January 8, 2026

Hand hygiene is universally recognised as the single most effective intervention to prevent healthcare-associated infections. Yet despite decades of global campaigns, educational programmes, and policy mandates, compliance rates in healthcare settings worldwide remain stubbornly low — averaging 40–60% across most facilities, with some studies reporting rates below 30% in high-risk units such as ICUs.

The question is no longer what to do — the evidence is clear. The question is why don't healthcare workers do it consistently, and what interventions actually produce lasting change?

The Behavioural Science of Non-Compliance

Research in health psychology identifies three root causes of hand hygiene non-compliance: (1) Capability gaps — staff don't know when or how to perform hand hygiene correctly; (2) Opportunity barriers — ABHR is not accessible at the point of care, or workflow makes compliance inconvenient; (3) Motivation deficits — staff don't believe their hands are contaminated, don't perceive the risk to their patient, or don't see peers and leaders doing it.

Most hospital interventions address only capability — through training and posters. This explains why compliance improves immediately after training and then rapidly decays. Lasting change requires simultaneously addressing opportunity and motivation.

What the Evidence Shows Works

The WHO Multimodal Hand Hygiene Improvement Strategy — implemented in over 100 countries — identifies five components that must be implemented simultaneously: (1) System change: ensuring ABHR is available at every point of care; (2) Training: educating all staff using WHO materials; (3) Evaluation and feedback: regular audit with unit-level data shared with teams; (4) Reminders in the workplace: cues at point of care; (5) Institutional safety climate: executive leadership visibly engaged.

Facilities that implement all five components achieve compliance rates of 70–80% — significantly above the global average. Those that implement only one or two components see minimal sustained improvement.

Electronic monitoring technology — including AI-powered video monitoring and sensor-based systems — is showing promise as an objective, real-time complement to direct observation, providing granular data that enables targeted feedback at the individual and unit level.

Published by No Infection Consulting & Education · January 8, 2026

February 12, 2026

In 2024, the Lancet published landmark data showing that antimicrobial resistance (AMR) directly caused 1.27 million deaths globally — more than HIV/AIDS and malaria combined. By 2050, AMR is projected to cause 10 million deaths annually unless dramatic action is taken. We are living through the early stages of what infectious disease specialists have called the post-antibiotic era.

For healthcare professionals in 2026, this is not an abstract global health concern — it is a daily clinical reality. Patients with infections caused by carbapenem-resistant Enterobacterales (CRE), pan-resistant Acinetobacter baumannii, or extensively drug-resistant tuberculosis face treatment options that were unthinkable a generation ago: last-resort antibiotics with significant toxicity, combination therapies with uncertain efficacy, or in the most severe cases, no effective treatment at all.

The Drivers of Resistance

Resistance emerges and spreads through a combination of evolutionary pressure (antibiotic use selects for resistant organisms) and transmission (resistant organisms spread between patients via healthcare workers' hands, contaminated surfaces, and shared equipment). Both drivers must be addressed simultaneously. Antibiotic stewardship programmes reduce selection pressure by ensuring antibiotics are used only when necessary and with the narrowest effective spectrum. Infection prevention programmes interrupt transmission by keeping resistant organisms from spreading once they are present.

The IPC Practitioner's Role

IPC practitioners are on the front line of the AMR response. Key responsibilities include: implementing and maintaining contact precautions for MDRO-colonised and infected patients; conducting active surveillance cultures in high-risk units; leading environmental decontamination using appropriate sporicidal agents; coordinating with the ASP team to share resistance data and co-manage outbreak investigations; and educating clinical staff about the connection between their individual prescribing and hand hygiene practices and the facility's resistance profile.

Published by No Infection Consulting & Education · February 12, 2026

March 5, 2026

The CLABSI bundle — maximal sterile barrier precautions, chlorhexidine skin antisepsis, optimal site selection, daily necessity review, and hub disinfection — has been the standard of care for over a decade. Yet across US hospitals, CLABSI rates persist at an average of 0.8 per 1,000 catheter days in adult ICUs. What separates facilities that achieve and sustain zero CLABSI from those that continue to have preventable infections?

