Passengers flying from Grand Cayman to the United States now have to sign a declaration that they have not set foot in the Democratic Republic of the Congo in the previous three weeks, under a U.S. public health order that took effect overnight and applies to every person on every aircraft bound for the country.

The order, issued by the U.S. Centers for Disease Control and Prevention (CDC) on 22 October and amended on 28 October, requires airlines to collect a signed attestation from each traveller before boarding and to refuse boarding to anyone who does not provide one. It applies to flights departing for the U.S. at or after 11:59pm Eastern Standard Time on 3 November, and Cayman Airways has told customers it applies to all of its U.S.-bound flights from the morning of 4 November.

The measure responds to an outbreak of Ebola disease caused by the Bundibugyo virus, first reported in the DRC in May. The CDC's latest situation summary records 10,563 confirmed cases and 5,130 confirmed deaths as of 1 November, almost all of them in the DRC. No case has yet been confirmed in the U.S.

What travellers must do

The form, published by the CDC with the order, has the traveller confirm that they have not been present in the DRC in the 21 days before boarding a flight to the U.S. Presence includes connecting through an airport in the DRC "even if the traveler did not disembark the plane or leave the airport". A parent or guardian may sign for a traveller under 18, and the form may be presented in printed or digital form.

The requirement applies regardless of nationality. The CDC states that the order "applies to all people boarding a flight to the United States from any foreign country, including U.S. citizens, U.S. nationals, and lawful permanent residents (Green Card holders)". It covers commercial, cargo and private flights, transit passengers and crew. Exemptions are limited to air medical transport and CDC humanitarian exemptions, which it says "are rare".

What Cayman Airways has told passengers

In a notice on its website, also carried on the Cayman Islands Government's news feed on 30 October, Cayman Airways Limited said passengers travelling to the U.S. "must complete and sign an attestation form confirming that they have not been in the Democratic Republic of the Congo (DRC) during the 21 days prior to boarding their flight" and must present it at check-in or before boarding. "Passengers who fail to provide the required attestation will not be permitted to board their flight," the airline said, urging customers to complete it in advance. The same obligation falls on every other carrier flying from Owen Roberts International Airport to the U.S.

What airlines must do

Under the CDC's technical instructions, airlines must confirm before boarding that every person on board has completed an attestation, refuse boarding to anyone who has not, and keep each form for at least 42 days and produce it to the U.S. government on request. The form warns that false or misleading information may lead to criminal fines and imprisonment under 18 U.S.C. 1001.

The CDC says the measure is "intended to reduce the risk of Ebola being introduced into the United States through air travel" and that "the overall risk to the American public and travelers remains low". The amended order, published in the Federal Register on 30 October under the Public Health Service Act, remains in effect until 11:59pm EST on 18 December and may be amended or rescinded before then.

For most travellers from Grand Cayman the practical effect is an additional form at check-in. The Health Services Authority's news page carried no item on the outbreak as of 4 November.