Landscape with a Footbridge, Albrecht Altdorfer (1518)

 

{Click on Image to Enlarge}

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Public Domain.

Source: 

Link: https://www.wikiart.org/en/albrecht-altdorfer/landscape-with-a-footbridge

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#Influenza A virus #H5N1 genotypes #B3.13 and D1.1 show #temperature-dependent restriction of #replication in primary #human respiratory epithelial cell cultures derived from the upper and lower respiratory tract

 

Abstract

H5N1 clade 2.3.4.4b avian influenza A viruses pose a significant threat to wild animal populations, domesticated animals, and potentially, the human population. For H5N1s to infect and transmit among mammalian species, mutations for improved utilization of mammalian receptors and enhanced replication at the lower temperatures of the upper respiratory tract need to be acquired. A human H1N1pdm09-like virus was compared to H5N1 genotypes B3.13 and D1.1 for replication at 33ºC, 37ºC, and 39ºC – temperatures consistent with the upper and lower respiratory tract in humans, and dairy cow udder tissue. All H5N1 viruses had increased plaque sizes on MDCK cells at 37ºC and 39ºC compared to H1N1pdm09. In primary, differentiated human nasal and bronchial epithelial cultures, all H5N1 viruses show restricted infectious virus production compared to H1N1 at 33ºC. While H5N1 D1.1 also showed restricted replication at 37ºC and 39ºC, the H5N1 B3.13 replicated to nearly equivalent titers as H1N1pdm09. All H5N1 viruses demonstrated similar cell tropism in cells from the upper and lower respiratory tract, infecting more ciliated than non-ciliated cells relative to H1N1pdm09. H1N1, H5N1 B3.13 D1.1 infection induced similar innate immune factors, with nasal epithelial cells producing higher levels compared to bronchial epithelial cells. These data suggest that genotype B3.13 and D1.1 H5N1 viruses show different temperature dependent replication patterns compared to H1N1pdm09.

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.08.27.747488v1

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History of Mass Transportation: The CP 0180 Steam Locomotive of Portuguese Railways

 

{Click on Image to Enlarge}

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By Nelso Silva - CP 0186, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=50084760

Source: 

Link: https://en.wikipedia.org/wiki/Comboios_de_Portugal

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2nd meeting of #IHR EC on #epidemic of #Ebola #Bundibugyo virus disease in #DRC – Meeting report (WHO, August 29 '26)

28 August 2026 | Statement | Geneva 

    The Director-General (DG) of the World Health Organization (WHO) is hereby transmitting the report of the second meeting of the International Health Regulations (2005) (IHR) Emergency Committee (Committee) regarding the epidemic of Ebola disease caused by Bundibugyo virus (BVD) in the Democratic Republic of the Congo (DRC), held on Tuesday, 18 August 2026, from 12:00 to 17:00 CEST.

    The DG welcomes the Statement by the Committee, presented at the beginning of its report, and expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee.

    Concurring with the advice expressed by the Committee during the meeting, the DG determined that the BVD epidemic in the DRC continues to meet the criteria of a public health emergency of international concern (PHEIC), but not those of a pandemic emergency. Accordingly, on 24 August 2026, the DG, considering the advice offered by the Committee, issued temporary recommendations to States Parties, available here.  

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Statement by Committee

    The Committee commends the Government of Uganda for the rapid control of BVD transmission, with no new cases detected since 16 July 2026, and recognizes the major efforts being undertaken by the DRC, affected communities, WHO and national and international partners. Nevertheless, the Committee considers the continuing rapid growth and geographic expansion of the epidemic in the DRC to be of grave concern, requiring urgent, intensified and sustained action.

    As of 18 August 2026, approximately 5,000 BVD cases have been reported in the DRC. Available modelling suggests that substantial under-ascertainment may be occurring, with the true number of infections potentially three- to four-fold higher. Without a rapid change in the trajectory of transmission, the epidemic risks reaching a scale with profound national and regional consequences, with the potential for case numbers and deaths to exceed those seen in the 2013-2016 Ebola disease epidemic in West Africa. The Committee therefore emphasizes the need for urgent, decisive and coordinated action to control BVD transmission in the DRC.

    The BVD epidemic is occurring in the context of an already severe and complex humanitarian emergency. Areas with some of the highest BVD transmission burdens substantially overlap with areas affected by armed conflict, insecurity, population displacement and constrained humanitarian access.

    These conditions endanger affected populations and responders, impede community engagement, surveillance, contact tracing, safe and timely access to care, infection prevention and control (IPC), and other essential response operations.