We spoke with IPC leads from three ICUs — a medical ICU in Boston, a surgical ICU in Houston, and a cardiothoracic ICU in Miami — that each maintained zero CLABSI for 24 or more consecutive months. Their stories reveal common themes that go beyond protocol compliance.

1. They Treat Every CLABSI as a System Failure, Not a Personal Failure

All three units conduct a formal root cause analysis for every CLABSI event — not to identify who failed, but to identify what system conditions allowed the failure to occur. This approach, grounded in just culture principles, surfaces genuine contributing factors (inadequate supply access, understaffing, knowledge gaps) rather than simply documenting that a protocol was not followed.

2. Nurses Are Empowered to Stop Non-Compliant Insertions

All three units have formalised the nurse's role as an observer during central line insertions, with explicit authority — and expectation — to halt the procedure and address technique concerns without fear of retribution. This requires sustained cultural and leadership investment, but dramatically reduces insertion bundle violations.

3. They Celebrate Every Milestone Publicly

Public celebration of CLABSI-free milestones — displayed on unit whiteboards, announced at huddles, shared with hospital leadership — reinforces the team's identity as a high-performing unit and creates social motivation to protect the record. This shifts the dynamic from compliance-as-obligation to compliance-as-pride.

Published by No Infection Consulting & Education · March 5, 2026

April 18, 2026

Occupational contact dermatitis (OCD) is one of the most prevalent work-related skin conditions among healthcare workers, affecting an estimated 10–30% of nurses and other clinical staff. Paradoxically, this condition — caused in large part by the very infection prevention measures healthcare workers are required to perform — can itself increase infection transmission risk. Damaged skin loses its integrity as a physical barrier, harbouring more pathogenic organisms and shedding more organisms during patient care.

Healthcare workers with symptomatic dermatitis are also significantly less likely to perform hand hygiene at the required frequency, creating a vicious cycle of reduced compliance and increased infection risk. Understanding and preventing OCD is therefore not merely an occupational health issue — it is an IPC imperative.

Types and Causes

Irritant contact dermatitis (ICD) is the most common form, caused by cumulative exposure to water, detergents, and chemical irritants. It typically presents as redness, dryness, cracking, and fissuring of the hands and wrists. Allergic contact dermatitis (ACD) is an immune-mediated reaction to specific allergens — most commonly latex proteins (from latex gloves), preservatives in ABHR products, and fragrances in skincare products. ACD causes more intense inflammation and requires identification and avoidance of the specific allergen.

Evidence-Based Prevention

Effective prevention strategies include: selecting ABHR products with added emollients (most modern products contain these — check the formulation); providing skin moisturiser containing dimethicone or glycerin in all clinical areas and encouraging use after each shift; switching to nitrile latex-free gloves facility-wide to eliminate latex sensitisation; avoiding antibacterial soaps with triclosan or high concentrations of iodine for routine hand hygiene; and providing occupational health assessment for any healthcare worker with persistent symptoms. Early identification and management of OCD prevents progression to chronic disease and supports sustained hand hygiene compliance.

Published by No Infection Consulting & Education · April 18, 2026

May 27, 2026

The rise of mandatory online learning in healthcare has produced a paradox: unprecedented access to IPC education, and unprecedented evidence that much of it doesn't change behaviour. Studies consistently show that knowledge scores improve immediately after completion of e-learning modules — and return to baseline within weeks, with little change in observed clinical practice.

What separates e-learning that creates lasting behavioural change from e-learning that merely satisfies a compliance checkbox? The answer lies in instructional design principles that are frequently ignored in healthcare e-learning development.

The Problem with Passive Content

Most healthcare e-learning presents information passively: text screens, narrated slides, videos. Learners absorb information briefly and then move on. Without active recall, spaced repetition, or application to real clinical scenarios, this information is not encoded into long-term memory. The click-through behaviour — advancing through slides as quickly as possible to reach the completion screen — is a rational response to poorly designed mandatory training.

Evidence-Based Design Principles

Effective IPC e-learning incorporates: (1) Case-based learning — presenting clinical scenarios requiring the learner to make decisions before revealing the correct answer; (2) Active recall — frequent low-stakes questions that require retrieval of previously learned information, exploiting the testing effect; (3) Spaced repetition — reintroducing key concepts at intervals to strengthen long-term retention; (4) Feedback — immediate, explanatory feedback on incorrect answers that addresses misconceptions rather than simply stating the correct answer; (5) Transfer-appropriate practice — scenarios that closely mirror the clinical situations where the behaviour must be applied. At No Infection, all our courses are designed on these principles — our final assessments are not afterthoughts but integral to the learning process.

