Bundibugyo Ebola in DRC and Uganda

This page last published the 2 August cut, so three days of movement arrive together: a derived 3,874 / 1,749 as of 3 August, then 3,973 / 1,801 as of 4 August, then 4,053 / 1,850 as of 5 August, a total of 251 confirmed cases and 143 confirmed deaths in three days. The 3 August point is arithmetic rather than a relay. ECDC states a movement of 99 cases and 52 deaths onto the 4 August cut, which fixes the total preceding it, and we mark it as derived because we have not seen situation report N°081 itself or any relay of it. The three daily movements read 72 and 42, then 99 and 52, then 80 and 49, so the ratio of deaths to new cases has settled at 0.58, 0.53 and 0.61 after the 0.93 that dominated our previous cut. The case-fatality rate has nonetheless climbed from 44.7% to 45.5% across these three days, because deaths keep accruing against cases confirmed earlier.

The question this page left open on 4 August is now answered, and the answer goes against the provisional reading we published. That cut showed 50 deaths against 54 cases with North Kivu taking 23 of the deaths on a caseload eight times smaller than Ituri's, and we wrote that a single day of death-registration catch-up would look identical from outside and that the next cut should settle it. It has. Across the two cuts to 4 August North Kivu added 22 confirmed cases and only 7 confirmed deaths, and its case-fatality ratio fell back from 68.8% to 67.0%. The spike was registration catching up, not a change in transmission. Ituri took 143 of the 171 new cases and 82 of the 93 new deaths over the same two cuts, which also closes the other provisional reading we were carrying: on 3 August we reported North Kivu outgrowing its share and called a southward shift in the epidemic's centre of gravity provisional rather than established. It has not held, and we are retiring it.

The one operational number that had been improving has reversed. ECDC puts contact-tracing follow-up at 77.7% of identified contacts for the 5 August cut, down from the 80.1% it recorded for 1 August, which was the first reading above 80% in this outbreak. Africa CDC and WHO put it lower still, at 75% as of 4 August against an operational target of at least 95%, and Africa CDC director general Jean Kaseya, speaking to the Associated Press for a STAT News report published 4 August, dropped the qualification entirely: "Contact tracing is not working." He put the share of new cases arising from community spread rather than from traced contacts at 60 to 70%, which is the same failure this page has tracked as roughly four in five new cases arriving unlinked, stated as a range and on a different denominator. Wherever this page gives a contact-tracing percentage, it means of identified contacts, not of the contacts that exist.

Both rankings are settled and carry WHO's own authority. This is the largest Ebola outbreak recorded in DRC and the second largest anywhere. DON614 puts the 2018-2020 Kivu epidemic at 3,317 confirmed cases, while WHO's final account of Kivu is 3,481 cases made up of 3,323 confirmed and 158 probable, with 2,299 deaths. DRC's 4,053 confirmed cases clear every version of the confirmed-against-confirmed comparison by 730 to 736, and the combined headline of 4,073 clears the 3,470 to 3,481 total that folds in probable cases by 592 to 603. What makes the crossing striking is speed rather than size: Kivu took close to two years to reach that total and this outbreak passed it in roughly two and a half months since it was declared on 15 May. On deaths Kivu still leads, 2,299 against 1,852, but the gap is down to 447 and closing at 42 to 52 a day, which brings the last comparison Kivu leads into range around the middle of August. The 2013-2016 West Africa epidemic, with 28,616 cases and 11,310 deaths, remains the largest by a wide margin and is not in reach.

Any read of the daily curve rests on notification counts WHO says undercount the epidemic by a factor of two to four. At a WHO briefing on 14 July, Dr Chikwe Ihekweazu, Executive Director of WHO's Health Emergencies Programme, put his name to the estimate: "We think, with some of our support and modelling, the scale of the outbreak is at least 2-4 times the number of cases we are finding." A figure ECDC carries from the WHO Africa Region situation report shows how much of the epidemic happens out of sight: 92.3% of 430 deaths investigated up to 5 July occurred in the community or before admission to a health facility. Africa CDC also cautions that part of the recent rise reflects cases and deaths only now being confirmed or recorded, so single-day movements should not be read as a clean incidence curve. The apparent case-fatality rate of 45.5% reflects confirmed-case reporting and will keep moving as late deaths and suspected cases are classified.