    At the same time, disruption of essential health services risks increasing preventable deaths from malaria, diarrhoeal diseases, maternal causes and other conditions. Uncontrolled transmission also carries potentially serious consequences for neighbouring countries and for the social and economic stability of the Great Lakes region.

    The Committee emphasizes that communities must be at the center of the response. Erosion of trust in authorities and responders, insufficient community ownership, insecurity and operational and coordination weaknesses are major impediments to effective control. These challenges cannot be addressed through public health interventions alone. The response must be built with affected communities and supported by trusted local leaders and organizations, with transparent communication, meaningful participation and mechanisms through which community concerns rapidly influence response operations.

    The Committee notes that current epidemiological, clinical and genomic evidence does not indicate a fundamental change in the known biology, modes of transmission or clinical characteristics of Bundibugyo virus (BDBV). The priority, therefore, is to deliver science-based public health response interventions of proven effectiveness at sufficient speed, quality, coverage and scale.

    The Committee is deeply concerned that implementation of core essential public health response interventions has not yet consistently achieved the coverage and performance required to interrupt BVD transmission. 

    An immediate and drastic operational intensification and scale-up of response operations is required, potentially with an operational reset. 

    Particular priority needs to be given to: 

        - ensuring community engagement and community-based surveillance; 

        - rapid case detection, 

        - investigation and isolation; 

        - comprehensive contact identification and follow-up; 

        - IPC in BVD isolation and treatment centers, other health-care facilities and communities; 

        - safe and dignified management of deaths; 

        - timely laboratory diagnosis; and 

        - accessible, high-quality clinical care. 

    All these areas require intensification of efforts, and all should be viewed as essential components of an effective response. While none of these areas can afford to be neglected or deprioritized, the Committee identifies below specific areas requiring urgent action and particular focus.

    Effective vaccines and therapeutics against BVD, should they become available and be demonstrated to be safe and effective through rigorous clinical trials, could make an important contribution to reducing transmission, morbidity and mortality; however, they should complement rather than be a substitute for rigorous implementation of core public health measures.

    The response must be planned not only for the immediate term but for the sustained engagement that will be required over the coming months, or even years. This requires predictable financing, adequate human resources, secure access to communities, resilient supply chains, continuity of essential health services, and sustained national, regional and international political commitment.

    The Committee therefore calls for an immediate, unified and fully resourced intensification of the response, under the leadership of the Government of the DRC and with sustained regional and international support. The temporary recommendations issued by the DG should be translated into one integrated, time-bound and costed national action plan for the DRC, serving as the common framework for aligning the efforts and resources of the Government and national and international partners.

    The plan should establish clear responsibilities, measurable milestones and indicators; identify operational and geographic gaps; quantify the human, logistical and financial resources required; and include a companion gap analysis to guide urgent resource mobilization. Implementation should be reviewed frequently against agreed indicators and the evolving epidemiological situation, with rapid corrective action where milestones are not being achieved.

    Given the intersection between ongoing transmission, armed conflict, insecurity and restricted humanitarian access, the Committee emphasizes that high-level political engagement is urgently required to secure safe, sustained and unhindered access for epidemic-control operations that is being called for. 

    National, regional and international leaders should use all appropriate diplomatic and humanitarian channels to create the conditions necessary for effective implementation of comprehensive response measures. Where required, this should include arrangements for temporary cessations of hostilities or other humanitarian access measures that enable affected communities to receive essential health services and allow response teams to operate safely and effectively.

    The imperative is clear: interrupt BVD transmission rapidly, protect affected communities and health workers, maintain essential health services, prevent further geographic and cross-border spread, and mobilize the political, operational and financial support necessary to bring the epidemic under control.

    The Committee calls for particular focus on the following urgent priority interventions:

        § Drastic scale-up of trust-building and community engagement through trusted communication channels and local actors, including local leaders, religious leaders, traditional healers and survivors, to support community participation in fostering the acceptance of public health measures, including early detection, case referral, contact tracing, safe and dignified burial practices, and adoption of protective behaviours.

        § Drastic scale-up of IPC measures to prevent transmission in BVD isolation and treatment centers, other healthcare settings, and, in some circumstances, at home in the community. With regard to the latter, although it is not realistic to expect community members to be able to maintain the same level of application of IPC measures as in healthcare settings, it must be recognized that, for myriad reasons, many sick persons cannot or will not seek care in health care facilities. Until clinical care capacity can be augmented, along with the requisite enhanced security and community trust to motivate and permit sick persons to seek care, steps to limit transmission in the home, such as distribution of personal protective equipment, materials and disinfectants, may reduce transmission risk and morbidity, and may also represent a conduit for greater community engagement.

