The relationship between #plasma #favipiravir concentrations and #clinical #outcomes in #COVID19

 

Abstract

Background

Favipiravir has shown efficacy against SARS-CoV-2 in patients <60 years old, but data linking plasma concentrations to clinical outcomes are limited. This study investigated whether favipiravir plasma concentrations influence clinical efficacy and outcomes in patients hospitalised with COVID-19. The main research question was, How can antiviral dosing strategies be optimised to improve pandemic preparedness and treatment efficacy?

Methods

Adult participants were drawn from the PIONEER trial, in which patients received oral favipiravir (1800 mg twice daily for 1 day, then 800 mg twice daily for 9 days) plus standard care. This analysis included patients with confirmed COVID-19 and ≥75% study adherence. Samples were collected between days 5 and 10 post-treatment initiation. The primary outcome was time to clinical improvement. Secondary outcomes included achievement of clinical improvement and mortality risk.

Results

Out of 140 patients (50% male; mean±sd age 59.5±14.8 years), target plasma concentrations were reached in 29 (21%). Mean time to improvement was 7.7±5.9 days in target achievers versus 9.1±7.2 days in non-achievers (p=0.26). The target was more often achieved in female (34%) than male (7%) participants (p=0.0002). Plasma concentration inversely correlated with body mass index (r= –0.4, p<0.0001), and with lower body mass index in achievers (26.0±5.1 kg·m−2 versus 30.5±6.9 kg·m−2, p=0.003). Alkaline phosphatase and alanine aminotransferase levels were also lower in achievers (p=0.004 and p=0.02, respectively).

Conclusion

Most patients did not reach target favipiravir levels. Concentrations were influenced by sex, body mass index and liver function, confirming the need for pharmacokinetically guided dosing and therapeutic monitoring to optimise antiviral efficacy in future pandemic responses.

Shareable abstract @ERSpublications

Plasma favipiravir concentrations vary with sex, BMI and liver function. Concentrations in most patients fail to reach therapeutic levels, highlighting the need for personalised, pharmacokinetically guided dosing to optimise antiviral efficacy in future pandemics. https://bit.ly/4a6PvEa

Source: 

Link: https://publications.ersnet.org/content/erjor/12/4/01560-2025

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Avian #Influenza #Report: July 26 – August 1, '26 (Wk 31) (HK CHP, August 4, 2026): Four New #Human #Infection with #H9N2 virus in #China

 

{Excerpt}

(...)

Avian influenza A(H9N2): 

    ° Gansu Province: 

        § A three-year-old girl with onset on July 11, 2026. 

    ° Jiangsu Province: 

        § A 12-year-old boy with onset on July 6, 2026. 

    ° Jiangxi Province: 

        § A 72-year-old woman with onset on July 5, 2026. 

    ° Yunnan Province: 

        § A 58-year-old woman with onset on July 13, 2026. 

(...)

Source: 

Link: https://www.chp.gov.hk/files/pdf/2026_avian_influenza_report_vol22_wk31.pdf

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Congolese #hospital #staff cohort admitted with infectious symptoms in the setting of the #Bundibugyo virus #outbreak, April and May 2026, Bunia, #DRC

 

{Excerpt}

On May 15, 2026, DR Congo announced an outbreak of Ebola disease caused by a new variant of Bundibugyo virus in Ituri Province.1 The outbreak's epicentre was Mongbwalu, a gold mining town located 80 km from Bunia, Ituri's capital. In the 2 weeks before this announcement, Centre Medical Evangelique's Centre Hospitalier de Bunia (CME-Bunia), had received 11 patients from Mongbwalu, 63% of whom eventually died. Most had fever, diarrhoea, and vomiting, and several developed bleeding. Subsequent chart review has shown similar cases arriving as early as April 2.

(...)

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00420-2/fulltext?rss=yes

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A One-Shot Multivalent Live-Attenuated Candidate #Influenza #Vaccine against Divergent #Zoonotic #H5N1 Clades

 