Published by No Infection Consulting & Education · May 27, 2026

July 14, 2026

Every hospital construction and renovation project represents a potential threat to the most vulnerable patients in the facility. Aspergillus fumigatus and other environmental moulds — ubiquitous in soil, decaying vegetation, and building materials — are mobilised in large quantities when walls are demolished, ceilings disturbed, or air handling systems disrupted. For immunocompromised patients, particularly those undergoing haematopoietic stem cell transplantation or receiving intensive chemotherapy, inhalation of even a small number of Aspergillus conidia can cause invasive pulmonary aspergillosis — a condition with mortality rates of 30–90% in the most immunosuppressed patients.

The Infection Control Risk Assessment (ICRA) is the systematic framework used to evaluate infection risks associated with construction, renovation, and maintenance activities in healthcare facilities, and to implement proportionate control measures before, during, and after the project.

The ICRA Process

The ICRA involves two matrices: (1) Patient risk group — from low risk (general medicine patients) to highest risk (allogeneic HSCT recipients); (2) Construction activity type — from Type A (minor maintenance without dust) to Type D (major demolition generating significant dust). The intersection of these two matrices determines the required infection control class (Class I through IV) and the specific barrier and monitoring requirements. For the highest-risk combination, requirements include: full dust barriers from floor to ceiling, sealed with tape; negative pressure within the construction zone maintained at all times; HEPA-filtered air supplied to the construction area; patient relocation from adjacent areas if barriers cannot be fully maintained; and daily monitoring of construction zone air pressure differentials.

Published by No Infection Consulting & Education · July 14, 2026

May 6, 2026 · No Infection Consulting & Education

An outbreak of Andes hantavirus pulmonary syndrome linked to the expedition vessel MV Hondius has been confirmed, with cases spanning multiple countries and involving both passengers and crew.

What Happened

The MV Hondius, an expedition cruise ship, departed Ushuaia, Argentina in early April 2026 after completing a birdwatching tour of the Patagonian region. Shortly after departure, passengers and crew began developing febrile illness. Laboratory testing confirmed Andes hantavirus.

The index case — a Dutch passenger — had undertaken a four-month road trip through Chile, Uruguay and Argentina before boarding the ship. He and his wife had spent time birdwatching in areas where rodents have previously tested positive for hantavirus. He returned to Argentina from Uruguay just four days before embarkation.

Why This Outbreak Is Unique

The Andes virus is the only known hantavirus strain capable of human-to-human transmission. This was first documented in the 2018 Epuyén outbreak in Argentine Patagonia, where a rural worker transmitted the virus to contacts at a birthday party. The MV Hondius event represents the first documented ship-based Andes virus cluster.

IPC Implications for Healthcare Teams

Any healthcare facility receiving passengers or crew from the MV Hondius should apply droplet and contact precautions immediately and notify public health authorities before laboratory confirmation. The maximum incubation period for Andes hantavirus is 8 weeks. Patients presenting with febrile pneumonia of unclear etiology who traveled to South America in the past 8 weeks warrant an explicit travel and exposure history..

Published by No Infection Consulting & Education · May 6, 2026

May 9, 2026 · No Infection Consulting & Education

The MV Hondius reached the Port of Granadilla de Abona in Tenerife, Canary Islands. WHO Director-General Tedros Adhanom Ghebreyesus flew personally to oversee the evacuation — a signal of how seriously international authorities are treating this event.

Case Count — May 9, 2026

Confirmed cases: 6 · Suspected: 2 · Deaths: 3 (2 confirmed Andes virus) · Possible 9th case: Woman in Alicante, Spain

US Repatriation to Nebraska

The 17 American passengers were transported to Offutt Air Force Base, Omaha, and transferred to the National Quarantine Center at the University of Nebraska. Each passenger underwent individual exposure risk assessment. Those without symptoms were offered home-based monitoring for 42 days — reflecting the maximum incubation period for Andes hantavirus.