        § Drastic scale-up of BVD isolation and treatment centers staffed by a specifically trained workforce, with appropriate provision of personal protective equipment and materials.

        § In-depth analysis or research to identify and characterize BVD transmission dynamics associated with specific settings, including related modes of BVD transmission (e.g. caretaking in the home, hospital, or at traditional healers, re-use of needles). A better understanding of the epidemiology of the epidemic is essential for the implementation of effective interventions.

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The Annex to this Report records the views of one Member of the Committee in relation to the “Statement by the Committee”.

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Proceedings of the meeting

    All 12 Members of, and five Advisors to, the Committee participated in the meeting convened by teleconference, via Zoom, on Tuesday, 18 August 2026, from 12:00 to 17:00 CEST.

    The DG joined in person and welcomed the participants, including Government Officials designated to present their views to the Committee on behalf of the three invited States Parties – the DRC, France and Uganda. The opening remarks by the DG are available here.

    The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and identified the mandate of the Committee under the relevant provisions of the IHR. 

    The Ethics Officer from the Department of Compliance, Risk Management, and Ethics proceeded with the rollcall and provided the Members and Advisors with an overview of the WHO Declaration of Interests process. 

    The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. 

    They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.

    The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the DG on whether the event continues to constitute a PHEIC, including a pandemic emergency, and to provide views on the proposed temporary recommendations.

Session open to representatives of States Parties invited to present their views

    Representatives of the DRC and Uganda updated the Committee on the BVD epidemiological situation in their countries, their current response efforts, needs and challenges. Ahead of the meeting, France submitted a written statement to the Committee regarding an imported BVD confirmed case from the DRC.

    The WHO Secretariat presented a comparative assessment of the indicators associated with each of the three criteria defining a PHEIC between 17 May 2026, when the PHEIC was determined, and 12 August 2026, as well as the indicators associated with each of the criteria defining a pandemic emergency, as per Article 1 - Definitions of the IHR. The WHO Secretariat also presented an overview of health operations and the scale up strategy in response to the BVD epidemic.

With respect to the indicators associated with the PHEIC criteria, the following assessment was presented.

1. Extraordinary

1.1. Growth rate (effective reproductive number (Rt))

    On 17 May 2026, the growth rate could not be calculated, though it was understood to be very high, given the orders-of-magnitude increase in the number of confirmed cases since then. Case-based estimates now suggest a doubling time of 52 days and an Rt of 1.24; however, low case ascertainment means these figures are likely to understate true transmission. Deaths are considered a more reliable indicator of epidemic growth, given higher relative ascertainment of fatal outcomes. Based on mortality data, the estimated doubling time is 21 days, with an Rt of 1.55. Triangulation across multiple methods and data sources further estimates that the true size of the epidemic is 3 to 4 times larger than what is reflected by surveillance data. Growth rate was assessed as ‘very high’ at the time the PHEIC was determined and continues to be assessed as ‘very high’ as of 12 August 2026, with confidence improving from ‘low’ to ‘moderate.’

1.2. Within country geographical spread (number of health zones with BVD in the DRC)

    On 17 May 2026, BDBV was known to be present in three health zones in the DRC. As of 12 August 2026, its presence had expanded to 55 health zones, 49 of which had active transmission. The geographic mapping of confirmed BVD cases likely understates the real extent of the spread, as some affected areas remain outside government control or are subject to insecurity limiting surveillance and response operations. Forecasting identifies 15 health zones at highest risk of further expansion in the coming week, four of which border Uganda, South Sudan, and Rwanda. The indicator increased from ‘moderate’ on 17 May 2026 to ‘high’ on 12 August 2026, with the level of confidence remaining ‘moderate’.

1.3. Challenges to contact tracing (proportion of BVD cases from listed contacts)

    Challenges with contact tracing persist unchanged. While the follow-up of listed contacts stands at approximately 80%, the average of 13 listed contacts per BVD case is far lower than that observed in previous viral hemorrhagic fever outbreaks. This results in only approximately 20% of BVD cases being identified through the follow up of listed contacts, and 40% of the BVD cases eventually linked to a chain of transmission. Challenges to contact tracing were assessed as ‘very high’ on 17 May 2026 and they remained ‘very high’ as of 12 August 2026. The level of confidence of those assessments moved from ‘low’ (17 May 2026) to ‘moderate’ (12 August 2026).