Abstract

The continued emergence of genetically diverse high pathogenicity avian influenza (HPAI) H5N1 viruses with zoonotic potential highlights the urgent need for developing vaccines capable of providing broad protection against multiple circulating clades. Here, we developed a one-shot, multivalent, live-attenuated influenza vaccine (LAIV) based on the temperature-sensitive (ts), cold-adapted (ca), and attenuated (att) influenza A/Ann Arbor/6/1960 master donor virus (MDV) that incorporates the hemagglutinin (HA) and neuraminidase (NA) glycoproteins from representative clades 2.3.4.4b (A/Louisiana/12/2024), 2.3.2.1a (A/Victoria/149/2024), and 2.3.2.1e (A/Cambodia/2302009/2023) H5N1 viruses. A single intranasal (IN) immunization of C57BL/6 mice with the multivalent LAIV elicited robust humoral immune responses, with immune sera exhibiting broad cross-reactivity against antigens from all three H5N1 clades included in the vaccine. Following homologous viral challenge, vaccinated C57BL/6 mice were completely protected from disease, demonstrating the immunogenicity and protective efficacy of the multivalent LAIV. By simultaneously targeting antigenically distinct H5N1 lineages with pandemic potential, this strategy expands antigenic coverage within a single LAIV to confirm pan-H5N1 protection. Together, these findings support the development and implementation of this multivalent LAIV as a broadly protective pan-H5N1 LAIV for pandemic preparedness.

Competing Interest Statement

The A.G.-S. laboratory has received research support from Avimex, Dynavax, Pharmamar, and Accurius, outside of the reported work within the last three years. A.G.-S. has consulting agreements for the following companies involving cash and/or stock within the last three years: Castlevax, Amovir, Vivaldi Biosciences, Contrafect, Avimex, Pagoda, Accurius, Applied Biological Laboratories, Pharmamar, CureLab Oncology, CureLab Veterinary, Virofend, Prosetta and A.A.C.T., outside of the reported work. A.G.-S. has been an invited speaker in meeting events within the last three years organized by Seqirus, Novavax and Hipra. A.G.-S. is inventor on patents and patent applications on the use of antivirals and vaccines for the treatment and prevention of virus infections and cancer, owned by the Icahn School of Medicine at Mount Sinai, New York, outside of the reported work. The Icahn School of Medicine at Mount Sinai has licensed some of these inventions to Medimmune, Avimex, Leinco Technologies, Castlevax, Virofend, Kerafast, Cell Signaling, EMD Millipore, Genentech, Paratus and Nura Bio, and as a result receives financial compensation. Subject to Mount Sinai receiving such financial consideration, AG-S will receive a portion of that consideration pursuant to the terms of the Mount Sinai Intellectual Property Policy. All other authors declare no commercial or financial conflict of interest.

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.08.02.742385v1

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#WHO TAG-VE #Risk #Evaluation for #SARS-CoV-2 #Variant Under Monitoring: PQ.16.1.1 (WHO, Accesed on August 4 '26)

Executive Summary 

    PQ.16.1.1, an NB.1.8.1-descendent SARS-CoV-2 lineage, has been designated a variant under monitoring (VUM) with increasing proportions globally, driven largely by detections in the Western Pacific Region, particularly Singapore. 

    Considering the available evidence, the additional public health risk posed by PQ.16.1.1 is evaluated as low at the global level. 

    Its mutation profile may confer additional immune escape, although direct phenotypic evidence is currently limited. 

    Available surveillance does not indicate increased clinical severity compared with other circulating variants, and existing vaccines are expected to continue providing protection against severe disease. 

Initial Risk Evaluation of PQ.16.1.1, 27 July 2026 

    PQ.16.1.1 is a descendant of the Omicron JN.1-derived lineage NB.1.8.1, with the earliest available sequence collected on 25 March 2026. 

    Compared with NB.1.8.1, PQ.16.1.1 has the additional Spike substitutions D253G, N417T, D420N and I478T, together with Nucleocapsid T135I and ORF8 G8E [1]. 

    PQ.16.1.1 is one of seven VUMs tracked by the WHO and was designated as a VUM on 27 July 2026. 

    The parent lineage NB.1.8.1 has demonstrated robust soluble human ACE2 engagement and pseudovirus infectivity, with only marginal additional immune evasion compared with LP.8.1 [2,3]. 

    Preliminary PQ.16.1.1-specific data indicate that its receptor-binding domain binds human ACE2 with significantly lower affinity than that of NB.1.8.1 (KD: 16.5 nM versus 8.22 nM). 

    Consistent with this, soluble human ACE2 showed reduced neutralization of PQ.16.1.1 pseudoviruses compared to NB.1.8.1 (IC50: 0.22 µg/mL versus 0.17 µg/mL). 

    Neutralizing antibody titres against PQ.16.1.1 and NB.1.8.1 were broadly similar in plasma from individuals with prior Omicron exposure. 

