Threat assessment brief: Ebola disease outbreak caused by Bundibugyo virus – Democratic Republic of the Congo and Uganda – 2026

Based on data reported by the World Health Organisation as at 20 May 2026, almost 600 suspected cases and 139 deaths among the suspected cases have been reported. In DRC, 51 cases were confirmed in Ituri and North Kivu Provinces. While two imported cases were confirmed in Kampala, Uganda. At least five deaths had been reported among the confirmed cases as at 18 May, four in DRC and one in Uganda. Due to the very recent declaration of the outbreak and the uncertainties related to the epidemiological information, it is probable that the outbreak is larger than what is currently being reported, not only regarding the number of affected cases but also to its geographical extent. 

BDBV transmission requires direct contact with blood, or other bodily fluids of living or deceased infected people, or any surfaces and materials soiled by infectious fluids. Transmission can also occur through contact with dead or live infected animals, including handling and/or consuming bushmeat, or by visiting caves or mines colonised by bats. There are currently no licensed vaccines or specific treatments available for BDBV disease.

Risk assessment

Although epidemiological information remains limited and there are important uncertainties, the likelihood of infection for people from the EU/EEA living in or travelling to affected areas is assessed as low, provided they adhere to the recommended precautionary measures. Transmission requires direct contact with blood, secretions, organs, or other bodily fluids of dead or living infected people or animals; all unlikely exposures for the general EU/EEA travellers or expatriates in affected areas. Staff members of humanitarian, religious and other organisations, particularly healthcare workers who are in direct contact with patients and/or local communities in the affected areas, are more likely to be exposed to the virus. Provided they adhere to the appropriate infection prevention and control measures, the likelihood of infection for this group is also low.

The most likely route by which the virus could be introduced to the EU/EEA is through people with a BDBV infection travelling from affected areas to the EU/EEA. During the Ebola disease outbreak in West Africa in 2013– 2016, which was the largest outbreak to date, where tens of thousands of cases were reported, with transmission in large urban centres, and hundreds of EU/EEA humanitarian and military personnel deployed to the affected areas, only a small number of imported cases to Europe were reported, most of them medically evacuated for treatment. Based on this experience, it is expected that imported cases would be a rare event.

The likelihood of secondary transmission of BDBV within the EU/EEA and the occurrence of sustained chains of transmission within the EU/EEA is considered very low, as cases are likely to be promptly identified and isolated and recommended control measures would be implemented. Although BDBV infection can cause severe disease in affected individuals, the population-level public health impact in the EU/EEA is expected to be very low because only very few cases would occur. Therefore, the overall current risk of BDBV for the general population in the EU/EEA is assessed to be very low.

Recommendations

EU/EEA countries should review and update the standard operating procedures on isolation and treatment for BDBV disease cases, and on contact tracing and quarantine for contacts of cases as needed. 

EU/EEA public health authorities should:

1. Increase awareness among travellers to, and residents of affected areas, as well as returning travellers;
2. Increase awareness among health professionals on:
   (i) the possibility of BDBV disease in travellers returning from affected areas;
   (ii) the clinical presentation of the disease and the need to ask about the travel history and contacts of people returning from affected areas;
   (iii) the availability of protocols for testing suspected cases;
   (iv) infection prevention and control (IPC) procedures and appropriate management of suspected or confirmed cases.
3. Strengthen readiness to rapidly detect imported cases, promptly isolate them, and implement appropriate infection prevention and control measures.
4. Review testing capacity and BDBV diagnostic procedures. The EU reference laboratory for public health on Emerging, rodent-borne and zoonotic viral pathogens (EURL-PH-ERZV) offers diagnostic services to EU/EEA countries lacking capability to diagnose BDBV infection.
5. Minimise exposure in healthcare settings requires appropriate procedures, trained staff, and equipment for the safe management of BDBV cases.
6. Provide all returning travellers with clear information on symptoms, route of transmission, and what to do if symptoms develop after arrival in the EU/EEA: travellers who develop symptoms compatible with BDBV infection within 21 days after return should self-isolate, seek medical care promptly, and report their travel history and possible exposures.

Exit screening in affected countries, including symptom checks and exposure assessment, is crucial as it contributes to risk reduction by identifying symptomatic travellers before boarding and preventing travel while symptomatic. Exit screening also helps dissuade ill people from travelling and enhance public and stakeholder confidence. However, it cannot fully prevent exportation of cases, because absence of symptoms at departure does not exclude subsequent onset of disease.

ECDC actions

ECDC is monitoring the outbreak through its epidemic intelligence activities to provide epidemiological updates, situational awareness and assess the risk for the EU/EEA. 

ECDC has deployed an expert through the EU Health Task Force and in collaboration with DG ECHO, DG INTPA and GOARN, to the Africa Centres for Disease Control and Prevention (Africa CDC) headquarters in Addis Ababa to support coordination and operational planning.

ECDC is in discussions with the European Civil Protection and Humanitarian Aid Operations (ECHO) and the Global Outbreak Alert and Response Network (GOARN) regarding the deployment of additional experts to support response activities in DRC and Uganda. 

The European Union Reference Laboratory for public health on emerging, rodent-borne and zoonotic viral pathogens (EURL-PH-ERZV) offers support to the EU/EEA national reference laboratories for the diagnosis of BDBV infection, biosafety advice for handling and inactivation of samples, and also offers diagnostic services to EU/EEA countries for BDBV infection.