1.4. Severity (case fatality ratio (CFR))

    Early in the epidemic (around mid-May 2026), the crude CFR appeared as low as 20%, as the numerator did not include several deaths among persons under investigation for suspected BVD. As surveillance improved, as of 12 August 2026, the crude CFR stands at approximately 46%, notwithstanding persisting limitations in data quality. As expected, the CFR varies by age, with no meaningful difference observed by sex. The assessment of the severity as ‘high’ remained unchanged between 17 May and 12 August 2026, with the level of confidence moving from ‘low’ to ‘moderate.’

1.5. Disruption to health services (various)

    Before the BVD epidemic was detected, health services in the areas with current BVD transmission were already under strain from a deteriorating humanitarian situation, compounded by funding withdrawals, attacks on healthcare facilities, and supply chain disruptions. According to the most recent assessment conducted after the BVD epidemic was detected, the use of health care services has fallen by more than 40% in some of the areas with BVD transmission. Despite that, the observed incidence of malaria, cholera, and trauma cases remain high. In Ituri Province, maternal deaths have doubled since May 2026, currently averaging more than six per week. As of 17 May 2026, the disruption to health services was assessed as ‘moderate’ and, due to its worsening, it was assessed as ‘high’ as of 12 August 2026. Due to the scarcity of data, the level of confidence in those assessments remained ‘low’ and unchanged between 17 May 2026 and 12 August 2026.

2. International spread

2.1. Number of States Parties with BVD cases (imported cases, including resulting in limited local transmission)

    Historically, imported cases of Ebola virus infection have been reported during past outbreaks. However, only in a very limited number of instances have imported cases resulted in onwards transmission - limited to a very small number of cases – in States Parties outside Africa. In the context of the ongoing BVD epidemic in the DRC, modelled estimates indicate the risk of BVD spread to States Parties outside Africa remains very low. With respect to the risk of BVD spread from the DRC to other States Parties in Africa, modelled estimates indicate that this is significant for States Parties sharing land borders with provinces of the DRC with BVD transmission. Beside the possibility of reintroduction of BVD into Uganda, the risk is highest for South Sudan, reflecting its connectivity with the DRC. It is noted that the Central African Republic was not included at the time the modelled estimates were calculated.

    As of 17 May 2026, two States Parties (the DRC and Uganda) had detected BVD cases, with BVD cases in Uganda resulting from importations from the DRC and limited onwards local transmission. At that time the indicator was assessed as ‘low’. As of 12 August 2026, active BVD cases were reported only in the DRC, following control of BVD transmission in Uganda. The single imported BVD case detected in France did not result in onward transmission. The assessment of this indicator therefore remains ‘low’. Between 17 May and 12 August 2026, the level of confidence moved from ‘moderate’ to ‘high.’

2.2. Gaps in preparedness in States Parties sharing land borders with the DRC (and Uganda) (composite percentage)

    States Parties considered in this assessment are those sharing land borders with the DRC, as well as with Uganda, given the detection of imported BVD cases in Uganda early in the epidemic, and include Angola, Burundi, Central African Republic, Kenya, Republic of Congo, Rwanda, South Sudan, Tanzania and Zambia. In the context of quarterly readiness self-assessment, coordinated by the WHO Regional Office for Africa, a specific BVD-readiness assessment was conducted in the third quarter of 2026. The average readiness score of that assessment, encompassing 11 readiness domains and expressed in percentage, is as follows: Central African Republic - 38%; Republic of Congo - 50%; Tanzania - 53%; Angola - 64%; South Sudan - 65%; Zambia - 70%; Rwanda - 94%. There are no data available for Burundi and Kenya. The assessment of this indicator as ‘high’ remained unchanged between 17 May and 12 August 2026, with the level of confidence remaining ‘moderate’.

3. International cooperation

3.1. In-country response capacity exceeded (expert judgement based on operational outputs and epidemiological data)

    Since the BVD epidemic was detected in the DRC, the national response capacity has been scaled up. As of 12 August 2026, there were 21 laboratories with BDBV testing capacity, and approximately 1000 beds for the treatment of BVD cases. Although these figures may represent the fastest scale-up on record and reflect a very large-scale operational response, the late detection of the epidemic and the resulting unprecedented growth in BVD cases have outpaced the combined response capacity of the Government and partners. For example, the estimated number of beds needed for the treatment of BVD cases is 3000. Furthermore, there is a need to maintain essential health and humanitarian services amid severe access constraints, large-scale displacement and logistical disruptions, including the closure of the airports in Goma and Bukavu. The closure of these airports has hindered the delivery of essential supplies and led to recurrent stock-outs, further increasing the risk of morbidity and mortality. While this indicator was assessed as ‘high’ on 17 May 2026, in light of mounting humanitarian pressures, dwindling resources and the pace of epidemic growth, it was assessed as ‘very high’ on 12 August 2026, with the level of confidence remaining ‘high’.