    In plasma from Wuhan-Hu-1-primed individuals, titres against PQ.16.1.1 were modestly lower than those against NB.1.8.1. 

    PQ.16.1.1 also showed substantially reduced susceptibility to class 1 RBD-targeting monoclonal antibodies. 

    These preliminary findings suggest that the growth of PQ.16.1.1 is unlikely to be explained by enhanced ACE2 receptor binding alone and may instead be partly related to escape from specific antibody classes [4]. 

    As of 8 July 2026, 457 PQ.16.1.1 sequences with collection dates through epidemiological week (EW) 25 had been submitted to GISAID from eight countries [1]. 

    Of these, 438 (95.8%) were from the Western Pacific Region (WPR), including 388 (84.9% of the global total) from Singapore. 

    The remaining sequences were reported from Hong Kong SAR (34), Australia (10), the United States of America (10), Canada (8), the Republic of Korea (5), France (1) and Taiwan, China (1). 

    No PQ.16.1.1 have been reported from the African (AFR) and Eastern Mediterranean (EMR) Regions. 

    Globally, the proportion of PQ.16.1.1 among available sequences increased from 2.7% in EW 18 to 29.6% in EW 25, Table 1. 

    Over the same period, its proportion increased from 5.4% to 39.3% in WPR. In the Region of the Americas, PQ.16.1.1 represented 6.4% of available sequences in EW 25, although this estimate was based on only three of 47 sequences. 

    Singapore reported an increase from 12.6% in EW 18 to 55.1% in EW 25. In Hong Kong SAR, the proportion increased from 20.0% to 66.7%, with fluctuations, but the EW 25 estimate was based on four of six sequences submitted that week. In Singapore, sentinel SARS-CoV-2 test positivity increased rapidly from 6.5% in EW 16 to a peak of 19.8% in EW 19. Test positivity remained elevated through EW 22 before declining through EW 25. 

    The timing and magnitude of the increase were consistent with the seasonal pattern observed in 2024 and 2025. 

    Compared with 2025, however, the period of elevated test positivity was shorter, with a more rapid decline following the peak. 

    No case or death data were reported to WHO during the reporting period [5]. 

(...)

    WHO and its Technical Advisory Group on Virus Evolution (TAG-VE) continue to recommend that Member States prioritize specific actions to address the remaining uncertainties concerning PQ.16.1.1: 

        • Confirm the preliminary neutralization findings using live-virus and pseudovirus assays with contemporary human sera representative of affected populations and varied vaccination and infection histories. 

        • Undertake comparative studies of cell entry, replication, fusogenicity and Spike processing in the complete PQ.16.1.1 genetic background. 

        • Conduct comparative evaluations of hospitalization, intensive-care admission and death, controlling for age, prior immunity, comorbidities and time since vaccination or infection. 

        • Assess the performance of antigen-based and molecular diagnostic assays and determine phenotypic susceptibility to available direct-acting antivirals. 

    WHO and its Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) continue to assess the impact of SARS-CoV-2 evolution on the performance of COVID-19 vaccines. 

    In its May 2026 recommendation, WHO TAG-CO-VAC advised the use of monovalent LP.8.1 as a COVID-19 vaccine antigen, while noting that other antigens, including XFG or NB.1.8.1, could also be used if they demonstrate broad and robust neutralizing-antibody responses or effectiveness against circulating variants. 

    Vaccination should not be delayed in anticipation of access to vaccines containing an updated antigen, and populations at highest risk of severe disease remain the priority [6]. 

    No PQ.16.1.1-specific vaccine-effectiveness estimates are currently available. 

    The risk evaluation below follows the published WHO framework for risk evaluation of SARS-CoV-2 variants [7] and is based on evidence available as of 21 July 2026. 

    This risk evaluation should be revised as additional epidemiological, phenotypic and clinical evidence becomes available. 

(...)

References  

{1} Khare, S.; Gurry, C.; Freitas, L.; Schultz, M.B.; Bach, G.; Diallo, A.; Akite, N.; Ho, J.; Lee, R.T.C.; Yeo, W.; et al. GISAID’s Role in Pandemic Response. China CDC Wkly. 2021, 3, 1049–1051, doi:10.46234/ccdcw2021.255. 

{2} Guo, C.; Yu, Y.; Liu, J.; Jian, F.; Yang, S.; Song, W.; Yu, L.; Shao, F.; Cao, Y. Antigenic and Virological Characteris cs of SARS-CoV-2 Variants BA.3.2, XFG, and NB.1.8.1. Lancet Infect. Dis. 2025, doi:10.1016/S1473-3099(25)00308-1. 

