DRC, Uganda: Ebola Outbreak Declared a Public Health Emergency of International Concern

• High risk of regional spread; particularly in urban settings, like Goma and Bunia, where dense populations, trade networks, and displacement dynamics increase transmission potential and complicate containment.  

• Response effectiveness is constrained by insecurity, population displacement, and operational access limitations, particularly in Ituri and North Kivu, disrupting surveillance, contact tracing, and safe burials.  

• The lack of approved BVD-specific vaccines or antiviral treatments makes rapid detection, infection prevention and control, community engagement, and cross-border coordination central to containment.

On May 15, the WHO was alerted to a cluster of unknown illness with high mortality in Mongbwalu Health Zone, Ituri Province, DRC, including the deaths of four healthcare workers. Subsequent laboratory testing confirmed BVD.  

As of May 20, health authorities had recorded 516 suspected cases and 33 laboratory-confirmed infections. Ituri remains the epicenter of the epidemic with 30 confirmed cases. The most affected health zones are Rwampara (19 confirmed cases), Bunia (6 confirmed cases), and Nyankunde (4 confirmed cases). Mongbwalu accounts for the most suspected cases (302 suspected cases). The outbreak has also reached North Kivu (3 confirmed cases), with confirmed cases in Goma, Butembo, and Katwa.

Additionally, Ugandan authorities reported two laboratory-confirmed cases in Kampala on May 15 and 16 involving individuals who had recently traveled from the DRC, although no direct epidemiological link between the two cases has been established. At present, no local transmission has been detected in Uganda.  

Health authorities are currently conducting contact tracing, case investigations, and community awareness activities while scaling up response operations. These include deployment of rapid response teams, strengthening surveillance and laboratory capacity, enhancing infection prevention and control (IPC), and expanding treatment and isolation facilities. However, there is limited understanding of the epidemiological links with known or suspected cases, and transmission chains may still be unidentified.   

Authorities across East and Central Africa are maintaining heightened surveillance at points of entry, including airports, border crossings, and major transport hubs.  

As of May 19:  

• Uganda has placed national surveillance and emergency response teams on high alert and postponed Martyrs' Day celebrations due to mass gathering risks.  
• The Kanugu border crossing points between DRC and Uganda is temporarily closed, including Ishasha and Kyeshero.
• Rwanda closed the Goma-Gisenyi border crossing on May 17, while allowing Rwandan and Congolese nationals to return home, and has increased screening along its DRC border.    
• Kenya, South Sudan, and Tanzania have strengthened surveillance, traveler screening, and preparedness measures.  
• The US Centers for Disease Control and Prevention (CDC) has issued several 'Travel Health Notices for Ebola' in response to the outbreak. As of May 19, the following notices are active/have been updated:  
  • Uganda: Level 1 - Practice Usual Precautions  
  • DRC: Level 3 - Reconsider Nonessential Travel. The CDC recommends avoiding nonessential travel to Ituri and Nord-Kivu provinces.
• The US has imposed Ebola-related entry restrictions and enhanced screening through at least June 17. Non-US passport holders who have traveled to Uganda, the DRC, or South Sudan in the previous 21 days are restricted from entry, while travelers arriving from affected areas will face increased public health screening and monitoring.  

Enhanced screening measures are expected to cause travel delays. Further escalation of the outbreak could prompt additional measures, including movement restrictions, limits on public gatherings, and further border closures.   

The outbreak is unfolding in a complex epidemiological, humanitarian, and security environment that is likely to complicate early containment. A delay of approximately four weeks between the likely index case onset and laboratory confirmation suggests early undetected transmission. Co-circulation of arboviruses and influenza-like illnesses may have further obscured detection, and initial diagnostic errors, including strain mismatch, contributed to delayed response activation.  

Healthcare-associated transmission is a major concern, highlighted by infections among healthcare workers, indicating potential breaches in infection prevention and control protocols. Reports of community deaths also raise concerns about unsafe burial practices contributing to early spread.  

The outbreak is occurring amid an ongoing humanitarian crisis. Affected areas in Ituri and North Kivu are characterized by insecurity, armed group activity, displacement, weak health systems, and limited access to services. These conditions significantly constrain surveillance, contact tracing, laboratory transport, safe burial operations, and overall response continuity.  

Operational access is uneven across affected areas. In Ituri, air links between Kinshasa and Bunia support the deployment of staff and supplies. Still, insecurity in health zones, including Djugu and Fataki, continues to restrict field operations and limit surveillance reach. In Goma, access constraints are more severe due to ongoing conflict dynamics, restricted airport access, and border closures, which disrupt coordination and supply chains.    

Key response gaps include limited isolation capacity, weak surveillance and contact tracing coverage, insufficient IPC implementation, fragmented coordination, limited laboratory capacity, and low community trust. These gaps are amplified by insecurity and population mobility.  

BVD is a zoonotic disease believed to originate in fruit bats. Human infection can occur through close contact with infected wildlife, including bats and non-human primates, particularly exposure to blood, secretions, organs, or other bodily fluids. The virus subsequently spreads between people through direct contact with bodily fluids of infected individuals, contaminated surfaces or materials, and exposure during unsafe burial practices.  

Symptoms typically appear from two to 21 days following exposure, and individuals are usually not infectious until symptom onset. Initial symptoms are often non-specific and may include fever, fatigue, headache, muscle pain, and sore throat, which can complicate early detection and diagnosis. As the disease progresses, patients may develop gastrointestinal symptoms followed by organ dysfunction and, in severe cases, hemorrhagic manifestations including unexplained bleeding or bruising. There are currently no approved vaccines or specific antiviral treatments for BVD.  

There is a continued risk of further geographic spread, including cross-border transmission. Key drivers include delayed detection, possible undetected transmission chains, healthcare-associated infection, insecurity, population displacement, high mobility, urban transmission potential, and the absence of approved vaccines or specific therapeutics for BVD.    

Geographic spread into urban and high-mobility settings increases the risk of further amplification. Reported cases in Bunia and Goma are particularly significant given their strong connections to regional trade, humanitarian activity, and dense population movement networks. The suspected linkage to Mongbwalu, a mining hub with frequent movement of workers and traders, further increases the probability of wider dissemination beyond the initial affected area.  

Insecurity and displacement further complicate containment efforts. Intensified insecurity in Ituri since late 2025 has displaced more than 100,000 people. Population movement associated with conflict increases the risk of undetected spread into urban centers, displacement camps, and across borders. It can disrupt contact tracing and fragment monitoring efforts.  

Regional exportation risk remains elevated. Ituri shares porous borders with Uganda and South Sudan, where cross-border movement is frequent and often informal, making it difficult to track. Overall, the full extent of the outbreak remains uncertain and may expand further, including geographically.    

This represents the most complete data available as of May 19. 

Learn more about leveraging our industry-leading regional and medical experts for intelligence that helps your organization stay ahead of health risks to your people and operations.