The Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo (DRC) has spread across seven provinces, with 8224 confirmed cases, 3982 deaths, and 2121 recoveries reported as of September 29, 2026. The outbreak also affected 158 healthcare workers, according to Manuel Albela Miranda, MD, epidemiologist with Doctors Without Borders, who spoke at a press conference. He described it as the most severe Ebola outbreak in the country’s history and warned that “the outbreak is not under control.”

During its first 3 months, the outbreak recorded six times as many cases as the 2014-2016 Ebola epidemic in West Africa did during the same period. Miranda and Cordula Häffner, the medical team leader coordinating the Doctors Without Borders response in Kisangani, northeastern DRC, emphasized that the response lacks sufficient resources. Kisangani, the capital of Tshopo Province, has a population of fewer than 2 million people.

Ebola Disease Spreads Across Seven Provinces in the DRC

On May 15, 2026, the Congolese Ministry of Health confirmed an outbreak of BVD in Ituri Province. By September 23, the outbreak had spread to seven provinces: Ituri, Haut-Uélé, Bas-Uélé, Tshopo, North Kivu, South Kivu, and Sud-Ubangi. New cases continued to emerge in different areas, indicating that e transmission had reached additional parts of the country.

“New cases continue to emerge in various regions,” Miranda said.

Many healthcare facilities were already overstretched and underfunded before the outbreak. The DRC also faces recurring outbreaks of cholera, measles, and malaria, and malnutrition continues to affect the lives of children.

The Trump administration’s cuts to foreign aid hampered relief efforts. The outbreak also highlights weaknesses in the region’s healthcare systems, particularly when cases remain undetected for weeks or months. “Many people also travel between the Democratic Republic of the Congo and neighboring Uganda, which could lead to further spread of the virus. All these factors make the outbreak more difficult to contain,” Häffner said.

The current outbreak is caused by BV, for which no approved vaccine or specific treatment is available. The case fatality rate is nearly 50%, which is higher than the 25%-40% reported in previous outbreaks. One factor contributing to the high fatality rate is that many patients either do not seek care at treatment centers or arrive too late, reducing their chances of survival. Early intensive supportive care, including fever-reducing medications, rehydration, and symptom management, can improve outcomes.

High-Risk Zones: Protective Gear Limits Work to 1 Hour

Several hot spots have been identified in Tshopo Province, covering an area of 199,567 km². Häffner reported two additional sites of concern: a private clinic in Kisangani and a preschool where a teacher tested positive for BVD. “We hope the children haven’t been infected,” she said.

BV spreads through contact with bodily fluids, including tears and sweat, and through open wounds. Early symptoms are often nonspecific and may include headaches, abdominal pain, joint pain, and fever. Nausea and diarrhea may develop as the disease progresses. Patients become infectious after symptoms develop.

Treatment facilities are divided into low- and high-risk zones. Staff can enter high-risk zones where patients receive care only while wearing protective equipment. “Working in the high-risk zone is very difficult. You can spend a maximum of 1 hour there in protective gear because the heat and humidity are extreme. Our staff must leave in time to avoid collapsing,” Häffner said.

The need for protective equipment also places a considerable financial burden on the response. Thousands of protective suits and gloves are required, and only a limited amount of equipment can be decontaminated. The remainder must be incinerated immediately.

Fear and Mistrust Hinder Treatment

Contact tracing is a major challenge in this regard. Häffner emphasized that although the Ministry of Health is making substantial efforts, the large number of cases makes contact tracing difficult. Limited laboratory capacity also delays test results, further complicating efforts to track outbreaks.

“In half of the cases, we don’t really know where they came from. And in 70% of the cases, the contacts were unknown,” Miranda said. “The outbreak is certainly not over, and we don’t know where we stand,” he added.

Fear of infection is one reason individuals avoid healthcare facilities, but financial pressure also plays a role. A day in isolation can mean a day without income or food for the family, making the immediate threat of hunger more pressing than the risk for Ebola. Fear of and mistrust of healthcare measures and treatment further complicate the response.

Häffner described a case of a young mother with BVD who could not breastfeed her uninfected 3-month-old daughter because of the risk for transmission.

To address misinformation and encourage individuals to seek care, health authorities use radio and television to educate the public about BVD. However, mistrust also led to violence against those involved in the response. In late September, Congolese politician Marie-Célestin Karondwa was beaten to death after speaking on the radio about the outbreak in Butembo, a new hot spot, and advocating preventive measures.

His death followed a series of attacks on healthcare workers and treatment centers fueled by rumors, misinformation, and mistrust. Häffner also reported that volunteers had objects thrown at their vehicles while traveling.

“There is a great deal of mistrust. Sometimes we hear: ‘You White people are the ones who brought this upon us,’” she said. She compared these reactions with those seen during the COVID pandemic, when conspiracy theories about the origins of the virus also circulated in Europe.

Against this backdrop, Häffner and her colleagues relied on Ebola survivors to help rebuild trust. After returning to their communities, survivors educate others about the disease and stress the importance of seeking treatment as early as possible.

Vaccine Cross-Protection and New Treatment Studies

Vaccines developed for previous Ebola outbreaks are being used in Kisangani, but those outbreaks were caused by the Ebola virus, not BV. Researchers are currently investigating whether these vaccines also provide cross-protection against BV. Researchers from the Helmholtz Centre for Infection Research have reported evidence that antibodies produced after Ebola vaccination can also neutralize currently circulating BV variants in laboratory experiments. Whether this finding translates to protection in humans remains uncertain.

In Tshopo Province, remdesivir, an antiviral drug previously used to treat SARS-CoV-2 and other viral infections, is being administered under a compassionate-use program.

Miranda highlighted two studies that began in July 2026. The PARTNERS trial is evaluating MBP134, a combination of two monoclonal antibodies isolated from the blood of a survivor of the 2014-2016 Ebola epidemic in West Africa, and remdesivir. This trial aims to assess whether these treatments can improve outcomes for patients with BVD.

The EBO-PEP trial is evaluating obeldesivir for post-exposure prophylaxis. Individuals who have had direct contact with patients with BVD or with individuals who have died from the disease receive the drug twice daily for 10 days to assess whether it can prevent infection. Post-exposure prophylaxis is also used for certain exposures to HIV, rabies, and hepatitis B, although the recommended interventions differ by pathogen and exposure.

This story was translated from Medscape’s German edition.