3.2. Need for coordination of international response (expert judgement based on response operations data)

    Since the BVD epidemic was detected in May 2026, a continental preparedness and response plan was developed to support the implementation of national plans and coordinate the work of more than 30 named partners, with all partner response activities coordinated under a Continental Incident Management Support Team. Under that framework, a joint financial tracking mechanism has been established. As of 12 August 2026, there were 94 partners reporting engagement in the BVD response, across multiple technical pillars, with operations concentrated in Ituri, North Kivu and South Kivu Provinces in the DRC, leaving critical gaps in partner support elsewhere in the country. The WHO Secretariat has deployed 274 staff, including through partner networks, against a target of 455. The overall need for coordination of the international response was assessed as ‘high’ on 17 May 2026, and remained such as of 12 August 2026, with the level of confidence remaining unchanged as ‘high’.

3.3. Access to BVD-specific countermeasures

    As was the case when the BVD epidemic was detected in May 2026, as of 12 August 2026, no BVD-specific countermeasure is licensed. This indicator therefore remains not applicable.

    Members of, and Advisors to, the Committee then engaged in questions and answers with States Parties’ Representatives and the WHO Secretariat.

Deliberative session

    Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC, including a pandemic emergency, and to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.

    The Chair reminded the Committee Members of their mandate and recalled the definitions of PHEIC and pandemic emergency, as per Article 1 - Definitions of the IHR.

    Except for one Member, the Committee expressed the view that the BVD epidemic in the DRC continues to constitute a PHEIC but does not meet the criteria of a pandemic emergency, and that the DG be advised accordingly.

    The Committee subsequently considered the temporary recommendations to States Parties proposed by the WHO Secretariat.

    The Committee, ahead of its meeting, had received proposed temporary recommendations drafted by the WHO Secretariat in accordance with the provisions of the IHR, and subsequently offered its insightful advice.

    Specifically, the Committee called for the formulation of temporary recommendations stressing the urgency of immediately intensifying core interventions, including a drastic operational scale-up of human resources, as well as for planning efforts to sustain the response to the BVD epidemic over a prolonged period.

Conclusions

    The Executive Director of the WHO Health Emergency Preparedness and Response Programme, on behalf of the DG, expressed his gratitude to the Committee’s Officers, its Members and Advisors and closed the meeting.

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Annex

    In accordance with paragraph 4.12, under Reports on Meetings of Committees in the WHO Regulations for Expert Advisory Panels and Committees, the Committee hereby records the divergent views expressed by one Member with respect to the “Statement by the Committee”.

    While the Statement reflects the deep concern expressed by the other Members of the Committee in the course of formulating their advice to the Director-General on whether the event constitutes a public health emergency of international concern, one Member indicated that the Statement extends beyond the terms of reference of the Committee, as set forth in Articles 12, 17, 48 and 49 of the IHR.

    The specific reasons provided by the Member relate to the following aspects addressed in the Statement: “operational management of the response, national response planning, resource allocation and mobilization, political or diplomatic engagement, or humanitarian and security arrangements.”

Source: 

Link: https://www.who.int/news/item/28-08-2026-second-meeting-of-the-ihr-emergency-committee-on-the-epidemic-of-ebola-bundibugyo-virus-disease-in-the-democratic-republic-of-the-congo---meeting-report

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#Ebola disease caused by #Bundibugyo virus - #DRC (WHO, August 28 '26): 5,794 cases and 2,786 deaths

 

Situation at a glance

    Since the last Disease Outbreak News was published on 14 August 2026, the outbreak has spread from 54 to 60 health zones. 

    The number of affected provinces stands at six out of 26 provinces of the country: Bas-Uélé, Haut-Uélé, Ituri, North Kivu, South Kivu, and Tshopo. 

    Six additional health zones reported cases since the last update - Ganga and Viadana health zones in Bas-Uélé province, Biena, Manguredjipa, and Mutwanga in North Kivu, and Tshopo health zone in Tshopo province. 

    As of 26 August 2026, a total of 5794 confirmed cases, including 2786 deaths, have been reported, corresponding to a crude case fatality ratio (CFR) of 48.1%. 

    These figures demonstrate a substantial increase in the scale and geographic extent of the outbreak over the past three months. 

