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Risk Statement
-- Given the evolving epidemiological situation of the current Ebola disease outbreak caused by Bundibugyo virus (BDBV) in the Democratic Republic of the Congo (DRC) with exportation to Uganda, the initial rapid risk assessment (RRA) on 15 May 2026 has been updated to incorporate newly available information, including recent epidemiological developments, cross-border implications, the declaration of the event as a Public Health Emergency of International Concern (PHEIC) by the WHO Director-General, and ongoing response activities.
-- On 5 May 2026, the WHO Country Office in the DRC detected social media reports of an unusual cluster of severe illness and deaths in the Mongbwalu health zone, a rural gold-mining area in Ituri Province in northeastern DRC, close to the borders with South Sudan and Uganda.
-- The affected area is characterised by high population mobility, insecurity, and intense cross-border connectivity with neighbouring countries.
-- Clinical presentation among suspected cases included fever, headache, vomiting, profound weakness, and haemorrhagic manifestations, raising concern for a viral haemorrhagic fever.
-- Retrospective investigation by a field team at the provincial level covering 15 April through 13 May 2026 identified 246 suspected cases and 65 deaths (Case Fatality Rate (CFR) 26.4%) from three health zones (Mongbwalu, Rwampara, and Bunia), including a family cluster of 15 deaths within a two-week window.
-- The presumed first case of the disease is a nurse of unknown age, who died at the local hospital in Bunia health zone on 24 April, where eight attending healthcare workers at the hospital also developed compatible symptoms.
-- Twenty samples were collected, representing 12 patients who had travelled from Mongbwalu health zone to Rwampara health zone and the eight healthcare workers who developed symptoms were sent to the Institut National de Recherche Biomédicale (INRB) in Kinshasa for testing.
-- On 14 May 2026, WHO was notified by national authorities at the Centre d'Opération des Urgences en Santé Publique (COUSP) of 8 laboratory-confirmed cases of an Orthoebolavirus among the 20 samples tested.
-- Further laboratory testing including genomic sequencing confirmed Bundibugyo virus.
-- On 15 May 2026, the Ministry of Health of Uganda reported one imported laboratory-confirmed case of a Bundibugyo virus disease (BVD) in Kampala.
-- The patient was an elderly male from DRC who travelled to Uganda to seek care at a hospital in Kampala on 11 May and died on 14 May 2026.
-- The body was repatriated to DRC on the same day.
-- This event confirms the cross-border movement of a symptomatic case and exposure within an urban healthcare setting in Uganda.
-- Genetic sequencing results by INRB released on 15 May came back positive for Bundibugyo virus (BDBV).
-- On the same day, both DRC and Uganda officially declared Ebola outbreaks in their respective countries.
-- On 19 May 2026, a suspected viral haemorrhagic fever alert was reported from Miti-Murhesa health zone in South Kivu Province following the death of a man aged between 25 to 30 years at a local hospital.
-- Investigations were initiated to determine whether the event was linked to the ongoing BVD outbreak.
-- The case was subsequently confirmed positive for BVD.
-- As of 21 May 2026 (the data used for this rapid risk assessment), the outbreak in DRC had expanded to 16 affected health zones, including 12 in Ituri Province, three in North Kivu Province, and Miti-Murhesa health zone in South Kivu Province.
-- In total, 661 suspected cases and 160 suspected deaths (CFR 24.2%) have been reported, including 63 confirmed cases and four confirmed deaths associated with BVD.
-- Uganda had cumulatively reported two confirmed cases of which one had died.
-- This is the 17th Ebola disease (EBOD) outbreak reported in DRC since 1976, and the second outbreak caused by BVD in the country.
-- Prior to this current outbreak, two BVD outbreaks had been documented: the first in Uganda during 2007–2008 and the second in DRC in 2012.
-- Together, these outbreaks resulted in more than 200 confirmed and probable cases and approximately 66 deaths (CFR 33%).
-- The risk at the national level (DRC), which was assessed as high on 15 May 2026, is now on 22 May 2026 assessed as very high due to substantial changes in the epidemiological situation.