{3} WHO World Health Organiza on Technical Advisory Group on COVID-19 Vaccine Composition: Statement on the Antigenic Compositon of COVID-19 Vaccines 15 May 2025. 

{4} He, P.; Song, Y.; Guo, C.; Yu, L.; Yu, Y.; Jian, F.; Shao, F.; Cao, Y. Antibody Evasion and Receptor Binding of SARS-CoV-2 Variants PQ.16.1.1 and RK.1. 2026, doi:10.64898/2026.07.21.739818. 

{5} World Health Organiza on WHO COVID-19 Dashboard 2026. 

{6} WHO World Health Organiza on Technical Advisory Group on COVID-19 Vaccine Composition: Statement on the Antigen Composition of COVID-19 Vaccines 16 May 2026. 

{7} World Health Organiza on SARS-CoV-2 Variant Risk Evaluation, 30 August 2023; World Health Organization: Geneva, 2023; 

{8} Planas, D.; Staropoli, I.; Michel, V.; Lemoine, F.; Dona , F.; Prot, M.;Porrot, F.; Guivel-Benhassine, F.; Jeyarajah, B.; Brisebarre, A.; et al. Distinct Evolution of SARS-CoV-2 Omicron XBB and BA.2.86/JN.1 Lineages Combining Increased Fitness and An body Evasion. Nat. Commun. 2024, 15, 2254, doi:10.1038/s41467-02446490-7. 6  

Source: 

Link: https://cdn.who.int/media/docs/default-source/documents/epp/tracking-sars-cov-2/21072026_pq1611_ire.pdf?sfvrsn=5d73f0b_4#:~:text=Considering%20the%20available%20evidence%2C%20the,profile%20may%20confer%20additional%20immune

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#Taiwan, Citizens Urged to Get Vaccinated against #COVID19 as epidemic intensified (CDC, Aug. 4 '26): PQ.16.1.1 dominant variant

 

    The Centers for Disease Control (CDC) stated today (August 4th) that the domestic COVID-19 epidemic continues to rise and is in its epidemic period. 

    The CDC urges the public not to let their guard down and to take good self-protection measures, including frequent handwashing; wearing masks when entering and exiting medical care facilities, taking public transportation, and going to crowded indoor places; if experiencing fever or respiratory symptoms, it is recommended to stay home as much as possible and avoid unnecessary outings, remembering to wear a mask when going out; those who have not yet been vaccinated should get vaccinated as soon as possible; and those with other risk factors for severe illness should seek medical attention immediately if they experience suspected symptoms, so that doctors can diagnose and treat them early and prescribe antiviral drugs, reducing the risk of severe complications or death after infection.

    According to CDC monitoring data, the domestic COVID-19 epidemic is rising. In the 30th week (July 26th - August 1st), there were 18,990 outpatient and emergency room visits for COVID-19, an increase of 74.8% compared to the previous week (July 19th - July 25th); last week (July 28th - August 3rd), there were 62 new local severe cases and 3 local deaths. 

    Since October 2025, there have been a total of 265 local cases of COVID-19 complicated by severe illness, of which 28 have died. 

    The majority of severe cases are among those aged 65 and above (74.0%) and those with a history of chronic diseases (85.3%). 

    89.1% of these cases have not been vaccinated this season. 

    In the past four weeks, the predominant variant strain in local cases is PQ.16.1.1. 

    The global positivity rate is trending upward, with the US and Europe showing a slight increase from their lows, while Southeast Asia and the Western Pacific are at a plateau. 

    The epidemic continues to rise in China, the US, and the UK; the epidemic is declining weekly in Hong Kong, Japan, and Thailand. 

    Recently, the predominant global variant strains are NB.1.8.1, XFG, and JN.1.

    The Centers for Disease Control (CDC) points out that as of August 2, 2026, approximately 1.772 million COVID-19 vaccinations have been administered this season, with vaccination rates among those aged 65 and above at 21.12% for the first dose and 0.78% for the second dose. 

    Taiwan has approximately 165,000 doses of COVID-19 vaccine in stock. 80,550 doses were allocated to various counties and cities for vaccination on July 30th, and an additional 45,000 doses are expected to be distributed on August 6th based on demand. 

    Those wishing to be vaccinated are reminded that the expanded vaccination program has been extended to September 28th; please take advantage of this period to get vaccinated. 

