For your safety and the well-being of those around you, please be informed that it is
mandatory to be screened for Marburg Virus Disease using Public Health Passenger
Declaration Form as part of preventive measures when you are departing from Rwanda.

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2

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4

STEP 1

Your Info

STEP 2

Your Info

STEP 3

Epidemiological Risk Factors and Exposures to MVD

STEP 4

Epidemiological Risk Factors and Exposures to MVD

Personal Info

Please provide vour passport, firstname, and lastname

Passport/National ID

Enter FirstName

Enter LastName

Personal Info

Please provide vour Email, Phone Number

Email

PhoneNumber

Epidemiological Risk

Have you, or any member of your group travelling with you, had any of the following symptoms during the past 21 days?
High fever (≥38 C) Yes No
Severe headache Yes No
Muscle ache Yes No
Vomiting/nausea Yes No
Diarrhea Yes No
Intense fatigue/general weakness/lethargy Yes No
Chest pain Yes No
Unexplained bleeding Yes No

Finishing up

During the past 21 days, have you, or a member of your group travelling with you, had close contact (Physical contact) with someone who had symptoms suggestive of Marburg virus disease?
Yes No I don’t know