WHO's own products continue to lag national reporting. Disease Outbreak News 614 of 1 August remains the most recent in that series, three cuts and 448 cases behind, and the weekly external situation report is still number 11 with data to 26 July; number 12 was due on Tuesday 4 August and had still not been published when we checked on 7 August, a second missed Tuesday. ECDC has meanwhile become the freshest structured channel, one cut behind national reporting, though it publishes no province split. The INRB-UMIE GitHub mirror of the situation-report series reached N°082 on 6 August. ReliefWeb hosts the primary INSP documents but refuses automated requests, as insp.cd does, so our figures still rest on relays rather than on the source PDF.

Ituri holds 87.1% of cumulative confirmed cases and 81.3% of deaths, and its own case-fatality ratio has drifted up from 41.7% to 42.3%. North Kivu is at 67.0% after the reversal described above, still the more lethal of the two large clusters. Haut-Uele is now unambiguously the third province at 67 and 39, a ratio of 58.2% across five of its 13 health zones, with the affected zones reported as Boma Mangbetu, Isiro, Pawa, Rungu and Wamba. Tshopo and South Kivu have been flat for four consecutive cuts at 7 / 5 and 3 / 1. South Kivu's follow-up remains closed after 59 days without a case at Miti-Murhesa.

The health-zone count reached 53 of 140 as of 5 August, up from 51 as of 2 August, and no split has been published for the new count. The last published split, for the 51-zone count, was Ituri 28 of 36, North Kivu 12 of 34, Haut-Uele five of 13, Tshopo five of 23 and South Kivu one of 34. Tshopo remains the one to watch: five affected health zones on a cumulative total of seven confirmed cases is dispersion without density, a province collecting separate introductions from Ituri rather than building a cluster of its own, and it is the pattern that preceded North Kivu becoming a second front. There is still no new affected province and no new affected country. DRC's national rapid-response team has been deployed to Bas-Uele, which has no confirmed cases, as preparedness rather than response.

The route into the two newest provinces is documented. On 30 June, Reuters reported that DRC health authorities were tracing possible spread to Haut-Uele and Tshopo, both linked to Ituri's Niania health zone. In Tshopo, the body of a pregnant woman who fell ill in Niania on 18 June and died on 27 June was carried about 300 kilometres by motorcycle to Kisangani, where a morgue sample tested positive. In Haut-Uele, two Niania contacts who had been placed in isolation fled to the province, one testing positive and the other awaiting confirmation, before both were returned to Niania. Haut-Uele borders South Sudan and the Central African Republic, and Tshopo lies west of Ituri around the Congo River hub of Kisangani, so Haut-Uele's involvement means the whole of DRC's northeast, home to about 15 million people, is now affected. Haut-Uele became the fourth officially affected province on 10 July and Tshopo the fifth by ECDC's 13 July update. INSP judged that although both provinces' cases appear imported from Nia-Nia in Ituri, both should be treated as epidemic zones.

The health-zone ranking, last published in the 18 July report, reads Bunia 621 cumulative confirmed cases, Rwampara 440, Mongbwalu 360, Nizi 198 and Nyankunde 99, against the Bunia 247, Rwampara 195, Mongbwalu 189 and Nyankunde 68 that WHO DON608 recorded on 17 June. Nizi, a gold-mining zone north of Bunia, did not feature among the top-ranked zones a month earlier and is now fourth.

Uganda's outbreak was declared over on 28 July 2026 with a final 20 confirmed cases: 15 with travel links to DRC and five associated with local transmission, all within the two districts of Kampala and Wakiso in the Kampala metropolitan area. Its most recent confirmed case was reported on 21 June and none followed, and ECDC records the end date on its outbreak page. Those 20 cases and 2 deaths stay inside the cumulative headline, which counts the epidemic rather than the active caseload. The DRC outbreak is unaffected and its own 42-day clock has not started.

France reported one imported confirmed case on 24 June in a doctor returning from a DRC transmission zone, now recovered. ECDC and CDC list it alongside two US citizens infected in DRC and treated in Germany, the first a doctor treated at Berlin's Charite hospital from May and discharged after about two weeks, the second a humanitarian worker admitted to Frankfurt University Hospital on 13 July. EbolaIntel notes all three separately and keeps them outside the DRC-plus-Uganda headline, which is why our total differs from running tallies that fold France in. Uganda and Rwanda have both closed their borders with DRC, and Africa CDC has named 10 at-risk neighbouring countries: Angola, Burundi, Central African Republic, Republic of Congo, Ethiopia, Kenya, Rwanda, South Sudan, Tanzania and Zambia. WHO assesses risk as very high in DRC, high in Uganda and in countries bordering documented BDBV detection, and low for the rest of Africa and globally.