    If you experience COVID-19 related symptoms such as sore throat, cough, nasal congestion, runny nose, fever, fatigue, headache, and muscle aches, you can first use a home rapid test kit for self-testing and then seek medical attention as soon as possible, or go directly to a clinic for a medical rapid test. 

    On holidays, you can also visit the Sunday and National Holiday Emergency Care Center (UCC) for evaluation, rapid testing, and antiviral medication. 

    The Centers for Disease Control (CDC) reminds the public that frequent travel during the summer holidays increases the risk of virus transmission and urges everyone not to be complacent and to strictly implement personal protective measures such as frequent handwashing, wearing masks, and vaccination. 

    For information regarding COVID-19 vaccination sites, contracted hospitals for publicly funded oral antiviral drugs, and the latest epidemic prevention policies, please visit the "COVID-19 Prevention Zone" on the Taiwan Centers for Disease Control and Prevention's website (https://www.cdc.gov.tw) or call the toll-free epidemic prevention hotline 1922 (or 0800-001922). 

    Information regarding home-use rapid COVID-19 test kits can be found on the Food and Drug Administration's "Home-use Novel Coronavirus Test Kit Supply Information Zone" (https://reurl.cc/XxWbbM), or purchased from nearby pharmacies, convenience stores, or other retail outlets.

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/lFK7neXKyk54GdPYg_hNDg?typeid=9

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Structural and functional characterization of a conserved cryptic #epitope on #SARS-CoV-2 #spike S2 subunit

 

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has undergone extensive evolution since its emergence in 2019, underscoring the continuous need for vaccines and therapeutics effective against multiple variants of concern (VOCs). The S2 subunit of the viral spike (S) glycoprotein is highly conserved among sarbecoviruses, making it an attractive target for broadly protective countermeasures. To elucidate the S2 antigenic landscape, we employed yeast surface display to isolate S2-targeted antibodies from COVID-19 convalescent donors. Biophysical characterization revealed that these S2 apex-directed antibodies preferentially bind to open spike conformations and a stabilized S2 construct but not to the closed, trimeric prefusion spike. Cryo-electron microscopy structures defined a cryptic epitope encompassing the upper helix and fusion peptide proximal region on S2. This epitope is conserved among sarbecoviruses but remains largely occluded in the closed prefusion conformation of the spikes. As a result, the antibodies exhibited weak neutralization activity against SARS-CoV-2 pseudoviruses, failed to neutralize authentic viruses, and did not provide protection in a lethal mouse challenge model using a mouse-adapted SARS-CoV-2 strain. These findings highlight a non-neutralizing epitope on S2 capable of eliciting antibodies during SARS-CoV-2 infection in humans and provide valuable reagents for probing S2 conformational dynamics and optimizing S2-based vaccine antigens.

Source: 

Link: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1014391

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History of Mass Transportation: The JŽ 412-096 Electric Multiple-Unit of Serbia's Railways

 

{Click on Image to Enlarge}

___

By Soviet at Serbian Wikipedia - Transferred from sr.wikipedia to Commons by Dakkus., Public Domain, https://commons.wikimedia.org/w/index.php?curid=9744916

Source: 

Link: https://en.wikipedia.org/wiki/%C5%BDS_series_412#/media/File:412rrr.jpg

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The Plague at Ashdod, Nicolas Poussin (1630)

 

{Click on Image to Enlarge}

___

Public Domain.

Source: 

Link: https://www.wikiart.org/en/nicolas-poussin/the-plague-at-ashod-1630

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#WHO #Position Paper on #COVID19 #vaccines– July 2026 (Weekly Epidemiological Record, August 2 '26, summary)

 

{Summary}

WHO Position Paper on COVID-19 vaccines– July 2026 

Introduction 

    In accordance with its mandate to provide normative guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers {1} on vaccines and combinations of vaccines against diseases that have an international public health impact. 

    These papers are concerned primarily with the use of vaccines in large scale vaccination programmes. 

    The position papers are intended for use by national public health officials and managers of immunization programmes. 

    They may also be of interest to vaccine advisory groups, international funding agencies, health professionals, researchers, the scientific media, vaccine manufacturers and the general public. 

    Recommendations on the use of vaccines against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were issued by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization {2} at its meeting in March 2026 and endorsed by WHO thereafter. 

    Evidence presented at this meeting, as well as SAGE’s conflict of interest  assessment, can be accessed at www.who.int/news-room/events/detail/2026/03/09/default-calendar/strategic-advisorygroup-of-experts-on-immunization-march-2026. 

