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Event description
The Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo has expanded further, with Dungu Health Zone in Haut-Uélé Province, bordering South Sudan, being the latest affected, bringing the total number of health zones affected to 63 since the start of the outbreak.
This latest geographic expansion heightens concern about further spread towards international borders, while transmission within the country remains increasingly heterogeneous across affected provinces and health zones.
Since External Situation Report #18, a further 475 confirmed cases and 222 confirmed deaths have been reported, bringing the cumulative total to 7733 confirmed cases, including 3732 deaths [crude case fatality ratio (CFR 48.3%)], as of 20 September 2026.
Ituri remains the principal focus, although its relative contribution continues to decline, accounting for 76.9% of cumulative confirmed cases, while substantial transmission continues in Nord-Kivu and persists in Haut-Uélé.
At the national level, daily incidence remains high and fluctuating, with the seven-day moving average rebounding in early September before declining in the most recent days. This national pattern masks divergent provincial trajectories.
Ituri continues a gradual decline from its late-July peak but remains at a high level, while Nord-Kivu experienced a marked increase, reaching its highest incidence in mid-September, followed by an apparent decline in recent days.
Transmission in Haut-Uélé remains sustained but below its August peak, while Tshopo shows renewed activity from a low baseline. Bas-Uélé continues to report sporadic transmission, with no recent transmission evident in Sud-Kivu.
Overall, the epidemic remains geographically heterogeneous, with recent declines in the principal transmission areas occurring alongside persistent low-level transmission and continued geographic expansion to new areas.
Figure 1. Daily national trend in confirmed Bundibugyo virus disease cases, with seven-day moving average, by date of report, Democratic Republic of the Congo, as of 20 September 2026
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During the most recent 21 days (31 August – 20 September 2026), a total of 1633 confirmed cases were reported nationally.
Compared with 1719 cases during the preceding 21-day period (10 – 30 August 2026), this represents a decrease of 86 cases (−5.0%).
Reported cases declined by 25.8% in Ituri, from 1255 to 931, and by 18.3% in Haut-Uélé, from 109 to 89.
In contrast, cases increased sharply by 72.7% in Nord-Kivu, from 341 to 589, while Tshopo increased from 10 to 20 cases.
Bas-Uélé reported three cases compared with four during the preceding period, while one case was reported in Sud-Ubangi.
Consequently, Ituri’s contribution to newly reported cases fell markedly from 73.0% to 57.0%, while Nord-Kivu’s contribution increased from 19.8% to 36.1%; Haut-Uélé’s contribution declined from 6.3% to 5.5%.
Overall, the modest 5.0% national decline masks a pronounced geographic redistribution of transmission, with the substantial decline in Ituri increasingly offset by continued high transmission in Nord-Kivu and geographic expansion to new areas.
During the same period, 782 confirmed deaths were reported nationally, compared with 939 deaths during the preceding 21 days, representing a decrease of 157 deaths (−16.7%).
The national decline was driven largely by Ituri, where reported deaths decreased from 654 to 448 (−31.5%), while deaths also declined in Haut-Uélé, from 50 to 31 (−38.0%).
In contrast, deaths increased substantially in Nord-Kivu, from 228 to 296 (+29.8%). Consequently, Ituri’s contribution to newly reported deaths fell from 69.6% to 57.3%, while Nord-Kivu’s contribution increased from 24.3%
to 37.9%; Haut-Uélé’s contribution declined from 5.3% to 4.0%.
Tshopo reported five deaths, Bas-Uélé one, and SudUbangi one during the latest period.
Overall, the decline in national mortality was driven predominantly by the substantial reduction in Ituri and masks the continued concentration of mortality in Nord-Kivu, which now accounts for more than one-third of newly reported cases and deaths nationally.
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Additionally, during the most recent 21 days (31 August–20 September 2026), 49 of the 63 affected health zones (77.8%) reported at least one new confirmed case, while 14 (22.2%) reported no new cases. Health zones reporting no cases were Adja, Aru, Ariwara, Aungba, Boga, Kambala and Mahagi in Ituri; Goma in Nord-Kivu; Gombari in Haut-Uélé; Lubunga, Tshopo and Wanie-Rukula in Tshopo; Miti-Murhesa in Sud-Kivu; and Buta in Bas-Uélé.
Provincial trends continue to mask important differences between health zones. In Ituri, where cases declined overall between the two consecutive 21-day periods, several health zones showed increasing or sustained transmission.
Cases nearly doubled in Komanda, from 36 to 69 (+91.7%), and increased substantially in Mongbwalu, from 44 to 79 (+79.5%), while remaining broadly stable in Lita, from 55 to 57 (+3.6%). In contrast, transmission declined substantially in several major hotspots, including Bunia, from 376 to 265 (−29.5%), Nizi, from 183 to 94 (−48.6%), Rwampara, from 190 to 104 (−45.3%), and Nia-Nia, from 77 to 54 (−29.9%). Mangala also declined from 130 to 91 cases (−30.0%).
