Health and Human Services Agency
California Department of Public Health

AFL 26-19

June 24, 2026

TO:

General Acute Care Hospitals

SUBJECT:

Ebola Disease Information and Preparedness

AUTHORITY: Title 22 California Code of Regulations (CCR) sections 70737(a), 70739, 71535, and 71537

All Facilities Letter (AFL) Summary

This AFL provides recommendations and resources from the California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC) regarding Ebola disease and other select viral hemorrhagic fever preparedness for hospitals and other emergency care settings (including urgent care clinics) that may need to manage a patient with Ebola-like symptoms and who has a potential exposure to Ebola.

Background

The Democratic Republic of Congo (DRC) and Uganda are currently experiencing a large outbreak of Ebola disease caused by the Bundibugyo virus, one of the four orthoebolaviruses known to cause human illness (refer to the CDC's Viral Hemorrhagic Fever (VHF) webpage). The situation is rapidly evolving, and the CDC is maintaining up-to-date case counts on their Ebola Outbreak webpage. The CDC is currently screening travelers returning from affected countries and evaluating them for risk of Ebola disease at entry to the United States. CDPH receives information on returned travelers and notifies local health departments (LHDs) of returned travelers in California. Returned travelers are monitored for 21 days after leaving an Ebola-affected country. Healthcare providers should periodically check for CDC updates and/or otherwise stay up to date on the situation and public health guidance.

Guidance for All Healthcare Facilities

The CDC has indicated that the risk of Ebola to the general public in the United States remains low. If a returned traveler under monitoring develops symptoms concerning for Ebola disease, CDPH and LHD authorities will make every effort to have that person evaluated at a healthcare facility prepared to provide the necessary care and evaluation. However, a patient with recent travel history to an Ebola-affected country with symptoms consistent with an infectious disease may seek care at a California healthcare facility without the awareness or prior notification of local, state, or federal health authorities.

Title 22 CCR sections 70739 and 71537 require hospitals to have a written infection control program for the surveillance, prevention and control of infections. CDPH reminds healthcare providers and hospitals to have protocols in place to ask patients with signs or symptoms of acute and possibly infectious illness about recent international travel. The CDC recommends and Joint Commission (Standard IC.07.01.01, EP1 (PDF)) requires that hospitals establish procedures for screening at the points of entry to the hospital for respiratory symptoms, fever, rash, and travel history (see the CDC's Clinical Screening and Diagnosis for VHFs webpage). All California hospitals should be able to:

Identify and triage persons with relevant Ebola exposure history and signs or symptoms compatible with Ebola disease, and immediately
Isolate the patient while continuing to provide appropriate care, ensure necessary steps are taken to protect staff caring for the patient, and immediately
Inform the facility infection control program, LHD, and respective district office.

After notification from the facility, the LHD, CDPH, CDC, and the healthcare facility will work together to determine if the patient meets the suspected case definition warranting testing for Ebola (refer to the CDC's Clinical Screening and Diagnosis for VHFs webpage), and if so, arrange a transfer as quickly as possible to a facility that can provide further Ebola assessment and care. Transfer may be delayed while arranging testing and transport, so all facilities should have plans to manage a suspected Ebola case for up to 36 hours as they await transfer.

All hospitals should prepare now to identify, isolate, and inform their LHD regarding a suspected Ebola case:

Develop or review Ebola-specific policies and procedures in accordance with CDC's guidance (refer to the CDC's Clinical Screening and Diagnosis for VHFs and Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected VHFs) and CDPH's guidance on personal protective equipment (PPE) for selected VHFs (refer to CDPH's PPE Guidance for Selected VHFs), including roles and points of contact within the facility and with the LHD.
Implement routine triage evaluation for international travel for all patients presenting with potentially infectious symptoms.
Develop processes that minimize the time in triage prior to isolation in a private room with a dedicated bathroom or commode for any person who should be evaluated for whether they meet suspected case criteria.
Determine a method for performing detailed patient/family interviews in coordination with public health to rapidly clarify a patient's exposure risk and clinical status with minimal contact between healthcare personnel (HCP) and the patient, such as via telephone communication while HCP remain outside the isolation room (refer to the CDC's Screening and Evaluating an Ill Person for VHF webpage).
Select and standardize the PPE ensemble(s) the facility will use for a suspected Ebola case in accordance with CDPH PPE guidance. It is unlikely that hospitals will be required to provide prolonged care for a severely ill patient at high risk for Ebola disease; most patients can be cared for using PPE in CDPH's guidance for a clinically stable suspected case (refer to CDPH's PPE Guidance for Selected VHFs webpage).
Ensure your facility has enough appropriate PPE supplies to care for a suspected Ebola case while awaiting transfer. The wait time for transfer is highly variable and facilities should prepare to provide care for up to 36 hours.
Identify and train a group of volunteer staff ahead of time who will care for a suspected Ebola case, including a trained observer to monitor PPE donning and doffing procedures. Provide repeated training and practice, especially for doffing PPE.
Conduct a first-patient drill or exercise to review and practice procedures and identify potential gaps in readiness.
Develop facility-specific protocols for safe handling of Ebola-related medical waste. CDPH has developed interim guidelines for EVD medical waste management. The interim guidelines can be found at the CDPH Medical Waste Management Program webpage, including guidance for Ebola Medical Waste (PDF).

Hospitals should prioritize planning for the most likely scenario, not the most extreme. An example of a more likely scenario is a clinically stable patient presenting with fever and travel from an affected country in the past 21 days but without an epidemiologic risk factor or known exposure to Ebola. Signs and symptoms of Ebola disease are similar to other illnesses associated with international travel, including malaria, which is the most common cause of undifferentiated fever in returning travelers from sub-Saharan Africa. Malaria can progress rapidly and severely, therefore early diagnosis and treatment are critical, and malaria testing should not be delayed. If CDPH and the LHD determine a patient is not a suspected Ebola case and does not require testing for Ebola, the patient can be managed with Standard and Transmission-based Precautions, as appropriate, while considering other diagnoses (e.g., malaria).