    The vaccine position papers are developed by the WHO SAGE Secretariat with input from WHO staff at the headquarters and regional levels. 

    The vaccine position papers summarize essential background information on diseases and vaccines and conclude with the current WHO position on the use of vaccines worldwide. 

    The position papers are reviewed by a large group of external subject-matter experts and end-users before finalization. 

    The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the evidence-to-decision tables are published alongside the position papers. 

    The methods followed by SAGE {3} and the processes {4} for preparation of vaccine position papers are described on the WHO website. 

    This position paper is concerned with vaccines and vaccination against COVID-19 and supersedes previous interim guidance issued by WHO on this subject. 

    Since the WHO declaration of the COVID-19 Public Health Emergency of International Concern (PHEIC) in early 2020, {5} WHO has issued a comprehensive set of strategic and guidance documents to support countries in planning, implementing, monitoring, optimizing and assessing the impact of COVID-19 vaccination. 

    These included the WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination; {6} successive roadmaps to prioritize vaccine use in response to evolving evidence, vaccine supply and epidemiological context; {7} vaccine product-specific and platform interim recommendations for the WHO Emergency Use Listing (EUL) and WHO prequalified COVID-19 vaccines; {8} COVID-19 vaccine delivery guidance, resources and tools; {9} and an overarching global COVID-19 vaccination strategy. {10,11} 

    In May 2023, WHO announced that COVID-19 no longer constituted a PHEIC due to decreasing trends in COVID-19 deaths and COVID-19-related hospitalizations and intensive care unit (ICU) admissions,  and the high levels of populationi mmunityto SARS-CoV-2.{12} 

    In December 2025, WHO published the Strategic plan for coronavirus disease threat management for the period 2025-2030,{13} which builds on and supersedes previous WHO strategic preparedness and response plans and provides the global framework for the sustained and integrated management of COVID-19 and other coronavirus diseases. 

    Recommendations in this position paper are provided in the context of Omicron and its sub-lineages being the predominant circulating SARSCoV-2 variant of concern with high population-level immunity to SARS-CoV-2 and the availability of mRNA and protein subunit COVID-19 vaccines. 

    The recommendations in this position paper will remain valid for new variant-adapted COVID19 vaccines. 

    They will be revised should new SARS-CoV-2 variants of concern arise, if there are significant changes in COVID-19 epidemiology, or if new evidence indicates that vaccine performance warrants modification of the policy recommendations.

(...)

___

{1} WHO Vaccine Position Papers. Geneva: World Health Organization (www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers (http://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers)). 

{2} Strategic Advisory Group of Experts (SAGE) on Immunization. Geneva: World Health Organization (https://www.who.int/groups/strategic-advisory-groupof-experts-on-immunization). 

{3} Guidance for the development of evidence-based vaccine-related recommendations. Geneva: World Health Organization; 2017 (www.who.int/publications/m/item/guidance-for-the-development-of-evidence-based-vaccine-related-recommendations). 

{4} Supplement to WHO Vaccine Position Papers. Geneva: World Health Organization; 2020 (www.who.int/publications/m/item/who-position-paper-process). 

{5} Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019nCoV). Geneva: World Health Organization; 2020 (https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-internationalhealth-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). 

{6} WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination Geneva: World Health Organization; 2020 ((https://www.who.int/publications/i/item/who-sage-values-framework-for-the-allocation-and-prioritization-of-covid-19-vaccination). Licence: CC BY-NC-SA 3.0 IGO. 

{7} WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines. Geneva: World Health Organization; 2023 (https://www.who.int/publications/i/item/WHO-2019-nCoV-Vaccines-SAGE-Prioritization-2023.1). Licence: CC BY-NC-SA 3.0 IGO.

{8} COVID-19 vaccines technical documents Geneva: World Health Organization; 2025 (https://www.who.int/groups/strategic-advisory-group-of-experts-onimmunization/covid-19-materials). Licence: CC BY-NC-SA 3.0 IGO. 

{9} COVID-19 vaccine delivery toolkit. Geneva: World Health Organization; 2026 (https://www.who.int/tools/covid-19-vaccine-introduction-toolkit). 

{10} Strategy to Achieve Global Covid-19 Vaccination by mid-2022. Geneva: World Health Organization; 2021 (https://www.who.int/publications/m/item/strategy-to-achieve-global-covid-19-vaccination-by-mid-2022). 