Two G7 countries have closed their borders over this outbreak, against WHO advice. A US CDC order suspends the entry of foreign nationals who have been in DRC, Uganda or South Sudan within the prior 21 days; a continuation was signed on 13 July, effective that day for 30 days, which points to expiry around 12 August 2026 unless amended. US citizens are exempt from that order but face a separate restriction: since 13 July the US has barred citizens who have been in DRC from boarding commercial flights home until they have spent at least 21 days in a third country, enforced through a do-not-board list, with case-by-case humanitarian exceptions. Samaritan's Purse, which has about 80 US citizens deployed in DRC and operates roughly 100 beds, said the requirement will impede staffing of treatment facilities; its chief executive Franklin Graham said it will "hurt us getting the staff that we need" and objected to health workers being treated "like they are damaged goods". Canada barred foreign nationals who have been in DRC in the previous 21 days from 20 July, with measures expiring 29 August 2026. US officials cited greater community spread into western DRC as their rationale; no primary source has confirmed a case outside the five eastern provinces, so that should be read as the stated basis for the policy rather than as a confirmed geographic extension.

The largest funding movement of the outbreak was announced on 5 August. The US Department of State said it intends, working with Congress, to provide an additional US$242 million for Ebola response and preparedness in DRC and Uganda and for related humanitarian assistance, taking total direct State Department assistance for this outbreak past US$512 million and making the United States the largest single financial contributor to the response. The announcement is aligned with the commitment of up to a further US$500 million made at the G7 leaders summit on 16 June. The release describes the money as covering emergency operations, surveillance and early detection, isolation and treatment, laboratory strengthening, community engagement and screening at points of entry, and reports nearly 300 metric tonnes of supplies distributed, support to more than 180 health facilities and more than 8.6 million health screenings. It sits against an Africa CDC estimate that the whole response needs about US$1.4 billion, and alongside the entry restrictions from the same government that organisations running treatment beds say impede staffing.

Treatment capacity is growing with it. UN News reported on 3 August that the International Medical Corps had opened a 100-bed Ebola treatment centre at the Kigonze displacement camp on the outskirts of Bunia, described as the largest in the country, with US support. Reporting back from Bunia at a WHO briefing on 14 July, Dr Chikwe Ihekweazu said treatment capacity there was close to 800 beds and rising weekly and that laboratory capacity had grown from 1 laboratory to 14, but that despite this "we have not caught up in the race". He named four constraints still holding the response back: a funding gap, attacks on health centres, the armed conflict in eastern DRC, and community mistrust. On 7 July, WHO's representative in DRC, Dr Anne Ancia, put the assessment plainly: "We would like to say it is stabilising, but frankly, we cannot say it yet."

The response is also disrupted from inside. On 13 July, dozens of staff at the Rwampara Ebola treatment centre in Bunia, among them epidemiologists, case investigators, drivers and gravediggers, stopped work over salaries and bonuses unpaid since the outbreak was declared, closing the facility and blocking its access road; strikers said suspending care and clinical surveillance would leave hospitalised patients with almost no chance. Health workers at Bunia General Hospital also walked out, and INSP confirmed that continuity of essential health services in Bunia and Rwampara had been compromised. Staff agreed on 14 July to resume work on condition the government paid within 72 hours, and health minister Roger Kamba said the delay came from verifying the response payroll after unrelated names were added to it. Work resumed after Ituri's military governor, Major-General Gaby Kasongo Mulumba, met the response's strategic coordination on 15 July, but the deadline passed without payment.