A Ship Not Built for This

The MV Hondius carries one doctor, oxygen tanks, and over-the-counter medications. No ventilators. No ICU. By the end of April, the ship's own doctor was among the ill. A passenger who happened to be a physician stepped in on May 1 to care for the others. The body of a third victim remained in storage aboard during the voyage to Tenerife.

Published by No Infection Consulting & Education · May 9, 2026

May 15, 2026 · No Infection Consulting & Education

Eleven people died in Epuyén in 2018. Three died on the MV Hondius in 2026. And yet, in both outbreaks, other infected people survived. Understanding why requires a look inside the immune system — and a tug of war that most people have never heard of.

The Virus Does Not Destroy Cells Directly

The first surprise about hantavirus is that it does not kill by destroying your cells. Instead, it targets a very specific cell type — the endothelial cells that line the inner walls of your blood vessels. These cells control fluid balance, blood pressure, and what stays inside the vessels.

The virus infects these cells and multiplies inside them, but does not destroy them directly. What it does is trigger an alarm. And in some people, that alarm response becomes catastrophic.

The Tug of War

When any infection is detected, the immune system releases chemical messengers called cytokines. There are two groups — and they work like two teams in a tug of war.

On one side: the pro-inflammatory cytokines — IL-1, IL-6, IL-8, TNF, and interferon-gamma. These are the attackers. They cause inflammation, recruit immune cells, and fight the invader aggressively.

On the other side: the anti-inflammatory cytokines — IL-4, IL-10, IL-11, and IL-13. These are the brakes. Their job is to calm the response once the threat is contained — to tell the immune system: "Enough. Stand down. We won."

In a healthy response, the two teams stay balanced. The attackers fight. The brakes activate. The body heals. But in some people infected with hantavirus, the attacking team pulls so hard and so fast that the braking team never gets a chance to respond. The result is the cytokine storm.

Drowning from the Inside

When the cytokine storm hits, the massive inflammatory response makes the blood vessel walls permeable — they begin to leak. Fluid escapes from the bloodstream and floods into the lungs. The air sacs fill. The patient cannot breathe.

They are not drowning in water. They are drowning in their own plasma, leaking from their own blood vessels into their own lungs. This is hantavirus pulmonary syndrome — and it is why patients can deteriorate from flu-like symptoms to respiratory failure within hours.

This same mechanism — the cytokine storm — is responsible for the most severe cases of COVID-19, dengue hemorrhagic fever, and bacterial sepsis. Different pathogens, but the same broken tug of war.

Why Some People and Not Others

Three factors determine whether the cytokine storm develops:

1. Genetics. Certain variants of the HLA system — Human Leukocyte Antigen — are associated with a more explosive immune response to hantavirus. These people are not weaker; their immune systems may actually be more powerful. But in this context, that power becomes a liability. This is why young, physically fit people sometimes die while older individuals survive.

2. Viral load. The more contaminated dust inhaled, the larger the initial viral dose. The larger the dose, the harder the attackers pull — and the harder it becomes for the brakes to stop them. This is why the most important prevention advice is simple: never dry-sweep a space where rodents may have been. Always wet-clean. Always ventilate before entering.

3. Speed of medical care. Hantavirus progresses in two phases. The prodrome — fever, intense muscle aches, headache — looks exactly like influenza. Then the transition: sometimes within hours, oxygen levels drop and respiratory failure begins. Patients who are already in intensive care before that transition have significantly better survival rates. Those who go home with a flu diagnosis and deteriorate overnight often do not make it back in time.

What to Do

If you or someone close to you has been in any environment where rodents may have been present — a garage, a storage room, a rural area in South America, a cabin that has been closed — and within eight weeks develops fever, intense muscle aches and any difficulty breathing: go to an emergency department immediately. And say these seven words: "I may have been exposed to hantavirus."

Those words change how a physician manages your case. They can save your life.

For healthcare professionals: add hantavirus to your differential for any patient with unexplained febrile illness and a history of rodent exposure or rural travel. The prodrome is clinically indistinguishable from influenza. The exposure history is your only early clue.