Nord-Kivu showed the opposite pattern, with continued broad-based intensification, although trends varied between individual health zones. Cases more than doubled in Beni, from 62 to 143 (+130.6%), and increased in Butembo, from 64 to 87 (+35.9%) and Musienene, from 31 to 42 (+35.5%). In contrast, Katwa remained at a very high level but declined slightly, from 161 to 154 cases (−4.3%). Haut-Uélé declined overall, but this similarly concealed divergent health-zone trajectories: cases in Pawa more than doubled from 16 to 35 (+118.8%), while declining in Isiro from 50 to 18 (−64.0%) and Wamba from 35 to 25 (−28.6%).
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Weekly confirmed deaths peaked at 364 during 10 – 16 August, before declining to 302 and 270 over the following two weeks. Deaths subsequently increased to 276 during 31 August – 6 September and 284 during 7 – 13 September, before declining to 222 during 14 – 20 September (−21.8%). This latest decline occurred in both settings, with community deaths decreasing from 193 to 136 (−29.5%) and deaths in treatment facilities declining from 91 to 86 (−5.5%).
Consequently, the proportion of deaths occurring in the community fell from 68.0% to 61.3%, continuing the decline from the peak of 75.0% during 31 August – 6 September. Despite this improvement, nearly two-thirds of confirmed deaths in the latest week continued to occur in the community.
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The geographic distribution of confirmed BVD community deaths has shifted substantially over time. Ituri remained the dominant contributor throughout most of the outbreak, but its share declined markedly in recent weeks as Nord-Kivu’s contribution increased, reaching near parity during 31 August – 13 September. In the latest week, 14 – 20 September, Ituri’s contribution increased to 58.8%, while Nord-Kivu’s declined to 33.8%, with Haut-Uélé accounting for 4.4% and only small contributions from other affected provinces.
Overall, the pattern indicates an important geographic redistribution of community mortality, with Nord-Kivu now contributing a substantially greater share than during the earlier phase of the outbreak, despite the recent decline.
Overall, 2,241 community deaths with age and sex information available were analysed.
Children aged <5 years accounted for 554 (24.7%) of these deaths, while 1,157 (51.6%) were male and 1,084 (48.4%) were female. During the most recent 21 days, 482 community deaths with age and sex information available were analysed. Of these, children aged <5 years accounted for 146 (30.3%), representing a greater proportional concentration than in the overall distribution. By sex, 251 (52.1%) were male and 231 (47.9%) were female, broadly consistent with the overall sex distribution. The greater representation of children under five among recent community deaths suggests that this age group may be experiencing increasing vulnerability to death before reaching appropriate care, warranting closer investigation of care-seeking, detection and referral pathways among young children.
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Available case investigation information suggests that community deaths may result from multiple barriers along the pathway to appropriate care, including missed diagnosis at peripheral health facilities, self-medication, care- seeking from traditional healers or religious places, refusal of referral, and no prior healthcare contact. Although their relative contribution cannot yet be quantified, these pathways highlight the need to strengthen early case identification, community detection, and timely referral to appropriate treatment.
Risk Assessment
The risk of further spread remains very high within the Democratic Republic of the Congo, reflecting sustained transmission, continued geographic expansion, high mortality, population mobility, insecurity and persistent response
challenges.
A two-week invasion-risk forecast identified 20 previously unaffected health zones at elevated risk of transmission. Dungu, which was among the health zones identified as high risk, has since reported confirmed transmission. The remaining 19 health zones are Rethy, Watsa, Nyarambé, Biringi, Makoro, Karisimbi, Angumu, Rutshuru, Nyiragongo, Niangara, Linga, Kirotshe, Bafwagbogbo, Alimbongo, Jiba, Poko, Rwanguba, Kamango and Kibirizi.
This development reinforces the value of risk-based preparedness and readiness measures in health zones identified as being at elevated risk.
The risk is considered high for neighbouring countries sharing land borders with the Democratic Republic of the Congo and low elsewhere in Africa and globally.
The second IHR Emergency Committee, convened on 18 August 2026, also reviewed the evolving situation and emphasized that the outbreak remains far from controlled, and continues to constitute a Public Health Emergency of International Concern.
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Situation interpretation
The outbreak remains uncontrolled and increasingly geographically dispersed, expanding the operational footprint of the response and placing additional pressure on already stretched resources. The emergence of transmission in Dungu, a health zone bordering South Sudan that was previously identified as being at high risk, further heightens the potential for cross-border spread and reinforces the need to accelerate readiness in areas where further spread is anticipated. At the same time, community mortality remains a major concern, with nearly two-thirds of recent deaths occurring in the community, indicating persistent delays in detection, referral and access to appropriate care.
Children under five are disproportionately represented among community deaths, suggesting particular vulnerabilities in early recognition of illness and timely care-seeking and referral for young children. The multiple pathways leading to community deaths, including missed recognition at health facilities, self-medication, alternative care-seeking, refusal of referral and no prior healthcare contact, indicate that reducing mortality will require interventions across the entire pathway to care.
Priorities should include stronger community detection, early recognition at peripheral health facilities, rapid referral and improved community trust and acceptance, alongside targeted investigation and interventions to address the specific barriers contributing to community deaths among children under five.
Source:
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