    The crude case fatality ratio of 48% underscores the severity of the disease and ongoing challenges related to timely case detection, access to and quality of clinical care, and effective interruption of viral transmission. 

    Delays in recognizing cases increase the likelihood of onward transmission within households, communities and healthcare facilities. 

    The outbreak remains a public health emergency of international concern, following the advice of Emergency Committee meeting convened on 18 August.

Description of the situation

    Since the previous Disease Outbreak News was published on 14 August 2026, additional confirmed cases and deaths of BVD have been reported only in the Democratic Republic of the Congo.  

    Cumulatively as of 26 August 2026, 5815 confirmed cases have been reported: 5794 in the Democratic Republic of the Congo (including two cases diagnosed in the Democratic Republic of the Congo and subsequently treated in Germany), 20 in Uganda and one in France. 

    A total of 2788 deaths have been reported, including two in Uganda. 

    As of 26 August, at least 1314 patients have recovered, including 1293 in the Democratic Republic of the Congo, 18 in Uganda, two in Germany and one in France.  

    As of 27 August, the 42-day enhanced monitoring period, as per international guidance, has been completed in both France and Uganda.  

    The continuing intensity of transmission in the Democratic Republic of the Congo means that the risk of further exportation across international borders remains. 

    Entry and exit health screening and surveillance measures are in place at airports, ports and official land border crossings; however, movement through informal border crossing routes may occur, presenting an ongoing risk of virus exportation, importation and onward transmission. 

    Therefore, cross‑border collaboration, and sustained surveillance and preparedness are essential to prevent further regional spread and ensure an effective public health response. 

    On 27 August, vaccination of health care workers using the Ervebo vaccine was initiated in the Democratic Republic of the Congo in some areas, including in Kisangani, Tshopo province. 

    Although Ervebo is a safe vaccine, and effective against Ebola virus disease, it is not known whether it provides protection against the Bundibugyo virus in humans. 

    Thus, starting a clinical trial of the vaccine, alongside this wider use, is key to provide important new evidence and inform future use of the vaccine. 

    The second IHR Emergency Committee meeting regarding the epidemic of Ebola Bundibugyo virus disease in the Democratic Republic of the Congo took place on 18 August. 

    Following the advice of the Committee, the Director-General agreed that the ongoing outbreak remains a Public Health Emergency of International Concern, and issued updated temporary recommendations to countries. 

(...)

Democratic Republic of the Congo  

    Since 14 August 2026 when the last Disease Outbreak News was published, an additional 1129 confirmed cases, including 602 confirmed deaths, have been reported in the Democratic Republic of the Congo. 

    Although part of this increase likely reflects expanded surveillance, enhanced laboratory testing, improved diagnostic capacity, and periodic data backlog reconciliation, the sustained rise in number of cases and deaths are the result of continued transmission and substantial outbreak expansion. 

    As of 26 August 2026, a total of 5794 confirmed cases, including 2786 deaths (CFR 48.1%), have been reported in the Democratic Republic of the Congo. 

    To date, 1293 patients have recovered. 

    Cases have been reported from 60 health zones (HZ) across six provinces. Ituri has 28 health zones affected out of 36, followed by North Kivu (15/34), Haut-Uélé (6/13), Tshopo (7/23), South Kivu (1/34) and Bas Uélé (3/11). 

    The most recently affected province, Bas-Uélé, started reporting cases since 12 August. 

    The most recently affected health zones are Biena and Manguredjipa in North Kivu province. 

    As of 26 August, of the 60 affected health zones, 81 new confirmed cases were reported in the last 24 hours from 19 health zones in Ituri, North Kivu, Haut-Uélé, and Tshopo provinces. Ituri remains the epicentre of the outbreak, with 4802 confirmed cases reported since the start of the outbreak, including 52 new confirmed cases reported in the last 24 hours, as of 26 August. 

    Nord-Kivu is the second most affected province, with a cumulative number of 775 confirmed cases, including 22 reported in the last 24 hours, as of 26 August. The highest CFR (68%) in this outbreak has been reported from North Kivu province; the reasons for this high CFR are under investigation. 

    The number of individuals requiring contact monitoring has also increased substantially as the outbreak has expanded. As of 26 August, the proportion of contacts followed up in the last 24 hours is at 82.3% (22 091 seen out of 26 850 to follow up). The large number of contacts reflects the scale of potential exposure within affected communities. 

    The outbreak is unfolding in a conflict-affected humanitarian context marked by insecurity, armed violence, and large-scale displacement. 

    More than 26 million people face acute food insecurity, and an estimated one million internally displaced people live in Ituri Province alone. Insecurity and displacement disrupt access to health care and essential services, restrict access for response teams, and impede surveillance, case investigation and contact follow-up. 