Published by No Infection Consulting & Education · May 15, 2026

May 16, 2026 · No Infection Editorial Team

This is the May 16 update to our ongoing coverage of the MV Hondius Andes hantavirus outbreak — the first documented ship-based cluster in history. For the first time since the outbreak began, there are signs of stabilization.

Case Count — May 16, 2026

Good News: No New Cases

For the first time since the outbreak was declared, the ECDC confirmed on May 16 that no new cases or deaths have been reported since the previous update. The risk to the EU/EEA general population remains very low. This is an encouraging sign — but the monitoring period is far from over. All former passengers and high-risk contacts remain under active surveillance until June 21, 2026 (42 days from May 10, the date set as Day 0 by the ECDC).

Passengers Quarantined Across 13 Countries

All original passengers have now disembarked and been repatriated. Former passengers are currently hospitalized or in quarantine in Australia, Canada, France, Germany, the Netherlands, Saint Helena, Singapore, South Africa, Spain, Switzerland, Turkey and the United States — spanning four continents.

The evacuation from Tenerife involved military and government aircraft from multiple countries. Spanish passengers were the first to leave, flown to Madrid and taken to a military hospital. French passengers landed in Paris where emergency vehicles were waiting on the tarmac. British passengers were bussed directly to the airport wearing full protective equipment.

United States: Nebraska Quarantine Update

The 18 American passengers were evacuated to Offutt Air Force Base, Omaha, and transferred to the National Quarantine Center at the University of Nebraska Medical Center. As of today, 16 are being monitored at the facility and one is housed in the biocontainment unit. Nine additional individuals with possible exposure who returned to their home states earlier are being monitored by state health departments.

Notably, an American physician who had initially tested positive announced that further confirmatory testing showed no evidence of hantavirus infection. The CDC has stated it will not provide updates on the individual clinical status of passengers in quarantine, citing patient privacy.

Across the United States, 41 people are currently under monitoring for potential infection — including 6 people who were on commercial flights with passengers later confirmed to have the virus. None have shown signs of illness.

The Ship: Returning to the Netherlands

The MV Hondius is currently at sea with 27 crew members and is scheduled to arrive at its final destination in the Netherlands on May 18, 2026. The ship departed with 175 passengers and crew from Ushuaia on April 1. Those 27 remaining crew members are themselves under active monitoring.

Index Case: The Landfill Question

New reporting this week has raised an important epidemiological question. Scientific American and other outlets are reporting that experts are examining whether the index case — the Dutch passenger who is believed to have acquired the virus before boarding — may have been exposed at an Argentine landfill site during the birdwatching tour, rather than in a conventional rural setting. Rodent activity around waste sites is known to be high, and this hypothesis is under active investigation by Argentina's Malbrán Institute, which continues to capture and test rodents along the route the passenger traveled.

Unrelated Case in Washington State

Washington State Department of Health announced a separate hantavirus case with no connection to the MV Hondius. The individual was infected through direct rodent exposure and carries a strain of hantavirus that does not spread person-to-person. This serves as a reminder that hantavirus risk in the United States exists independently of the ship outbreak — across 48 states, year-round.

IPC Key Points for Healthcare Teams

Monitoring period: The 42-day window runs until June 21, 2026. Any former passenger or high-risk contact presenting with fever, myalgia and respiratory symptoms before that date must trigger a hantavirus exposure inquiry.

Testing: The ECDC's rapid scientific advice specifies that testing should only be performed in symptomatic high-risk contacts. Asymptomatic individuals should not be tested routinely — the test is not validated for pre-symptomatic detection.

IPC precautions: Standard and droplet precautions remain appropriate for suspect cases. Escalate to airborne precautions only for aerosol-generating procedures. The Andes virus is the only hantavirus strain with documented human-to-human transmission — this characteristic must be communicated clearly to frontline teams receiving returning passengers.

Risk assessment: The CDC has classified this as a Level 3 emergency response. The WHO and ECDC continue to assess the risk to the general public as very low. The critical risk group remains close contacts of confirmed cases.

Published by No Infection Consulting & Education · May 16, 2026

May 17, 2026 · No Infection Consulting & Education

This morning, the World Health Organization declared a Public Health Emergency of International Concern for the Ebola Bundibugyo outbreak in the Democratic Republic of the Congo and Uganda — the most serious classification the WHO can apply short of a pandemic emergency. This is an evolving situation. No Infection will continue to update this article as new information becomes available.

