Experts say recent outbreaks pose little risk to 2026 World Cup, but preparedness remains key

Delaney Van Wilpe

With millions of fans expected to travel across North America for the 2026 FIFA World Cup, recent Ebola and hantavirus outbreaks have renewed attention to infectious disease risks. Experts, however, say the likelihood of either outbreak affecting the tournament remains low.

“The risk for either an Ebola outbreak or a hantavirus outbreak is exceedingly low. It’s not something that we expect to happen,” Dr. Preeti Mehrotra, senior medical director at Beth Israel Deaconess Medical Center in Boston and an adult and pediatric infectious disease physician, said.

The outbreaks come as millions of visitors are expected to travel across 16 host cities in the United States, Canada and Mexico for the monthlong tournament, according to the Centers for Disease Control and Prevention (CDC).

While experts say the risk for an Ebola or hantavirus outbreak is low, mass gatherings like the World Cup can be the prime environment for infectious diseases to spread because of close contact among travelers from around the world.

“The world has gotten very small with air travel,” Dr. Keith Kaye, an infectious disease physician and professor at Rutgers Robert Wood Johnson Medical School, said.

Hantavirus and Ebola outbreaks

The outbreaks are unrelated and involve different transmission patterns, but both emerged in the weeks leading up to the tournament.

The first outbreak was linked to the MV Hondius cruise ship, which sailed in the Atlantic Ocean during April and May. After multiple passengers became seriously ill and three deaths were reported, testing confirmed that several individuals were infected with the Andes strain of hantavirus, one of the few strains known to spread from person to person.

As of May 27, the World Health Organization (WHO) reported 13 cases linked to the MV Hondius, including 11 confirmed Andes virus infections and two probable cases among passengers and crew.

While officials continue monitoring possible hantavirus exposures, a larger Ebola outbreak continues to spread in the Democratic Republic of the Congo and Uganda.

The WHO was alerted to a deadly outbreak on May 5. Ten days later, testing determined that eight of the 13 blood samples were positive for Bundibugyo virus disease, a species of Ebola.

According to the WHO, no vaccine is available for Bundibugyo virus disease, and previous outbreaks have recorded fatality rates ranging from 30% to 50%.

As of June 2, health officials had reported 378 confirmed cases and 63 confirmed deaths. No cases have been reported in the United States.

Identify, isolate, inform

Despite the low risk, Kaye said the outbreaks have encouraged health officials to stay on top of any emerging diseases.

“I think it’s really served as sort of a shot across the bow that we need to be prepared as much as we can and this is no joke,” Kaye said. “International sporting events are wonderful. The World Cup is a great thing, soccer/football is a great sport, but there’s obviously risk with these mass gatherings.”

A central approach to prevention is known as “identify, isolate, inform,” which Mehrotra described as the “bedrock of how both public health and medicine function together.”

The strategy calls for health officials to take the steps to identify potentially infectious patients, isolate them when appropriate and notify the relevant medical personnel and public health authorities.

Kaye said rapid identification is critical to preventing wider transmission within hospitals and communities.

“The longer that cases are missed and the longer that there are exposures and potential spread, it just exponentially gets more and more difficult to control,” Kaye said. “This would be an urgent emergency if there is any sort of thing like Ebola or hantavirus or other viral hemorrhagic spread — even one case in these areas.”

Federal health officials have already taken steps to address Ebola-related risks. On May 18, the CDC implemented enhanced screening and entry restrictions for travelers who recently visited the Democratic Republic of the Congo, Uganda or South Sudan.

Certain non-U.S. citizens who have been in affected areas within the past 21 days will be prohibited from entering the country, while U.S. citizens and nationals are subject to enhanced screening at designated airports.

Experts said prevention and screening efforts must extend beyond airports.

“The premise of ‘identify’ starts off at the frontline clinician — the triage questions asked, the screening questions asked,” Dr. Trini Mathew, medical director for infection prevention and stewardship at a community hospital in Michigan, said.