{11} Global COVID-19 vaccination strategy in a changing world: July 2022 update. Geneva: World Health Organization; 2022 (https://www.who.int/publicatio ns/m/item/global-covid-19-vaccination-strategy-in-a-changing-world--july-2022-update). 

{12} Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. Geneva: World Health Organization; 2023 (https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committeeregarding-the-coronavirus-disease-(covid-19)-pandemic). 

{13} Strategic plan for coronavirus disease threat management: advancingintegration, sustainability, and equity, 2025–2030. Geneva: WorldHealthOrganization; 2025 (https://www.who.int/publications/i/item/9789240117662). Licence: CC BY-NC-SA 3.0 IGO.

(...)

Source: 

Link: https://www.who.int/publications/i/item/who-wer101-30-138-156

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#Ebola disease caused by #Bundibugyo virus - #DRC (WHO D.O.N., August 1 '26): 3605 cases and 1587 deaths, CFR: 44% in DRC

Situation at a glance

    The Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo is intensifying, with sustained transmission and continued increases in reported cases and deaths. 

    

    Initially confined to the Mongbwalu health zone in Ituri Province, over the last two months, the outbreak has expanded to five provinces (Ituri, North Kivu, South Kivu, Haut-Uélé and Tshopo), now affecting 49 health zones. 

    The outbreak is now the largest Ebola outbreak ever reported in the Democratic Republic of the Congo. 

    As of 30 July 2026, a total of 3605 confirmed cases, including 1587 deaths, have been reported, corresponding to a crude case fatality ratio (CFR) of 44%. 

    The continued increase in cases, expanding geographic spread, and persistently high mortality underscore the rapidly evolving nature of this public health emergency. 

    During the most recent complete reporting week (epidemiological week 30), the highest weekly number of reported cases (567) and deaths (296) to date were recorded, underscoring the exceptional pace of transmission. 

    The convergence of insecurity, population displacement and mobility, and cross-border movements complicate response operations and increase the risk of further geographical spread. 

    National authorities in the Democratic Republic of the Congo, in collaboration with WHO and partners, continue to implement extensive response measures, however, a substantial scaling up of response activities is needed to get ahead of the outbreak. 

    A regional preparedness and prioritization framework continues to guide readiness and response activities across the African Region. 

    On 28 July, the Ministry of Health of Uganda declared the end of the BVD outbreak in the country, following 42 days without a new confirmed locally transmitted case after the last confirmed case was discharged from care on 16 June 2026. 

    The most recent imported case was discharged from a treatment centre on 16 July after two negative tests results. 

    Following international guidance WHO will be monitoring the situation for 42 days from this date to ensure no chains of transmission have been missed. 

    Uganda remains at risk of imported cases and re-introduction of BVD, due to ongoing transmission in neighbouring Democratic Republic of the Congo. 

    WHO reiterates the need to maintain heightened surveillance, preparedness and control measures, particularly in view of continued population movement and the risk of cross-border transmission.

Description of the situation

    Since the previous Disease Outbreak News was published on 17 July 2026, additional confirmed cases and deaths have been reported only in the Democratic Republic of the Congo.

    Cumulatively, 3626 confirmed cases have been reported: 3605 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 1589 deaths have been reported, including two in Uganda. 

    As of 30 July, at least 651 people in the Democratic Republic of the Congo, and 18 from Uganda have recovered.

    This outbreak is now the largest recorded Ebola virus disease outbreak in the country, surpassing the previous largest outbreak, which occurred from 2018 to 2020, and resulted in 3317 confirmed cases. 

(...)

Democratic Republic of the Congo

    Since 17 July 2026 when the last Disease Outbreak News was published, an additional 1481 confirmed cases, including 759 confirmed deaths, have been reported in the Democratic Republic of the Congo. 

    The increase is in part due to expansion of surveillance activities, enhanced laboratory testing, and diagnostic capacity. However, most of the increase reflects the expansion of the outbreak.

    As of 30 July 2026, a total of 3605 confirmed cases, including 1587 deaths (CFR 44%), have been reported in the Democratic Republic of the Congo. 

    To date, 651 patients have recovered.

    Cases have been reported from 49 health zones (HZ) across five provinces: Ituri (28/36 HZ), North Kivu (11/34 HZ), South Kivu (1/34 HZ), Haut- Uélé (5/13 HZ) and Tshopo (4/23 HZ).[1] An additional HZ, Wanie-Rukula in Tshopo, is awaiting data harmonisation at the health province level.

