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Event description
Democratic Republic of the Congo
The epidemiological pattern of the Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo is becoming increasingly heterogeneous, with divergent transmission trends across affected provinces and health zones.
Ituri remains the principal focus, while substantial transmission continues in Nord-Kivu and Haut-Uélé and new areas continue to be affected.
Since External Situation Report #16, a further 586 confirmed cases and 276 confirmed deaths have been reported, bringing the cumulative total to 6686 confirmed cases, including 3226 deaths [case fatality ratio (CFR) 48.3%], as of 6 September 2026.
Ituri accounts for 80.2% of cumulative confirmed cases, down from 82.2% in the previous update, while Nord-Kivu has now surpassed 1000 cumulative cases.
The number of affected health zones increased from 60 to 61 across six provinces, with Kayna Health Zone in Nord-Kivu being the latest affected.
At the national level, daily incidence remains high but fluctuating, with the seven-day moving average declining from its mid-August peak before rising again in early September. This overall pattern masks increasingly divergent provincial trajectories.
Ituri, while still the main driver of the outbreak, has declined substantially from its mid-August peak but remains at a high level with recent fluctuations.
In contrast, Nord-Kivu is experiencing a marked and sustained increase, reaching its highest incidence since the start of the outbreak, while transmission remains sustained in Haut-Uélé. Tshopo and Bas-Uélé continue to report low but intermittent transmission, while no recent transmission is evident in Sud-Kivu.
Overall, the trends reinforce an increasingly heterogeneous epidemic, with declining transmission in some areas occurring alongside intensification and continued geographic spread elsewhere.
During the most recent 21 days (17 August – 6 September 2026), 1665 confirmed cases were reported nationally.
Compared with 1759 cases during the preceding 21-day period (27 July – 16 August 2026), this represents a decrease of 94 cases (−5.3%).
Reported cases declined by 18.3% in Ituri, from 1356 to 1108, but increased by 47.4% in Nord-Kivu, from 293 to 432, and by 14.0% in Haut-Uélé, from 100 to 114. Consequently, Ituri’s contribution to newly reported cases fell from 77.1% to 66.5%, while Nord-Kivu’s contribution increased from 16.7% to 25.9% and Haut-Uélé’s from 5.7% to 6.8%. The latest period also included eight cases in Tshopo and three in Bas-Uélé. Overall, the modest national decline masks a continued redistribution of transmission away from Ituri, particularly towards Nord-Kivu, where incidence continues to increase.
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 06 September 2026
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During the same period, 848 confirmed deaths were reported nationally, compared with 941 deaths during the preceding 21 days, representing a decrease of 93 deaths (−9.9%). The national decline was driven by Ituri, where reported deaths decreased from 671 to 548 (−18.3%). In contrast, deaths increased from 224 to 253 (+12.9%) in NordKivu and from 42 to 43 (+2.4%) in Haut-Uélé. Consequently, Ituri’s contribution to newly reported deaths declined from 71.3% to 64.6%, while Nord-Kivu’s increased from 23.8% to 29.8% and Haut-Uélé’s from 4.5% to 5.1%. Tshopo and BasUélé reported two deaths respectively during the latest period, with no net increase in cases and deaths.
Overall, the modest national reduction in both cases (−5.3%) and deaths (−9.9%) masks divergent provincial trajectories and should be interpreted cautiously given reporting delays and retrospective data reconciliation. The continued increase in both cases and deaths in Nord-Kivu, alongside sustained transmission in Haut-Uélé, indicates that the outbreak is increasingly geographically heterogeneous rather than showing a uniform decline.
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Additionally, during the most recent 21 days, 52 of the 61 affected health zones (85.2%) reported at least one new confirmed case, while nine (14.8%) reported no new cases: Adja, Kambala and Mahagi in Ituri; Goma in Nord-Kivu; Lubunga, Tshopo and Wanie-Rukula in Tshopo; Miti-Murhesa in Sud- Kivu; and Buta in Bas-Uélé. Importantly, provincial trends should not be interpreted as uniform across their constituent health zones. In Ituri, for example, the overall 18.3% decline in cases occurred alongside renewed or increasing transmission in several health zones, including Bunia, Nizi, Mangala, Bambu, Komanda, Lita and Mandima, while previously prominent hotspots such as Mongbwalu showed declining activity. Similarly, the overall increase in Nord- Kivu reflects both strong resurgence in established hotspots, particularly Katwa, Beni and Butembo, and recent or renewed activity in additional health zones.
These divergent subprovincial trajectories indicate that transmission is shifting geographically rather than declining uniformly, underscoring the need to monitor and target response interventions at the health-zone level rather than relying on provincial or national trends alone.
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Weekly confirmed deaths peaked at 364 during 10 – 16 August, followed by declines to 302 and 270 over the subsequent two weeks. However, this downward trend did not continue in the most recent week, with deaths increasing slightly to 276 during 31 August – 6 September (+2.2%). More importantly, the latest increase was driven entirely by community deaths, which rose sharply from 171 to 207 (+21.1%), while deaths occurring in treatment facilities continued to decline from 99 to 69 (−30.3%). Consequently, the proportion of confirmed deaths occurring in the community increased from 56.6% during 17 – 23 August to 63.3% during 24 – 30 August and 75.0% during 31 August – 6 September, the highest weekly proportion observed during the reporting period. This divergence is concerning, as the increase in community deaths alongside the continued decline in treatment facilities deaths indicates that the earlier reduction in overall mortality has not been sustained.
The persistence of high community mortality may reflect multiple barriers along the pathway to care, including delayed detection and notification, delayed referral or transfer to treatment facilities, limited recognition of illness or perceived severity, geographic and transport barriers, care-seeking outside formal health facilities, and community acceptance or trust. These factors may result in patients reaching treatment facilities late or dying before referral can be completed.
The increasing proportion of community deaths, despite expanding treatment capacity, therefore suggests that increasing bed capacity alone may be insufficient and reinforces the need to strengthen early case detection, rapid referral and community-level pathways to timely care.
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Risk Assessment
The risk of further spread remains very high within the Democratic Republic of the Congo and high for neighbouring countries sharing land borders with the country. This assessment reflects sustained transmission, continued geographic expansion, high mortality, population mobility, insecurity and persistent response challenges.
The risk is considered 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 heterogeneous, with improving trends in some areas occurring alongside continued transmission, geographic redistribution and the emergence of new hotspots. The widening geographic footprint is creating an increasingly complex operational environment, requiring response capacity to be sustained across widely dispersed and sometimes difficult-to-access areas.
The six affected provinces collectively cover an area of approximately 630 000 km², although transmission remains concentrated within specific health zones and health areas. This geographic dispersion increases demands on surveillance, contact tracing, referral and case management capacity, laboratory networks, logistics and field coordination, and increases the risk that emerging transmission may not be detected or contained rapidly. Further gains will therefore depend on translating the substantial expansion in response capacity into rapid, locally delivered action in active and emerging hotspots.
Priorities should include early detection and referral, enhanced contact tracing, IPC interventions around cases, addressing the drivers of community deaths, and maintaining operational readiness in areas at risk of further spread.
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