What Is the Bundibugyo Strain — and Why Is It Different?

The Bundibugyo virus (BDBV) is one of six known species of Ebola virus. Unlike the Ebola Zaire strain — responsible for the 2014–2016 West Africa epidemic and the 2018–2020 DRC outbreak — Bundibugyo has been documented only twice before in history: in Uganda in 2007 (131 cases, 42 deaths) and briefly in 2012.

This rarity has a critical consequence: there is no approved vaccine and no approved treatment for Bundibugyo. The only licensed Ebola vaccine (rVSV-ZEBOV / Ervebo) and the only licensed therapeutics (Inmazeb, Ebanga) are all specific to the Zaire species and are not effective against Bundibugyo. The case fatality rate is estimated between 25% and 40%. Treatment is limited to early supportive care — rehydration, electrolyte management, oxygen and blood pressure stabilisation.

Case Count — May 17, 2026

The 62% positivity rate among samples tested is a critical signal. It strongly suggests the true case count is substantially larger than current official numbers. The WHO stated explicitly that available data "all point toward a potentially much larger outbreak than what is currently being detected and reported."

Timeline: How the Outbreak Went Undetected

April 24, 2026: First known suspected case — a health worker in Bunia, Ituri Province — develops fever, hemorrhage, vomiting, and intense malaise. Dies within days at a medical centre in Bunia.

May 5, 2026: WHO is alerted via social media reports of a high-mortality unknown illness in Mongbwalu Health Zone, including four health workers who died within four days. By this point, approximately 50 deaths had already occurred — the virus had been circulating silently for at least two weeks in a region of active conflict and limited healthcare access.

May 13–14, 2026: WHO rapid response team investigates Mongbwalu and Rwampara health zones. INRB laboratory in Kinshasa receives 13 blood samples from Rwampara.

May 15, 2026: INRB confirms Bundibugyo virus in 8 of 13 samples. DRC officially declares its 17th Ebola outbreak. Uganda confirms an imported case in Kampala — a Congolese man who subsequently dies.

May 16, 2026: A second confirmed case in Kampala — with no apparent epidemiological link to the first. A case is reported in Kinshasa (approximately 1,000 km from the epicentre) but later ruled out by confirmatory testing.

May 17, 2026: WHO Director-General declares PHEIC. The outbreak is now the largest Bundibugyo outbreak ever recorded.

International Risk Assessment

The two confirmed cases in Kampala represent the most significant international signal. Kampala is Uganda's capital and a major regional hub — and the two cases had no apparent epidemiological link to each other, suggesting independent introduction events rather than a single transmission chain. Both individuals were admitted to ICUs in Kampala.

Ituri Province shares borders with Uganda and South Sudan. The WHO has classified all countries sharing land borders with DRC as being at high risk for further spread, due to population mobility, trade and travel linkages. Countries at elevated risk include Uganda, South Sudan, Rwanda, Burundi, Tanzania, the Republic of Congo, the Central African Republic, and Zambia.

This outbreak is occurring in the same region as the second-largest Ebola outbreak in history — the 2018–2020 North Kivu and Ituri outbreak involving 3,470 cases and 2,287 deaths. That outbreak was also complicated by active armed conflict, which severely limited response capacity. The ongoing security situation in Ituri Province poses the same challenges today.

IPC Guidance for Healthcare Professionals

Transmission: Ebola spreads through direct contact with the blood, secretions, organs, or other bodily fluids of infected persons, and with surfaces contaminated with these fluids. It does not spread through the air. Deceased patients remain infectious and must be handled with full PPE.

PPE requirements: For any patient with suspected Ebola: full PPE including fluid-resistant gown, double gloves, face shield or goggles, N95 or higher respirator, and boot covers. Strict donning and doffing protocols must be observed. At least 4 healthcare workers have died in this outbreak — transmission within healthcare settings is documented.

Recognition trigger: Any patient presenting with fever, unexplained hemorrhage, vomiting, diarrhea, or severe malaise who has traveled to DRC, Uganda, or neighboring countries within the past 21 days (the maximum incubation period) should trigger immediate isolation and urgent public health notification — before laboratory confirmation.