    Overcrowding, limited water, sanitation and hygiene services, and restricted access to healthcare in mining communities, informal settlements and sites for internally displaced people further hinder early detection, infection prevention, and appropriate care. These conditions also make it harder to implement response measures consistently and to reach affected populations.  

Figure 2: Number of confirmed Bundibugyo virus disease cases in the Democratic Republic of the Congo, by date of notification, as of 26 August 2026

{Click on Image to Enlarge}

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Figure 3: Number of deaths among confirmed Bundibugyo virus disease cases in the Democratic Republic of the Congo by date of notification, as of 26 August 2026

{Click on Image to Enlarge}

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    Between 18 May and 28 August 2026, enhanced public health intelligence conducted by WHO identified 76 Ebola-related signals across 23 countries and territories, supporting rapid verification, risk assessment and information sharing with national authorities through IHR National Focal Points. Most signals, 92% (70/76), including suspected cases among travellers and health-care workers and reports circulating in public sources, were subsequently ruled out through investigation and laboratory testing. The remaining six were confirmed as Ebola events. 

Epidemiology

    Bundibugyo virus disease (BVD) is a severe Ebola disease caused by the Bundibugyo virus, one of the Orthoebolavirus species. It is a zoonotic disease, with fruit bats suspected to be the natural reservoir. 

    

    Human infection is thought to occur through close contact with the blood or secretions of infected wildlife, such as bats or non-human primates, and it subsequently spreads from person-to-person through direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals or contaminated surfaces and materials. Transmission is particularly amplified in health-care settings when IPC measures are inadequate and during unsafe burial practices involving direct contact with deceased individuals. 

    The incubation period for BVD ranges from two to 21 days, and infected individuals are not infectious until symptom onset. Early symptoms such as fever, fatigue, muscle pain, headache, and sore throat are non-specific, which complicates clinical diagnosis and can delay detection. These symptoms then progress to gastrointestinal symptoms, organ dysfunction, and, in some cases, haemorrhagic manifestations. 

    CFRs in the past two BVD outbreaks, reported in Uganda and in the Democratic Republic of the Congo in 2007 and 2012, were 30% and 50%, respectively. 

    Differentiating BVD from other endemic febrile illnesses such as malaria is challenging without laboratory confirmation using PCR or antigen- or antibody-based assays. Outbreak control relies on rapid case identification, isolation and care, contact tracing, safe burials and strong community engagement, as no approved vaccines or specific treatments currently exist for BVD. 

    Since first detected in May 2026, this BVD outbreak has rapidly evolved into a large and geographically expanding epidemic in the Democratic Republic of the Congo, with sustained transmission, high mortality and an increasing risk of further international spread. The current outbreak is the second documented Bundibugyo virus disease outbreak in the country, after the 2012 outbreak, and the largest Ebola disease outbreak ever recorded in the Democratic Republic of the Congo irrespective of Ebola virus species. The population at greatest risk of exposure is concentrated in communities living in and moving through areas with active transmission.  

(...)

WHO risk assessment

    On 14 August 2026, WHO reassessed the risk of the outbreak of BVD to incorporate newly available information. The risk for countries sharing land borders with the Democratic Republic of the Congo was separated from the risk for other countries in the African Region. 

    The risk in the Democratic Republic of the Congo was assessed as very high due to ongoing transmission and the continued expansion of the outbreak into new health zones, increasing the potential for further national and regional spread. The main considerations supporting this assessment include the substantial increase in the number of cases and considerable geographic extension of the outbreak since the previous risk assessment, and potential further increase in CFR as additional deaths are investigated and outcomes are established. In addition, reported transmission among healthcare workers, ongoing conflict and insecurity, laboratory capacity constraints, and absence of licensed vaccine or specific antiviral treatment were also considered as factors maintaining the very high risk. 

    The risk for countries sharing land borders with the Democratic Republic of the Congo was again assessed as high due to sustained population mobility linked to cross-border trade and mining activities, variation in capacities and experience of BVD response, and variable levels of readiness. Uganda, the Central African Republic and South Sudan are of particular concern for importation given their proximity, high population mobility and connectivity with areas of the Democratic Republic of the Congo currently experiencing intense transmission. For the Central African Republic and South Sudan, these risks are further compounded by high humanitarian needs, population displacement, insecurity and underlying limitations in health-system capacity. 

    The risk for the rest of the African region and at the global level was again assessed as low. 

(...)