    Of the 49 affected health zones, the outbreak remains active in 33, with confirmed cases reported within the past seven days. During this period, 641 confirmed cases, including 282 confirmed deaths, were reported.

    Ituri remains the most affected province, accounting for 88% (3176/3605) of all confirmed cases and 82.6% (1311/1587) of reported deaths nationwide. Within the province, the highest number of confirmed cases have been reported from Bunia (880 cases), Rwampara (627 cases), Mongbwalu (541 cases), Nizi (377 cases), Lita (131 cases), and Nyankunde (114 cases) health zones.

    As of 30 July, 17 863 contacts have been identified and are under follow-up across Ituri (11 638), North Kivu (5667), Haut-Uélé (458) and 65 in Tshopo. Of these, 13 455 contacts were under active follow-up, corresponding to follow-up rates of 75.5% in Ituri, 74.6% in North Kivu, 80.6% in Haut-Uélé, and 66.2% in Tshopo. Previously identified contacts in South Kivu have completed the required 21-day follow-up period.

    Infections among health workers continue, with 151 confirmed cases, including 44 deaths (CFR: 29%) and 68 recoveries. These infections highlight ongoing occupational exposure risks, persistent challenges in implementing infection prevention and control (IPC) in health-care facilities, and continued exposure risk in the community.

    The outbreak is occurring in a complex humanitarian and conflict-affected setting, characterized by population displacement, high population mobility, and limited access to essential services, including health care, clean water, food, shelter, and protection.  These conditions increase the risk of disease transmission, including in overcrowded sites for internally displaced persons (IDPs).

    Insecurity and attacks affecting health facilities have hampered response operations in affected provinces, by restricting access for response teams, disrupting surveillance and response activities and increasing the risk of undetected transmission. These challenges underscore the importance of community-centred response efforts led by local authorities and trusted community leaders. 

Figure 2: Number of confirmed cases (n = 3605), in the Democratic Republic of the Congo, by date of reporting, as of 30 July 2026

{Click on Image to Enlarge}

___

{*} Note that the large number of reported cases on 22 July represents the completion of a data reconciliation exercise, including cases that occurred earlier in the outbreak, rather than newly recorded cases.

___

Figure 3: Number of deaths among confirmed cases (n = 1587), in the Democratic Republic of the Congo, by date of reporting, as of 30 July 2026. 

{Click on Image to Enlarge}

___

{*} Note that the large number of reported deaths on 22 July represents the completion of a data reconciliation exercise, including deaths that occurred earlier in the outbreak, rather than newly recorded deaths.

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.

Public health response

    Health authorities in the Democratic Republic of the Congo, in collaboration with WHO and partners, continue to implement extensive public health measures, including implementing the continental preparedness and response plan a strategic six-month framework plan designed to guide coordinated efforts to strengthen outbreak response measures, including emergency coordination, disease surveillance, laboratory testing, infection prevention and control, clinical care, community engagement, research, logistics and support for essential health services, engaging donors and mobilizing additional resources to address critical funding gaps and sustain response operations across affected and at-risk areas. A substantial scale-up will be needed in all pillars to get ahead of the outbreak.

    For further information about public health response actions by the respective Ministry of Health, WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: Ebola Bundibugyo Virus Disease Outbreak Democratic Republic of the Congo | Uganda Weekly External Situation Report | WHO | Regional Office for Africa 

WHO risk assessment

    On 6 June 2026, WHO reassessed the risk of the outbreak of BVD to incorporate newly available information and align with the WHO Temporary Recommendations. The risk for countries sharing land borders with countries with documented Bundibugyo virus detection, the Democratic Republic of the Congo and Uganda at the time of assessment, 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 risk in Uganda was assessed as high due to confirmed cross-border spread through imported cases and ongoing epidemiological links along the eastern Democratic Republic of the Congo–western Uganda corridor, which has historically been affected by Ebola outbreaks, including Bundibugyo virus and Sudan virus disease.

    The risk for countries sharing land borders with countries reporting BDBV detection was 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.

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

    For further information, please see the WHO Rapid Risk Assessment – Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo, Uganda and countries with land borders adjoining countries with documented BDBV detection v3.

    An updated Rapid Risk Assessment is currently being developed in advance of the upcoming IHR Emergency Committee meeting regarding the epidemic of Ebola Bundibugyo virus disease scheduled for 18 August. 

(...)

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON614

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