The ongoing outbreak of Bundibugyo virus disease (BVD) in the Democratic Republic of the Congo (DRC), with cases reported in other countries, is a stark reminder that BVD remains an active global health security threat. On 17 May 2026, the WHO declared this outbreak a public health emergency of international concern, citing confirmed cross-border transmission, incomplete epidemiological links, and probable underdetection.1 The outbreak probably began weeks before its declaration on 15 May 2026, allowing transmission to remain undetected.2 As of 15 October 2026, the DRC had reported 9277 laboratory-confirmed cases, including 4478 deaths, with a crude case-fatality ratio of approximately 48%. Uganda had reported 20 laboratory-confirmed cases, including two deaths, while France reported one imported case with no deaths. Kenya also reported an imported case in October.3 However, the outbreak may be larger than reported owing to undetected case clusters, unreported community deaths, and incomplete epidemiological links.4

Ebola disease is caused by filamentous, nonsegmented, negative-sense single-stranded RNA viruses5 that belong to the Orthoebolavirus genus of the Filoviridae family. Six species of Orthoebolavirus have been identified,6 but only three—Ebola virus, Sudan virus, and Bundibugyo virus (BDBV)—have caused large outbreaks in humans. Ebola disease is zoonotic, with occasional spillover from wildlife into humans.7 Initial human infections can occur through direct contact with infected wildlife. Subsequent person-to-person transmission occurs through direct contact with infected blood or other body fluids, or contaminated objects and surfaces, often in healthcare settings.6

The first recognized Ebola disease outbreaks occurred in 1976 in what are now South Sudan and the DRC.6 The BDBV was first identified in Bundibugyo District in western Uganda in 2007 [Figure 1].8,9 In 2012, the second BDBV outbreak was reported in the DRC. The current outbreak, the third recognized BDBV outbreak, is the largest and deadliest on record. This is also the 17th Ebola disease outbreak reported in the DRC.2,10 The current outbreak’s epicenter is in Ituri Province, an active conflict zone where weak health systems, mining-related population mobility, displacement, and limited healthcare access likely delayed detection and amplified transmission.10,11 As in past outbreaks, frequent cross-border population movement, weak surveillance, diagnostic delays, and gaps in infection prevention and control (IPC) have increased international spread. Although three licensed Ebola virus vaccines target Ebola virus (formerly known as Zaire ebolavirus),4 no vaccine or specific therapeutic, including monoclonal antibodies, has been approved for BVD.8

The epidemiology of BVD is less well studied than that of Ebola virus disease. However, available information suggests that the epidemiological and virological characteristics, genomic makeup, clinical presentation, and case-fatality ratio of BVD may differ substantially from those of other ebolavirus species known to cause large-scale outbreaks.11 The absence of licensed vaccines and approved specific treatments challenges outbreak control [Table 1].

The Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE), despite their geographic distance from Central Africa, face a tangible risk of importation. The GCC’s strategic role as a global hub for commerce, business travel, and religious pilgrimage, especially the annual Hajj and year-round Umrah, draws millions of visitors each year, creating multiple pathways for viral introduction. A large expatriate workforce originating from diverse regions of Africa, including areas near the epicenter of the current outbreak, further enhances the risk of importation by returning travelers; extensive air connectivity between the GCC countries and Africa amplifies this vulnerability.18 Air travel and religious gatherings have previously facilitated transmission of filoviruses from Africa to other countries within days.2 Thus, the present risk should not be taken lightly.

The WHO’s regional risk assessment currently suggests a low probability of importation into the Eastern Mediterranean Region, but this general estimate may not fully reflect the GCC’s intensive and sustained travel and labor-migration patterns. This higher risk warrants sustained vigilance, real-time multi-country surveillance, and enhanced preparedness rather than complacency.

