Bundibugyo Ebola Outbreak Widens in Eastern Congo and Uganda, Response Scaled Up

U.N. agencies and aid partners are rapidly expanding the Ebola response in eastern Democratic Republic of the Congo as an outbreak caused by the rarer Bundibugyo strain grows faster, spreads across borders and becomes harder to contain in a conflict zone.

The acceleration is visible in the numbers. The World Health Organization said in a report published June 13 that there were 676 confirmed cases and 136 confirmed deaths in Congo as of June 10, and 695 confirmed cases across Congo and Uganda combined. By June 18, however, Africa CDC told The Associated Press that the two-country outbreak had climbed to about 894 confirmed cases and had passed 200 deaths. WHO and Congolese authorities have said part of the increase reflects expanded testing and the clearing of sample backlogs, not only same-day transmission, but the rise still underscores how quickly the outbreak is widening.

Congo declared the outbreak May 15 after laboratory testing identified Bundibugyo ebolavirus, according to WHO’s Disease Outbreak News. The outbreak is centered in eastern Congo, especially Ituri province, and has expanded into health zones in North Kivu and South Kivu, according to WHO and U.N. reporting. Cross-border transmission into Uganda has also been confirmed. WHO reported 19 confirmed cases in Uganda as of June 11, including imported infections and some secondary cases, showing that the outbreak is no longer confined to one country.

Containing Ebola in eastern Congo is especially difficult because the outbreak is unfolding amid armed violence, population displacement and attacks that disrupt health services. Those conditions complicate basic control measures such as tracing contacts, isolating people who are sick and carrying out safe burials. “We cannot build community trust or isolate the sick while bombs are falling,” WHO Director-General Tedros Adhanom Ghebreyesus said, according to U.N. Geneva on May 27. Médecins Sans Frontières, or Doctors Without Borders, warned June 15 that major gaps remain in surveillance, diagnostics, contact tracing and community engagement. “One month on, the Ebola disease outbreak is outpacing the response effort,” said Kate White, MSF’s emergency medical coordinator in Congo.

The Bundibugyo strain adds another layer of difficulty. Unlike some Ebola outbreaks caused by Zaire ebolavirus, there is no licensed vaccine and no approved strain-specific treatment for Bundibugyo ebolavirus, according to WHO, leaving responders with fewer proven tools. WHO Director-General Tedros determined on May 17 that the Congo-Uganda Bundibugyo outbreak constitutes a Public Health Emergency of International Concern, the agency’s highest level of alarm for an extraordinary public health event that risks spreading internationally and requires a coordinated response. WHO has also noted that this is Congo’s 17th recorded Ebola outbreak.

The response is now being scaled up across the region. WHO, Africa CDC and partners have launched a broader preparedness and response plan seeking about $518 million for affected and at-risk countries. WHO, UNICEF, the International Organization for Migration, the U.N. refugee agency and other partners are increasing personnel, supplies, mobile laboratories, logistics support and community outreach in Congo, Uganda and neighboring countries at risk. The push reflects a stark reality that health officials and aid groups are now stating openly: the response is being expanded because the outbreak is outpacing current efforts to bring it under control.