航空传播传染病风险评估指南（RAGIDA）：埃博拉疾病更新

Risk assessment guidelines for infectious diseasestransmitted on aircraft (RAGIDA) – Ebola disease update 30 May 2026 Background The ongoing outbreak of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo (DRC) andUganda reported in May 2026 [1] has prompted ECDC to review its operational guidance relevant to air travel. In thiscontext, updated guidance is needed to support preparedness and public health action if a case is identified during orafter a flight. This ECDC rapid scientific advice builds on the Ebola disease content previously included in the haemorrhagic feverschapter of the ‘Risk assessment guidelines for diseases transmitted on aircraft (RAGIDA)’ [2]. In the original 2010guidance, Ebola disease was included under haemorrhagic fevers; in 2011, the guidance was expanded to coveradditional diseases. This updated information is intended to support public health authorities and other competent national authorities inEuropean Union/European Economic Area countries by providing actions to consider after the identification of asuspected or confirmed Ebola disease case during or after a flight. Early recognition of the disease and risk assessment are needed to support an appropriate public health response whena potentially infectious passenger is identified during or after a flight, while avoiding unnecessary alarm or disruption toair traffic. Methods The methods used to develop the original operational guidance are described in the RAGIDA – Part 2 document [2]. Forthis rapid scientific advice, the content relevant to Ebola disease was reviewed and adapted from the haemorrhagicfevers chapter of that guidance. The text was updated, where needed, in light of evidence and operational experienceaccrued since the publication of the 2011 guidance. To produce this update, ECDC experts reviewed the peer-reviewed and grey literature for reports relevant to Eboladisease and air travel (Annex 1) and consulted additional operational and guidance documents relevant to public healthmanagement in relation to air travel (Annex 2). Results of the literature review The literature search did not identify any published reports describing orthoebolavirus transmission events associated with airtravel. After the 2013–2016 Ebola disease outbreak in West Africa, several publications described travellers who tookcommercial flights from West Africa to such countries as the United Kingdom, the United States (US) and Italy who weresubsequently diagnosed with Ebola disease [3-7]. However, these reports did not describe symptoms occurring during theflight. In one of these publications, an imported case was detected after the passenger arrived in the US. Public healthauthorities carried out contact tracing of passengers and crew members who had been on the same flight, as the date ofsymptom onset was unclear. None of the traced contacts were later found to be positive for Ebola virus infection [5]. Ebola disease case definitions For the purposes of this guidance, an index case is a person under investigation or a confirmed case identified during or aftera flight, based on the applicable outbreak-specific case definitions in use at the time. For the current outbreak of Eboladisease caused by Bundibugyo virus in DRC and Uganda, the relevant case definitions are available on the ECDC website [8]. In relation to air travel, the key considerations that might prompt contact tracing or other public health action arewhether the person met the applicable case definition and was symptomatic during the flight. Detection of an index case In this guidance, an ‘index case’ is a person under investigation or a confirmed case identified in relation to a flight. Thedistinction between identification during a flight or after a flight reflects when the case first comes to the attention of thecrew or public health authorities. In both situations, the key question is whether or not the person was symptomaticduring the flight, because Ebola disease is not considered transmissible before symptom onset. Symptoms compatible with Ebola disease may include fever, severe headache, muscle pain, weakness, fatigue, sorethroat, vomiting, diarrhoea, abdominal pain, or unexplained bleeding or bruising. If the case is identified during the flight If a passenger develops symptoms compatible with Ebola disease during the flight, the crew should assess whether theperson meets the applicable outbreak-specific case definition and manage the event as a possible Ebola disease case. The International Air Transport Association (IATA) has published recommendations related to air transport andcommunicable disease [9,10]. These provide the cabin crew with guidelines for how to manage a suspected case ofcommunicable disease onboard [11]. The following actions should be considered if a passenger becomes unwell during the flight: i.Assess the exposure history of the passenger (related to the epidemiological and high-risk exposure c