Circular Letter of the Directorate General of Disease Prevention and Control Number SR.03.01/C/2783/2026 Strengthening National Preparedness for the Ebola Emergency

Introduction

On May 19, 2026, the Ministry of Health through the Directorate General of Disease Prevention and Control issued Circular Letter of the Directorate General of Disease Prevention and Control Number SR.03.01/C/2783/2026 on Awareness of Ebola Disease (“SR.03.01/C/2783/2026”). SR.03.01/C/2783/2026 was issued to strengthen the preparedness of healthcare facilities in preventing the entry and spread of Ebola disease in Indonesia.

SR.03.01/C/2783/2026 was issued following reports from the health authorities of the Democratic Republic of the Congo and the Africa Centers for Disease Control and Prevention (“Africa CDC”) on May 15, 2026, regarding the resurgence of an Ebola disease outbreak caused by the Bundibugyo virus (“BDBV”) in the Congo and Uganda. Ebola disease is caused by a virus from the genus Orthoebolavirus, including the Zaire, Sudan, and Bundibugyo types, and is transmitted through contact with the body fluids of infected persons or animals through open wounds. This disease has an incubation period of 2 to 21 days, with an average of 8 to 10 days.

On May 16, 2026, the World Health Organization (“WHO”) designated the outbreak as a Public Health Emergency of International Concern (“PHEIC”). The designation took into account several factors, including cross-border transmission, the emergence of mortality clusters, including among healthcare workers due to inadequate Infection Prevention and Control (Pencegahan dan Pengendalian Infeksi, “PPI”), uncertainty regarding the number and extent of case transmission, high positivity rates and regional transmission risks, security conditions and humanitarian crises in affected areas, as well as the unavailability of approved therapies or vaccines for BDBV. Although Indonesia has not reported any confirmed cases of Ebola disease, the high mobility of the population and international travel to and from affected countries continue to increase the risk of Ebola disease entering Indonesia, meaning that awareness and early detection measures must be enhanced.

Key Provisions

Duties and Responsibilities of Regional Health Offices

Point A of SR.03.01/C/2783/2026 regulates the obligations of Provincial and Regency/City Health Offices to enhance awareness of Ebola disease within their respective regions. Health offices are required to conduct surveillance by monitoring cases of viral hemorrhagic fever syndrome with associated risk factors detected in healthcare facilities. Such monitoring is conducted through Event-Based Surveillance (“EBS”) reporting using the Early Warning and Response System (Sistem Kewaspadaan Dini dan Respons, “SKDR”) application. Numbers 2, 3, and 4 of Point A also regulate several measures that health offices must undertake, including:

1. Controlling risk factors through integrated health promotion and conducting investigations as well as mitigation responses involving relevant cross-sectors;

2. Disseminating information regarding the prevention and detection of Ebola disease to all medical and healthcare workers, in reference to the Guidelines for Preparedness Against Ebola Virus Disease;

3. Coordinating case management and awareness with referral hospitals, Technical Implementation Units (Unit Pelaksana Teknis, “UPT”) in the field of health quarantine, and public health laboratories regarding standardized specimen management;

4. Providing a specific budget allocation for the awareness and mitigation of Ebola Extraordinary Occurrences (Kejadian Luar Biasa, “KLB”) in accordance with laws and regulations;

5. Formulating and/or developing emergency response plans (contingency plans) as an effort to minimize the recurrence of KLBs.

Awareness of Healthcare Facilities

Hospitals, Community Health Centers (Pusat Kesehatan Masyarakat, “Puskesmas”), and other healthcare facilities are required to perform case detection through viral hemorrhagic fever syndrome for patients with risk factors and execute case management pursuant to the provisions set forth in Point B. Operational definitions and case management must refer to the Guidelines for Preparedness Against Ebola Virus Disease and the Technical Guidelines for Sentinel Surveillance of Emerging Infectious Diseases. In addition to implementing surveillance, Numbers 2 and 3 of Point B also regulate several measures that healthcare facilities must undertake, including:

1. Applying standard and transmission-based precautions, including contact, droplet, and airborne precautions for aerosol-generating procedures, as well as providing Personal Protective Equipment and isolation rooms;

2. Enhancing health promotion and conducting disease mitigation investigations and responses in coordination with the local health office;

3. Enhancing human resource capacity in both primary healthcare facilities (fasilitas pelayanan kesehatan tingkat pertama, “FKTP”) and advanced healthcare facilities (fasilitas pelayanan kesehatan tingkat lanjutan, “FKTL”), including through refresher activities regarding the detection and management of Ebola disease;

4. Enhancing case management capabilities within the network of hospitals managing emerging infectious diseases (penyakit infeksi emerging, “PIE”);

5. Coordinating with the regional public health laboratory network regarding specimen management while adhering to universal precaution principles; and

6. Updating hospital facility availability data periodically, including intensive care unit (“ICU”) beds, negative-pressure isolation ICUs, isolation wards, and ventilators through the online hospital application and the Facilities, Infrastructure, and Medical Equipment Application (Aplikasi Sarana, Prasarana, dan Alat Kesehatan, “ASPAK”).