Preparing for the World Cup

For some, the focus on preparedness predates the recent outbreaks. Months before the World Cup, a group of infectious disease specialists began developing guidance for health care providers preparing for the tournament.

Their commentary paper, “Sports fever! Getting the ball rolling to prevent infections at the World Cup™ and beyond,” examines health risks associated with large international sporting events and offers recommendations for health care providers and public health officials.

After learning more about the scale of the tournament and discussing it with colleagues, Mathew said she realized there was a gap in awareness among frontline clinicians.

“We don’t have any information from our federal agencies, from CDC, or from certain states giving us recommendations on what to expect,” Mathew said. “I was learning how businesses are ramping up the efforts to meet the needs of visitors, both domestic and international visitors coming in, and we frontline clinicians were not ramping up our plans.”

Mathew and Mehrotra led the project with the help of six additional health professionals, including Kaye.

“It’s not just random travelers coming. We have concentrated, intentional travel from all over the world, and people aren’t necessarily going to be on their best behavior, either,” Kaye said. “There’s going to be probably unsafe behavior, so we felt that this was sort of a potential time bomb and wanted to make certain that we at least tried to prepare as much as possible.”

Diseases to watch

Based on expert opinion and lessons from previous mass gatherings, the authors identified several diseases health officials should monitor during the tournament:

Hepatitis A
Norovirus
E. coli
Measles
COVID-19
Influenza
Tuberculosis
Mpox
HIV and other sexually transmitted infections
Multidrug-resistant bacteria

The authors also recommended remaining alert for high-consequence pathogens such as hantavirus and Ebola, even though they are less likely to occur.

Still, they said more common illnesses pose a greater concern during mass gatherings.

Mehrotra said respiratory illnesses such as influenza, COVID-19 and the common cold, along with foodborne illnesses and sexually transmitted infections, are more likely to affect World Cup visitors.

Kaye also encouraged health care workers to remain alert for measles, which continues to circulate in the United States and is highly contagious. According to the CDC, there have been 1,983 confirmed measles cases in the United States this year as of May 28.

Although Ebola has attracted significant attention because of the outbreak in Central Africa, federal officials agree that the risk to the United States remains low.

“Let me reiterate at this time the risk for the United States remains low; however, outbreaks like this remind us that infectious diseases don’t respect borders, and CDC will continue working with partners to stop transmission at its source, protect affected communities and help ensure the United States remains prepared,” Dr. Satish Pillai, the incident manager for the CDC’s Ebola response, told reporters on May 29.

Mathew said one factor that may aid detection efforts is that symptoms of Ebola do not easily go unnoticed.

“We know how the transmission happens, and what we’ve learned from 2014 is that if we identify a person having Ebola, that person is always coming and seeking care,” Mathew said. “That person is not going to be able to hang out and party, that person is really down sick, really under the weather, and they’re going to come to a health care facility, which is where all the health care facilities, of course, are aware and being prepared.”

What attendees can do

Experts say attendees can reduce their risk of illness by staying current on vaccinations, practicing good hand hygiene, monitoring symptoms and seeking medical care if they become ill during travel.

“It’s up to every individual here in the U.S. also to be aware that you really need to be seeking health care if you’re not feeling well. You should really not be going to games,” Mathew said. “If you’re going to be going out and spreading your microbes that are potentially very contagious, then that whole community is being impacted, including your friends and family.”

Mathew acknowledged that convincing visitors to seek treatment while away from home may be challenging.

FIFA’s host-city websites include information on accessing medical care during the tournament. The Houston host committee website, for example, provides information on treatment options and a map of nearby health care facilities. State health departments, like New Jersey, also have resources on their websites.

“For an outbreak to really occur, it’s going to be really low risk, as long as people are availing of health care,” Mathew said.

Matches begin June 11 and will be played in 16 cities across the United States, Canada and Mexico.