At a press briefing in Bunia on 18 July, officials committed to paying the arrears and announced corrective measures rather than a date: validating personnel lists, digitalising the payment system and shifting progressively to digital payments. They attributed the arrears to administrative and logistical problems rather than to a lack of money, and Radio Okapi reported on 19 July that no payment date had been given. The dispute remains unresolved in the official record: the 18 July situation report still lists non-payment of response workers among its principal challenges and records the impact as an interruption of response activities including safe and dignified burials. SOS Medias Burundi reported on 18 July that the action had spread to Butembo, Beni and Kisangani; that rests on a single outlet and we have not corroborated it. On 25 July a fresh walkout hit Bunia's Elikya treatment centre, where the Associated Press reported about 100 doctors, nurses and security staff stopped work over two months of unpaid performance bonuses; the response's operations chief Adelard Lufongola said the same day that payments were being cleared through mobile money. Rwampara and Bunia are the same two sites hosting the EBO-PEP prophylaxis trial.

Security is the other constraint, and it is quantified. On 18 July the Associated Press reported at least a dozen attacks on health facilities and health workers during this outbreak, attributed to Pierre Akilimali, incident manager for the response. Response staff have been held captive in some health zones and safe-burial teams threatened in cemeteries, and safety fears are pushing health and aid workers to withdraw from remote communities into Bunia, shrinking the surveillance footprint precisely where undetected chains are suspected. The most recent incident was at Nyankunde in Ituri on 15 July, where a crowd attacked the hospital and the adjoining treatment centre after a woman who had come to give birth died of severe anaemia when the hospital declined a blood transfusion her family offered, transfusions being restricted under outbreak protocol. Stones were thrown, the perimeter fence was damaged, several patients escaped, the medical team withdrew and the generator stopped working; Samaritan's Purse evacuated staff and treatment resumed the next day. The situation report also records an attack on safe-burial teams at the Muchanga bridge and community resistance at Komanda and Mandima, and attributes access constraints to the armed groups CODECO and ADF. UN OCHA has recorded 76 security incidents affecting response and aid workers across Ituri, North Kivu and South Kivu, with 45 wounded; on 7 July attackers raided a treatment centre in Butembo and set part of it alight.

The 18 July report keeps numbers on capacity: 724 patients in isolation, 272 confirmed and 452 suspected, against 857 beds nationally, an occupancy rate of 84.5%. North Kivu was over its limit at 123.1%, with 181 patients in 141 beds, while Ituri ran at 76.3% and Tshopo at 40%. The Musienene health zone in North Kivu, which has no treatment or transit centre at all, took four of that province's 16 new confirmed cases. Only 175 of 1,170 triage units in Ituri were functional, with shortages of protective equipment and chlorine listed among the drivers of frontline infections, and four patients absconded from treatment structures in 24 hours. Of the 40 deaths confirmed that day, 30 were community deaths detected by post-mortem swab and 10 occurred inside a treatment centre, the ratio that keeps the response behind the virus. Surveillance volume is high: 872 alerts in a day, 825 investigated within 24 hours, validating 192 suspected cases of whom 80 were community deaths. Laboratory positivity was 38.1% in Ituri against 12.6% in North Kivu, and national test positivity has since been reported above 40%, a rate that is itself evidence of under-testing.

ECDC records 694 people hospitalised in isolation as of 5 August, effectively flat on the 690 it reported for 1 August after an unexplained fall from 807. Recoveries reached 793 in DRC. Earlier in the response, WHO reported treatment capacity growing from fewer than 10 beds to more than 500 across 19 health centres and laboratory capacity to more than 2,000 tests a day, alongside more than 21,000 community health workers in training. On 16 July the Global Fund approved US$4.6 million for an intensified malaria response across four Ituri health zones, explicitly to protect the Ebola response by reducing the number of febrile patients who present as suspected Ebola cases and occupy isolation beds. On 15 July, Medecins Sans Frontieres appealed for an urgent scale-up of the international medical response in Ituri, reporting that its 90-bed Elikiya centre in Bunia is almost always at full capacity, so patients keep arriving late and critically ill. On 2 July the UN Development Programme estimated the outbreak could cut DRC economic output by more than US$1 billion and push nearly one million more people into poverty.

On 2 July, WHO announced that patient enrolment had begun in the PARTNERS trial, the Platform Adaptive Randomised Trial for New and Repurposed Filovirus TreatmentS, the first clinical trial of treatments for Bundibugyo virus disease, which enrolled its first patient in Bunia. Sponsored by WHO and coordinated by the Congolese National Institute of Biomedical Research, the Institute of Tropical Medicine in Antwerp and the University of Oxford, it randomises patients of any age with confirmed disease to standard care alone, standard care plus MBP134, standard care plus remdesivir, or both drugs plus standard care, with mortality at 28 days as the primary endpoint and a target of 700 to 1,000 participants over six months. The United States and Gilead Sciences are donating the doses.