Border Control by Health Quarantine

UPTs in the field of health quarantine are required to carry out control and surveillance at ports, airports, and state border posts as regulated under Point C. Numbers 1, 2, 3, and 4 of Point C govern the inspection of conveyances, goods, and persons from affected countries, including through the verification of the All Indonesia health declaration at international arrival areas. Officers are also required to observe signs and symptoms and conduct temperature screenings using thermal scanners for all travelers entering Indonesia. In addition, UPTs in the field of health quarantine are required to:

1. Immediately refer travelers to referral hospitals if symptoms of fever, joint or muscle pain, fatigue, diarrhea, vomiting, or external or internal bleeding, such as nosebleeds, bleeding gums, vomiting blood, or bloody stools, are detected, in accordance with the operational definition of cases;

2. Monitor the arrival of conveyances using risk-based assessment methods, and conduct physical inspections onboard vessels categorized under medium and high risks;

3. Conduct investigations and mitigation responses as well as enhance health promotion for the public and travelers at airports, ports, and state border posts;

4. Enhance logistical preparedness for health quarantine officers and coordinate awareness with relevant cross-sector authorities, including immigration, customs, animal, fish, and plant quarantine, health offices, laboratories, and referral hospitals;

5. Support and coordinate the specimen shipment process while consistently applying PPI principles; and

6. Formulate and/or develop emergency response plans and contingency plans within their respective working areas.

Governance of Public Health Laboratories

UPT Centers/Public Health Laboratories are required to conduct surveillance and specimen testing as set forth in Point D. Numbers 1, 2, and 3 of Point D govern several mandatory obligations, including:

1. Entering all Ebola specimen test results into the routine sentinel surveillance reporting application or other related applications;

2. Controlling risk factors by applying biosafety and biosecurity principles during the specimen management process to prevent transmission within the workplace;

3. Conducting self-assessments of facility capacity and ensuring the readiness of supporting facilities and infrastructure, including the provision of reagents and medical consumables (bahan medis habis pakai, “BMHP”) for Ebola disease testing; and

4. Coordinating with the Center for Health Biology Laboratories, provincial/regency/city health offices, referral hospitals, and UPTs in the field of health quarantine regarding specimen management.

Monitoring, Integrated Reporting, and Education

Health offices, healthcare facilities, UPTs in the field of health quarantine, and laboratories are required to perform monitoring and coordination for Ebola disease mitigation as regulated under Point E. All institutions are required to monitor the development of Ebola cases at the global and national levels through the official channels of the World Health Organization and Emerging Infections of the Ministry of Health, conduct epidemiological studies and risk assessments regarding the potential for Ebola extraordinary occurrences involving cross-programs and sectors, and urge the public not to disseminate unverified information and to always refer to official government sources. For the purpose of prevention, Number 2 of Point E also mandates the provision of public education to:

1. Apply health protocols, including washing hands with soap or hand sanitizer, wearing masks for symptomatic individuals and vulnerable groups, and maintaining cough and sneeze etiquette;

2. Avoid direct contact with infected persons or animals, as well as contaminated objects;

3. Ensure the consumption of animal meat that has been thoroughly and perfectly cooked, and avoid consuming wildlife;

4. Comply with health protocols from local authorities when traveling to affected countries; and

5. Immediately seek medical examination at a healthcare facility if experiencing Ebola symptoms, such as fever or bleeding, within 21 days after returning from an affected country.

In addition, Number 5 of Point E mandates the reporting of case detections within less than 24 (twenty-four) hours through event-based surveillance on the SKDR application and via the phone/WhatsApp number of the Public Health Emergency Operation Center (“PHEOC”) at 0877-7759-1097. Furthermore, pursuant to Number 6 of Point E, all Ebola disease case specimens must be sent to the Center for Health Biology Laboratories at Jalan Percetakan Negara II Number 23, Jakarta 10560 (Information Center Contact for BB Lab Biokes: 0812-9990-7400).

Closing

SR.03.01/C/2783/2026 has been effective since May 19, 2026, as a national awareness measure against the risk of the entry and spread of Ebola disease in Indonesia following the resurgence of the Bundibugyo virus outbreak in the Congo and Uganda, as well as the designation of a Public Health Emergency of International Concern by the World Health Organization. Under this circular, Provincial and Regency/City Health Offices are required to enhance surveillance through the Early Warning and Response System application, perform risk factor control, provide budgets for extraordinary occurrence mitigation, and formulate contingency plans. Hospitals, Puskesmas, and other healthcare facilities are also required to perform case detection based on viral hemorrhagic fever syndrome, apply transmission-based precautions, prepare isolation rooms and Personal Protective Equipment, enhance health worker capacity, and update facility data through the online hospital application and the Facilities, Infrastructure, and Medical Equipment Application. In addition, UPTs in the field of health quarantine are required to tighten control at border entry points through the verification of the All Indonesia health declaration, temperature screening using thermal scanners, risk-based assessment monitoring of conveyances, and cross-sector coordination in case management and specimen shipment. On the other hand, UPT Centers/Public Health Laboratories are required to report specimen examination results, apply biosafety and biosecurity principles, ensure the readiness of testing facilities, and coordinate with health offices, referral hospitals, and UPTs in the field of health quarantine regarding specimen management. Point E also requires all relevant institutions to monitor the development of Ebola cases, conduct extraordinary occurrence risk assessments, provide public education regarding health protocols and transmission prevention, and report case detections within less than 24 (twenty-four) hours through event-based surveillance on the Early Warning and Response System application and the Public Health Emergency Operation Center. Furthermore, all Ebola disease case specimens must be sent to the Center for Health Biology Laboratories in Jakarta pursuant to the provisions in SR.03.01/C/2783/2026.