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON616

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#Fatal case of respiratory #diphtheria in an unvaccinated #child in #Italy (ECDC, August 28 '26)

 

{Excerpt from ''Weekly Communicable Disease Threats Report, Week 35, 22–28 August 2026''}

(...)

Overview:

Summary

    ° On 20 August 2026, media sources reported a fatal case of diphtheria  in Palermo, Sicily, involving a four-year-old {girl}. According to media  reports, the case manifested initial symptoms, including fever, reduced  appetite and vomiting between 10 and 11 August. The patient's condition  deteriorated progressively, with the development of high fever and respiratory  distress on 15 August. Owing to the worsening clinical presentation, the child was  hospitalised in the intensive medical care unit.

    ° Despite receiving organ-supportive treatment and diphtheria antitoxin, the patient died on 20 August. The child had not been vaccinated against diphtheria. 

    ° Clinical specimens were submitted to Italy's National Institute of Health (Istituto Superiore di Sanità, ISS) for laboratory confirmation of suspected  diphtheria. On 25 August, the ISS confirmed the detection of  Corynebacterium diphtheriae and identified the presence of the diphtheria  toxin gene, indicating infection with a toxigenic strain capable of causing  respiratory diphtheria.

    ° A second probable case was reported in a four-year-old cousin of the  first case, who was admitted to hospital with milder symptoms. According to  media reports, the child had been previously vaccinated against diphtheria.  The patient is being managed in isolation and is reported to be in a stable clinical condition.

    ° Local health authorities have initiated an epidemiological investigation, including contact tracing and active monitoring of contacts to  identify potential additional cases and limit further transmission.

    ° Public health measures have also been implemented, including  chemoprophylaxis of contacts and vaccination of the siblings of the first case. 

    ° Media sources have reported that 10 additional family members have tested positive for C. diphtheriae. These individuals were reported to be  vaccinated and in good clinical condition.

    ° However, as of 25 August, no additional cases besides the two described  above have been reportedofficially by local health authorities.

Background

    ° Diphtheria is a vaccine-preventable bacterial disease caused by  Corynebacterium diphtheriae.

    ° Transmission can occur from person to person through respiratory  droplets, direct contact with respiratory secretions, contact with exudate from  infected skin lesions or contaminated surfaces. 

    ° Infection may present as respiratory or cutaneous diphtheria.  Asymptomatic infection is also common, particularly in highly vaccinated  populations. The pathogenicity of C. diphtheriae is primarily related to the  production of the diphtheria toxin, which can cause local tissue damage, severe  systemic complications and even death. 

    ° Diphtheria is largely preventable through vaccination, and  unvaccinated or under-vaccinated individuals are at  higher risk of severe  disease and death. 

    ° Without timely diagnosis and treatment, respiratory diphtheria  can be  life-threatening, especially in unvaccinated, young children.

    ° Diphtheria remains a relatively rare disease in the EU/EEA due to high  vaccination coverage. In 2022, a large multi-country outbreak was recorded,  primarily affecting migrants and asylum seekers, with limited evidence of spread  to the general population. Reported cases declined in subsequent years, although  sporadic cases and localised transmission continue to occur, particularly among  vulnerable populations, including migrants, people experiencing homelessness,  and unvaccinated or under-vaccinated individuals.

ECDC assessment:

    ° The probability of widespread transmission of diphtheria in the general  population in the EU/EEA is considered low, due to high levels of  population immunity achieved through routine vaccination programmes. The  impact on the general population is also assessed as low, as high vaccination coverage reduces the risk of severe disease and death. Therefore, the  overall risk to the general population in the EU/EEA is considered low.

    ° Nevertheless, sporadic cases and localised clusters may occur in  settings where vaccination coverage is suboptimal or where conditions facilitate  transmission, such as overcrowded environments and settings with poor hygiene.  Imported cases may also occur among individuals travelling from endemic  geographical areas. Severe disease is more likely among susceptible groups,  including unvaccinated or under-vaccinated individuals, young children, older  adults, and immunocompromised individuals.

    ° Achieving and sustaining high vaccination coverage in the population is  crucial to prevent serious or fatal disease. In the event of cases, rapid clinical  recognition, prompt laboratory confirmation, timely administration of appropriate  treatment, and the identification and management of close contacts are essential to reduce morbidity, mortality, and onward transmission.

Actions:

    ° ECDC continues to monitor this event through epidemic intelligence activities and is liaising with the relevant national public health authorities to  collect additional information on the case and ongoing contact tracing and contact follow-up activities.

(...)

Source: 

Link: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-22-28-august-week-35

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