Testing: Contact your national public health authority before collecting samples. Ebola diagnostics require specialized containment. Do not attempt standard laboratory processing of samples from suspect cases.

Key message for triage teams: The words "I recently traveled to the DRC or eastern Uganda" from a febrile patient should activate your facility's viral hemorrhagic fever protocol immediately.

Risk to the General Public

The WHO has specifically advised against border closures and travel restrictions, noting these measures historically impede the reporting of cases and the movement of response resources without providing proportionate benefit. The risk to the general public outside affected areas remains very low. Ebola does not spread through casual contact, through the air, or through food or water.

What stops Ebola is contact tracing, rapid isolation of cases, strong infection control in healthcare facilities, safe burial practices, and community engagement. MSF has confirmed it is preparing to scale up its response. The DRC has managed 17 Ebola outbreaks since 1976 and has significant institutional expertise in response.

No Infection Consulting & Education will publish updates as this situation develops. Monitor our blog and the Infectious Diseases in Focus YouTube channel for ongoing coverage.

Published by No Infection Consulting & Education · May 17, 2026

May 18, 2026 · No Infection Consulting & Education

Case Count — May 18, 2026

United States Implements Entry Restrictions

In a significant escalation, the CDC and Department of Homeland Security today implemented enhanced travel screening, entry restrictions, and public health measures under a Title 42 Order, suspending the right of entry for certain persons from countries where Bundibugyo virus disease is present. This is the first Title 42 public health order targeting Ebola since the 2014–2016 West Africa epidemic.

At least 6 Americans in the DRC have been identified as having had exposure to the virus, with 3 classified as high-risk. One American may have developed symptoms, according to STAT News — though this could not be independently verified at time of publication.

Expert Assessment

Dr. Daniela Manno of the London School of Hygiene & Tropical Medicine offered critical context: "The PHEIC declaration reflects the operational complexity of the outbreak and the need for coordinated international support — not a high global risk to the general public."

The WHO continues to advise against border closures and trade restrictions, noting these measures impede response resources without proportionate benefit. The risk to the general public outside affected areas remains very low.

Published by No Infection Consulting & Education · May 18, 2026

May 18, 2026 · No Infection Consulting & Education

Ship Arrives Rotterdam — End of the Voyage

The MV Hondius arrived at the Port of Rotterdam, Netherlands today, May 18 — completing what became one of the most extensively documented infectious disease events aboard a civilian vessel in history. Oceanwide Expeditions confirmed no symptomatic individuals were present on board during the final leg. The 27 remaining crew members disembarked in a staggered approach coordinated with the cleaning and disinfection process, overseen by the Dutch National Institute for Public Health and the Environment (RIVM).

Canada Confirms New Case — Total Reaches 11

The Public Health Agency of Canada confirmed that one of the four repatriated Canadian passengers tested positive for hantavirus — raising the total number of confirmed and probable MV Hondius cases to 11. The individual is receiving care in Canada. This is the first confirmed case outside of the original cluster countries.

Dr. Kornfeld: "I Feel Great — It's Nice to Be Negative"

Dr. Stephen Kornfeld of Bend, Oregon — the only American passenger to have tested positive for hantavirus — received confirmed negative results on follow-up testing and was transferred from the biocontainment unit to the general quarantine facility at the University of Nebraska Medical Center, where he joins the other 15 American passengers.

In a statement to ABC News, Dr. Kornfeld said: "I physically feel great — I have felt great for many, many days. Emotionally I feel wonderful. It's nice to be negative for hantavirus." The CDC confirmed no cases of Andes hantavirus have been confirmed in the United States.

United States: 41 Under Monitoring, None Symptomatic

All 18 Americans from the MV Hondius are now at the National Quarantine Center at the University of Nebraska Medical Center — including two who had been temporarily at Emory University in Atlanta. Across the broader country, 41 Americans are under monitoring for potential Andes virus exposure, including passengers who returned home early and individuals who shared flights with symptomatic cases. None have shown any signs of illness.

The CDC's Incident Manager Dr. David Fitter confirmed the Andes virus "does not pass easily between people and requires close, prolonged exposure." The CDC is not providing updates on the individual clinical status of quarantined passengers, citing privacy.