-- Key factors informing this reassessment include:
• Outbreak caused by BVD for which no licensed vaccine or specific therapeutics are currently available for prevention and treatment. Early intensive supportive care remains the only current treatment option, along with packages of public health interventions, as done in previous outbreaks.
• On 15 May, confirmed and suspected cases were reported from both Mongbwalu and Rwampara health zones, with suspected cases also identified in Bunia and alerts from Beni and Butembo health zones in North Kivu Province, indicating early signs of geographic spread beyond the initially affected areas.
• By 21 May 2026, the outbreak had expanded rapidly from a limited number of affected health zones to 16 health zones across three provinces. Confirmed and suspected cases had been reported in 12 health zones in Ituri Province (Aungba, Bambu, Bunia, Fataki, Komanda, Logo, Lolwa, Mangala, Mongbwalu, Nizi, Nyankunde, and Rwampara), three health zones in North Kivu Province (Butembo, Goma, and Katwa) and one in South Kivu in Miti-Murhesa Health Zone. This rapid geographic expansion over a short period, combined with intense population mobility and cross-border connectivity, indicates a very high risk of further spread within DRC.
• As of 21 May, high mortality has been reported with an overall CFR of 24.2% (160/661), among suspected cases and 6.3% (4/63) among confirmed case. The current CFR is an underestimation of the actual situation as investigations are still ongoing to identify and re-classify all suspected deaths.
• The rapid increase in cases and deaths within a short period, combined with the spread across multiple health zones and cross-border transmission, is highly concerning.
• Reports of numerous community deaths and the absence of documented safe and dignified burial practices may have facilitated continued community transmission through exposure during funerals and handling of bodies.
• Healthcare worker infections and low infection prevention and control (IPC) scorecard performance in the area indicate a high risk of exposure in healthcare settings and significant gaps in IPC.
• Delays in verification of initial signal by authorities and retrospective identification of cases and deaths suggest prolonged circulation before confirmation.
• Epidemiological links and the full chain of transmission are not yet clearly established, and the source of the outbreak remains under investigation.
• The affected provinces of Ituri and North Kivu are highly insecure, with intensified fighting in recent months, causing more than 100 000 people to be newly displaced.
• The affected area is also characterized by intense population mobility linked to mining activities, trade, and movement between rural and urban centres.
• Bunia serves as a major referral, transport, and commercial hub, increasing the risk of spread to other provinces.
• Ongoing conflict in Ituri and North Kivu provinces restricts the movement of surveillance teams, limits the deployment of Rapid Response Teams, and hinders the secure transport of laboratory samples, as well as challenges in contact tracing, safe and dignified burials and control of population movement of high-risk contacts in those conflict zones.
• Significant distrust of health and external authorities among the local population.
• Limited healthcare infrastructure and inadequate isolation capacity may facilitate continued transmission in DRC.
-- The level of risk at the regional level (including Uganda) is still assessed as High due to:
• Confirmed cross-border spread through imported cases to Uganda.
• As of 20 May, Uganda has cumulatively reported 2 confirmed cases, both were imported cases who came to Uganda to seek medical care. One case died following admission to the local Hospital, and the second case is currently receiving care at the Ebola isolation unit at a Referral hospital.
• Frequent movement across porous borders between Ituri (DRC), Uganda, and South Sudan.
• Ongoing epidemiological links along the eastern DRC–western Uganda corridor, historically affected by Ebola outbreaks, including Bundibugyo and Sudan virus disease outbreaks.
• While not directly bordering Ituri province, Rwanda and Burundi share borders with Eastern DRC and have experienced recent cross-border disease transmission (i.e., mpox), further intensified by ongoing conflict and displacement.
• High mobility linked to mining, trade, and displacement.
• Potential for undetected chains of transmission in border communities.
• Potential for continued spillover to Kampala, Uganda – a densely populated urban hub or other cities with close transport links
-- The level of risk at the global level is assessed as low due to:
• As of 21 May 2026, the outbreak remained geographically limited to DRC with exportation of cases to Uganda at present.
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{1} Confidence refers to the level of confidence in the data/information or the quality of the evidence available at the time the RRA is conducted. Poor quality information may increase the overall perceived risk due to the incertitude in the assessment.
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