for a humanitarian organization in the DRC had tested positive for Bundibugyo virus disease. Yet, that person had not been providing direct patient care. CDC then needed to trace and assess exposures among humanitarian personnel, some of whom had recently returned to, or were planning to return to, the US.¹ The best way to prevent an Ebola contact from transmitting the virus inside the US is to ensure they have completed the 21-day quarantine before entry.

What Is Still Unanswered?

Three questions matter to anyone planning a deployment, and none yet has a published answer.

Who pays for the added 21-day stay? Federal guidance is clear that travelers generally bear their own costs.^2,7 No primary source states who is billed when a traveler is held at a government-run site.

How does the process treat federal responders? The entry suspension order excepts US government personnel serving overseas, subject to agency assurances.¹ That order never applied to citizens in the first place. No published guidance describes how the Do Not Board process handles CDC or other federal staff rotating out of the DRC.

How is an exception requested? CDC states that case-by-case humanitarian or law enforcement exceptions exist.² No public process for requesting one has been described.

What Does a Travel Order Have to Do With My Facility?

Directly, not much. Indirectly, more than you may know.

CDC's own guidance puts part of this on our radar. Health care personnel returning from an outbreak area are told to notify the receiving facility's infection prevention or occupational health professional before providing patient care within the incubation period.¹⁴ That notification only works if someone on our side is expecting it.

If anyone in your organization deploys to the DRC or travels internationally, the trip home requires thoughtful planning. Anyone who flies into the DRC or sets foot onto DRC territory will be held to the order. That applies to a formal response team, a faith-based mission, an academic partnership, or personal leave. A couple of things worth settling before the next person goes:

Keep current on CDC guidance for returning travelers and the Do Not Board order. Colleagues weighing a deployment will ask, and so will the leaders deciding whether to support one.

Work closely with Employee Health on policies for staff deploying to the DRC. The situation is evolving, and IP input may be needed to keep those policies up to date.

The members of our teams who are supporting this effort will still go, putting people and patients first. The decision to require a 21-day quarantine before returning to the US delays when these selfless individuals can return home to their families.

Additional Resources

• Nelson EL, Kivlehan SM. Humanitarian aid workers. In: CDC Yellow Book: Health Information for International Travel. 2026 ed. CDC; April 23, 2025. Accessed August 3, 2026. https://www.cdc.gov/yellow-book/hcp/travel-for-work-other/humanitarian-aid-workers.html
• Viral hemorrhagic fevers: information for health care providers. CDC. Accessed August 3, 2026. https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/index.html

References

1. 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. CDC. Docket No. CDC-2026-0892. July 13, 2026. Accessed August 2, 2026. https://www.federalregister.gov/d/2026-14365
2. Information for travelers returning from Ebola-affected areas. CDC. Accessed August 2, 2026. https://www.cdc.gov/ebola/situation-summary/returning-travelers.html
3. Additional consular information for Americans regarding the Ebola outbreak. US Department of State, Bureau of Consular Affairs. Updated July 24, 2026. Accessed August 2, 2026. https://travel.state.gov/en/international-travel/travel-advisories/global-events/ebola_additional_information.html
4. Tsvetkova M, Das K. US quarantine order for Americans returning from Congo will hurt Ebola response, aid group says. Reuters. July 15, 2026. Accessed August 2, 2026. https://www.cnbcafrica.com/2026/us-quarantine-order-for-americans-returning-from-congo-will-hurt-ebola-response-aid-group-says
5. 7 Americans quarantine at Kenya Ebola facility, aid group says. The EastAfrican. Reuters. July 17, 2026. Accessed August 2, 2026. https://www.theeastafrican.co.ke/tea/sustainability/health/7-americans-quarantine-at-kenya-ebola-facility-5529762
6. Musambi E. Ebola quarantine center for Americans is up and working in Kenya despite a court ban, activists say. Associated Press. July 20, 2026. Accessed August 2, 2026. https://www.usnews.com/news/us/articles/2026-07-20/ebola-quarantine-center-for-americans-is-up-and-working-in-kenya-despite-a-court-ban-activists-say
7. US Embassy Kinshasa. Health alert: US Embassy Kinshasa, Democratic Republic of the Congo. July 11, 2026. Accessed August 2, 2026. https://cd.usembassy.gov/health-alert-u-s-embassy-kinshasa-democratic-republic-of-the-congo-july-11-2026/
8. Health alert: US Embassy Kinshasa, Democratic Republic of the Congo. US Embassy Kinshasa. July 24, 2026. Accessed August 2, 2026. https://cd.usembassy.gov/health-alert-u-s-embassy-kinshasa-democratic-republic-of-the-congo-july-24-2026/
9. Emergency financial assistance for US citizens abroad. US Department of State, Bureau of Consular Affairs. Updated August 11, 2025. Accessed August 2, 2026. https://travel.state.gov/en/international-travel/help-abroad/financial.html
10. First meeting of the IHR Emergency Committee regarding the epidemic of Ebola Bundibugyo virus disease in the Democratic Republic of the Congo and Uganda 2026: temporary recommendations. World Health Organization. May 22, 2026. Accessed August 2, 2026. https://www.who.int/news/item/22-05-2026-first-meeting-of-the-ihr-emergency-committee-regarding-the-epidemic-of-ebola-bundibugyo-virus-disease-in-the-democratic-republic-of-the-congo-and-uganda-2026-temporary-recommendations
11. Africa CDC demands US ends Ebola travel ban on Uganda. Daily Nation. Reuters. July 21, 2026. Accessed August 2, 2026. https://nation.africa/kenya/news/africa/africa-cdc-demands-us-ends-ebola-travel-ban-on-uganda-5533890
12. Daily epidemiological update on acute public health events: Ebola disease (Bundibugyo virus). World Health Organization. Data as of July 31, 2026. Accessed August 2, 2026. https://www.who.int/emergencies/alert-and-response
13. Bogage J, Abutaleb Y. US quarantined citizens at New York military base after return from Congo, sources say. Reuters. July 22, 2026. Accessed August 2, 2026. https://www.reuters.com/business/healthcare-pharmaceuticals/us-quarantined-citizens-new-york-military-base-after-return-congo-sources-say-2026-07-22/
14. Recommendations for organizations sending US-based personnel to areas with VHF outbreaks. CDC. May 6, 2025. Accessed August 2, 2026. https://www.cdc.gov/viral-hemorrhagic-fevers/php/partners/recommendations-for-vhf-outbreaks.html