On 14 July, recruitment opened in Ituri for EBO-PEP, the first trial of any post-exposure prophylaxis against Bundibugyo virus. It tests obeldesivir, an investigational oral antiviral developed by Gilead with no Bundibugyo-specific human efficacy data, in nearly 1,000 participants aged over 12 who had direct contact with a confirmed case within the previous five days and are symptom-free at enrolment, with daily monitoring for 21 days and a final visit at day 42. The first PEP centres sit alongside the ALIMA-run treatment centres in Bunia and Rwampara. It is coordinated by ALIMA with DRC's INRB and France's ANRS Emerging Infectious Diseases, supported by Medecins Sans Frontieres and Africa CDC, and funded by EUR 3.4 million from the Global Health EDCTP3 partnership, US$1 million from Africa CDC and US$5 million combined from DRC and South Africa. Several newsrooms have described it as a Gilead-run trial, which it is not. A secondary protocol offers compassionate-use remdesivir to children under 12 and to pregnant or breastfeeding women, who are excluded from the obeldesivir arm.

On 13 July, the Oxford Vaccine Group launched BD-Ebov, the world's first Phase 1 trial of a Bundibugyo vaccine candidate, testing ChAdOx1 BDBV for safety and immune response in 50 healthy adults aged 18-55 in Oxford. On 24 July it vaccinated the first volunteer, the first time ChAdOx1 BDBV has been given to a human, with further volunteers being enrolled and dosed over the following weeks. The Serum Institute of India has manufactured and stockpiled about 620,000 doses of the candidate in two weeks and supplied 4,000 investigational doses for the Phase 1 study. Neither product is approved, and a Phase 1 trial measures safety and immune response rather than efficacy. The single-dose rVSV-based BDBV candidate developed by IAVI, which WHO has identified as the most promising vaccine in development, is seven to nine months from human efficacy trials.

On 1 June, CEPI committed up to US$62 million to fast-track three BDBV vaccine candidates: up to US$50 million for a Moderna mRNA candidate, US$8.6 million for the Oxford ChAdOx1 BDBV candidate, and US$3.2 million for the IAVI rVSV-BDBV candidate, covering preclinical work and Phase 1 trials. On 9 June it added US$1.9 million to Public Health Vaccines LLC to generate master viral seed stock for a second rVSV-based Bundibugyo candidate, a fourth developer alongside Moderna, Oxford and IAVI.

The only regulatory milestone this outbreak has produced is diagnostic rather than preventive or therapeutic: on 2 July WHO added the first Bundibugyo virus test to its Emergency Use Listing, an RT-qPCR kit from Shanghai ZJ Bio-Tech that detects and distinguishes pathogenic ebolavirus species. No vaccine and no therapeutic has received Emergency Use Listing or prequalification for Bundibugyo virus, a point the International Pandemic Preparedness Secretariat restated in its 100 Days Mission Day 60 report on 16 July.

Alongside the trials, the wider response architecture: WHO and Africa CDC launched a six-month US$518 million continental preparedness and response plan on 5 June covering June to November 2026, DRC President Tshisekedi announced a national response plan budgeted at US$319 million on 30 June, and CDC said on 18 June that it had more than 125 staff in DRC and Uganda and had accessed US$107 million in emergency funding. On 17 June, WHO issued filovirus clinical-management guidelines covering Bundibugyo virus disease, with emphasis on early recognition, rapid referral, optimized supportive care, laboratory monitoring, careful rehydration, shock management, antibiotics when bacterial infection is present, and structured after-care for survivors.

A Rockefeller Foundation and Echelon Insights poll published on 7 July, fielded 12-16 June among 2,022 US voters, found that 75% of Americans support restoring US disease-prevention aid for the DRC Ebola outbreak and 90% support funding overseas disease-prevention programmes generally. The State Department announcement of 5 August, which takes total direct US assistance for this outbreak past US$512 million, is the largest single reversal of that trend the outbreak has produced, though it arrives through a different channel than the dismantled agency and alongside entry restrictions that treatment providers say cost them staff.