Historic Ebola Outbreak Continues to Outpace Containment Efforts

• The current BVD outbreak is the largest and fastest spreading in the DRC's history. The outbreak is likely to remain active in the near term, particularly in Ituri.  

• Response measures remain insufficient to interrupt transmission. Insecurity, population displacement, and community mistrust remain major constraints on surveillance, contact tracing, and other response activities.  

• The wider health impact is likely to increase if the outbreak persists, as disruptions to routine health services could drive preventable morbidity and mortality unrelated to Ebola.  

• The risk of further geographic spread within the DRC remains very high, with an elevated risk of cross-border transmission into Uganda, South Sudan, and the Central African Republic. 

The BVD outbreak has spread to 60 health zones across six provinces. As of Aug. 28, health authorities recorded 5,945 confirmed cases and 2,862 deaths, corresponding to a case fatality rate (CFR) of 48.1 percent. The CFR has risen sharply from approximately 20 percent in early June, likely reflecting persistent gaps in surveillance, case detection, and access to care rather than increased viral lethality.  

Transmission remains concentrated in Ituri (4,911 cases), which accounts for 82.6 percent of confirmed cases and 77 percent of deaths. Bunia (1,375 cases) is the most affected health zone, followed by Rwampara (939 cases), Nizi (646 cases), and Mongbwalu (608 cases).

The outbreak's trajectory is markedly different from previous major Ebola outbreaks. The outbreak surpassed 1,000 confirmed cases within 40 days of response activation, compared with roughly 235 days for the 2018-2020 outbreak, and has already exceeded that epidemic's 3,317 total cases and death toll. More than 2,000 deaths were recorded in roughly three months, compared with nearly five months for the 2014-2016 West Africa outbreak to reach 1,000 deaths. At its current pace, it could overtake that outbreak's total of more than 28,000 cases and over 11,000 deaths. Sustained high incidence and continued geographic expansion indicate that transmission has not yet entered a clear declining phase.  

Response capacity has expanded substantially since May, including additional treatment facilities, laboratory capacity, contact tracing, community engagement, and infection prevention and control (IPC) activities. More than 21,000 community health workers have been trained, while diagnostic capacity has become increasingly decentralized.  

Surveillance and contact tracing remain the main barriers to containment. Of 25,015 registered contacts as of Aug. 28, 84.4 percent were successfully followed, below the 95 percent operational target. Approximately four in five new infections are occurring outside known transmission chains.  

Deaths outside treatment centers remain another major concern. From Aug. 10-24, 63 percent of reported deaths (451 of 719 deaths) occurred in the community. This highlights persistent delays in case detection, referral, and access to designated treatment facilities.

Community mistrust also continues to undermine response activities. Misinformation, denial of Ebola, resistance to safe and dignified burials, and dissatisfaction over the non-payment of community actors remain significant challenges. Some communities reportedly feel insufficiently consulted, while disruption to essential services, difficulty accessing healthcare, and broader humanitarian pressures have further reduced confidence in authorities and health services. These factors can delay care-seeking and limit cooperation with contact tracing, decontamination, and burial teams.  

Healthcare facilities remain potential sites of transmission. As of Aug. 27, at least 163 healthcare workers have been infected, including 47 deaths. Despite expanded IPC measures, healthcare worker infections continue, underscoring the need for stronger triage, personal protective equipment (PPE) use, exposure management, and adherence to IPC protocols.  On Aug. 27, health worker vaccination with the Ervebo vaccine began in parts of the DRC. While Ervebo is effective against Ebola virus disease, its protection against BVD in humans remains uncertain; a concurrent clinical trial aims to address this evidence gap.

Operational pressures are further limiting the response. Delayed remuneration and non-payment of response personnel have contributed to strikes and declining workforce motivation, disrupting community activities, decontamination, and points of entry operations. Although 49 treatment and transit facilities provided 1,308 active beds as of Aug. 23, localized shortages remain. Ambulance and referral capacity are also insufficient in several provinces.  

Insecurity and displacement further compound these challenges. Armed groups continue to restrict humanitarian access and movement, while 12 attacks on healthcare facilities have been recorded since May. Overcrowding, inadequate water and sanitation, population movement, and distrust of health services could facilitate rapid transmission in these settings. The affected provinces host approximately 4.4 million forcibly displaced people, raising amplification risk in overcrowded, underserved settings.  

The outbreak is increasingly disrupting broader healthcare delivery. In Ituri, use of essential health services fell 42 percent between April and June in the main transmission hotspots, while province-wide utilization declined by nearly 13 percent. Routine childhood immunization coverage fell by more than half in the worst-affected areas.  

Maternal healthcare has also been severely affected in Ituri, with facility-assisted deliveries falling 13 percent in the province and substantially more in some hotspots. Prolonged disruption could increase morbidity and mortality from non-Ebola conditions, while reduced routine vaccination could raise the risk of vaccine-preventable disease outbreaks.  

The outbreak is likely to remain active in the near term, particularly in Ituri, with further geographic spread plausible while most infections continue to occur outside known transmission networks. Insecurity, displacement, and cross-border population movement will continue to complicate containment. A sustained improvement would require contact follow-up to approach the 95 percent target, a greater proportion of cases to arise among known contacts, and declines in community deaths and treatment-center pressure. Until several of these indicators improve simultaneously, transmission is likely to continue outpacing containment efforts.

Following its Aug. 18 meeting, the IHR Emergency Committee advised that the outbreak continues to constitute a Public Health Emergency of International Concern (PHEIC), prompting updated temporary recommendations for countries. The WHO assesses the risk of further geographic spread in the DRC as very high, given ongoing transmission and continued expansion into new health zones. The risk of cross-border spread remains elevated, particularly for Uganda, South Sudan, and the Central African Republic, due to geographic proximity and established population movements. Enhanced health screening and other travel measures could cause delays at airports, land borders, and checkpoints, while further deterioration could prompt additional movement restrictions or border controls.  

Overall, the BVD outbreak is becoming increasingly geographically dispersed while transmission remains intense in established hotspots. High mortality, community deaths, gaps in surveillance, operational disruption, and uneven treatment capacity indicate that current interventions have yet to achieve sufficient coverage or speed to interrupt transmission. This represents the most complete data available as of Aug. 31.  

• Business travelers should avoid non-essential travel to areas experiencing active Ebola transmission, particularly affected health zones in Ituri and other provinces reporting ongoing cases.  
• Where travel is essential, travelers should maintain heightened situational awareness, follow guidance from local health authorities and their organization’s medical and security teams, and allow additional time for health screening or disruption at airports, land borders, and checkpoints.  
• Travelers should avoid contact with people who are unwell, blood or other body fluids, deceased persons, funeral or burial activities, and healthcare facilities treating suspected or confirmed Ebola cases unless access is medically necessary.  
• Any traveler who has had a potential exposure, or who develops fever or other compatible symptoms during or after travel, should immediately seek medical advice, disclose their travel and exposure history, and avoid further travel or close contact with others until appropriately assessed.  

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