What Comes Next

The 42-day monitoring period (Day 0 = May 10) ends on June 21, 2026. Until that date, all former passengers classified as high-risk contacts must continue daily symptom monitoring and self-quarantine, testing only if symptomatic. Scientists are heading to Ushuaia to investigate whether hantavirus was already circulating in the region before the MV Hondius departed on April 1.

Published by No Infection Consulting & Education · May 18, 2026

May 19, 2026 · No Infection Consulting & Education

Dr. Peter Stafford — The American Doctor

The American confirmed with Ebola Bundibugyo is Dr. Peter Stafford, a medical missionary working with the organization Serge at Nyankunde Hospital in Bunia, Ituri Province — one of the epicenters of the outbreak. Dr. Stafford has served at the hospital since 2023. He was exposed while treating Ebola patients and tested positive on May 17.

His wife, Dr. Rebekah Stafford, and a colleague, Dr. Patrick LaRochelle, were also potentially exposed. Both are asymptomatic as of this morning and are following established quarantine and monitoring protocols.

The CDC confirmed Dr. Stafford and six other high-risk American contacts will be transported to Germany — not the United States. Germany was chosen for its shorter flight time from DRC and its deep experience managing high-consequence infectious disease patients. The Charité hospital in Berlin, the Robert Koch Institute, and Germany's national network of isolation units have handled Ebola and other hemorrhagic fever patients before. Specifically, the CDC noted Germany's experience compared to flying patients back across the Atlantic to US facilities.

Case Count — A Near-Doubling in 72 Hours

The jump from 88 to 131 deaths in less than 72 hours does not indicate sudden acceleration of the virus — it reflects the delayed reporting of deaths that were already occurring in areas with limited surveillance capacity. As the WHO warned at the time of the PHEIC declaration, the 62% sample positivity rate strongly suggested the true outbreak was far larger than official figures showed. That prediction is now being confirmed.

A Ray of Hope: mRNA Vaccine Candidate Published Today

In a study published today in the Proceedings of the National Academy of Sciences, Chinese researchers described an mRNA-based vaccine designed to target three Ebola strains simultaneously — including Bundibugyo. The vaccine has not yet reached human clinical trials, but its existence represents the first publicly described vaccine candidate specifically engineered for the Bundibugyo strain.

The context matters: the current approved Ebola vaccines — Ervebo (Merck) and the Johnson & Johnson regimen — target only the Zaire strain. Animal studies confirm they provide little to no cross-protection against Bundibugyo. The mRNA platform, which demonstrated its potential during COVID-19, theoretically allows rapid development and reformulation — but human trials, regulatory review, and manufacturing at scale remain months to years away at minimum.

For Dr. Stafford and patients currently infected, there is no approved antiviral. Treatment remains entirely supportive: fluid resuscitation, electrolyte management, oxygen therapy, vasopressors, and intensive care monitoring.

US Response — Entry Restrictions Expand

Entry restrictions implemented on May 18 remain in force: non-US citizens who have been in DRC, Uganda, or South Sudan in the previous 21 days are prohibited from entering the United States. Enhanced screening is in place at all major US ports of entry. The CDC has 25 personnel in its DRC country office and is providing technical assistance to both the DRC and Uganda Ministries of Health.

President Trump, asked whether Americans should be concerned, stated: "I'm concerned about everything, but certainly am. I think that it's been confined right now to Africa, but it's something that has had a breakout."

IPC Guidance — Updated for May 19

For healthcare professionals: With an American now confirmed positive and evacuated to Germany, the patient pathway is clear — but the vigilance required at US facilities remains unchanged. Any patient presenting with fever, myalgia, or unexplained hemorrhage who reports travel to DRC, Uganda, or South Sudan in the past 21 days requires immediate isolation and notification of the state or local health department before any laboratory workup. The early prodrome is clinically indistinguishable from influenza. Travel history is the only early discriminator.

For the general public: The CDC has confirmed no cases of Ebola Bundibugyo in the United States. Risk to the American public remains low. Entry restrictions are designed to maintain that status. Monitor cdc.gov/ebola for the most current situation summary.

Published by No Infection Consulting & Education · May 19, 2026