Because BVD’s early symptoms mimic other febrile and viral hemorrhagic illnesses, and laboratory confirmation requires access to appropriate testing, a high index of suspicion is needed. A patient without hemorrhagic manifestations or a travel history may have had contact with a returning traveler [Table 1]. Healthcare facilities can become sites of transmission amplification during the early phases of outbreaks if diagnosis is delayed and initial cases are missed.5 During the current BVD outbreak in the DRC, the outbreak was officially declared only after a healthcare worker (HCW) died following a severe, unexpected illness.5

Healthcare facilities across GCC countries must therefore use a sensitive case definition and a screening algorithm that considers symptoms, travel, and exposure history at every point of care, including outpatient clinics. Rapid isolation of suspected cases, minimizing unnecessary contact, and immediate access to appropriate personal protective equipment for all HCWs are essential. Training of frontline HCWs must be recurrent rather than one-off, particularly where staff turnover is frequent, and must cover correct donning and doffing, hand hygiene, environmental decontamination, and safe waste management. Protocols for the safe and dignified handling of deceased patients should be established and rehearsed, since unsafe burial and body-handling practices have been recurrent drivers of transmission.6

Past Ebola disease outbreaks and the current BVD outbreak reinforce the principle that early identification of suspected cases and rapid laboratory confirmation provide a window for interrupting transmission. Prompt isolation, clinical care, and contact tracing are essential. Contacts, including exposed HCWs, should be monitored for 21 days after their last exposure.6

Successful control of filovirus disease requires integrating proven medical countermeasures, including clinical care, surveillance, diagnostics, and coordinated multinational public health efforts.5 A regionally coordinated response should therefore rest on four interlocking pillars: cross-border surveillance, decentralized laboratory capacity, IPC, and risk communication with community engagement. Real-time outbreak intelligence, combining clinical and epidemiological data with genomic surveillance and assessment of signals from social media, may help identify unusual transmission patterns early, particularly in countries with mass gatherings.

Active case-finding and digitally supported contact tracing should be tested and made ready for rapid activation if cases occur; these activities could increasingly be assisted by artificial intelligence-based tools to predict hotspots. A decentralized regional laboratory network supported where appropriate by mobile diagnostic capacity, safe specimen collection and transport, shared assays, genomic sequencing, and joint quality-assurance programs, could shorten the time to diagnosis. Healthcare facilities must maintain triage and safe referral systems, workforce training, and supportive supervision. Risk communication strategies should be tailored to the GCC’s exceptionally diverse population of expatriate residents and pilgrims, using trusted channels, including social media and community and religious leaders, to build trust and counter misinformation.

GCC countries should test, not merely draft, their BVD preparedness plans through regular multisectoral simulation exercises involving health, immigration, border-control, transport, and communication authorities. Point-of-entry screening and traveler education cannot be relied on alone, given the incubation period of 2–21 days, during which infected travelers may be asymptomatic and afebrile.6 People infected with ebolaviruses are not considered infectious before symptom onset. Temperature checks at points of entry therefore cannot exclude infection. WHO advises against general travel or trade restrictions in response to this outbreak.19 Cross-country collaboration among GCC countries, including harmonized surveillance and contact-tracing protocols, secure sharing of case and contact information, timely reporting by countries and joint deployment of trained experts, is indispensable. The Gulf Center for Disease Prevention and Control is well placed to coordinate this regional effort. GCC countries should also prepare to access candidate BDBV vaccines, therapeutics, and diagnostic tools and, where feasible, participate in ethically approved clinical trials of candidate vaccines and therapeutics and clinical evaluations of diagnostic tools.20

The GCC countries sit at the crossroads of global travel and business and are inherently exposed to the risk of importing emerging pathogens such as BDBV. Sustained investment in core public health functions can improve outbreak detection and response capacity for filovirus infections and other emerging pathogens. National governments must collectively strengthen surveillance, laboratory diagnostics, IPC, clinical care, and risk communication in an integrated manner and test these systems regularly. The region has experience in successfully managing and controlling other high-threat pathogens. This knowledge should now be applied. The risk of BVD importation should be treated as a call to action: an opportunity for GCC countries to consolidate preparedness now, so they are ready to respond swiftly to BVD and future epidemic threats.

references

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