The Bundibugyo virus outbreak in the Democratic Republic of Congo (DRC) is now the DRC largest Ebola outbreak ever recorded, regardless of virus species, the World Health Organization (WHO) said in a Disease Outbreak News report published on 6 November.
As of 3 November, the DRC had reported 10,668 confirmed cases and 5,198 deaths, a crude case fatality rate of 48.7 per cent, and 2,881 recoveries, according to WHO. Cases have been recorded in 67 health zones across eight provinces, with active transmission in 51.
Inside the DRC largest Ebola outbreak
Since the previous WHO report, 964 new confirmed cases and 511 deaths were reported. Of the 512 deaths recorded since 21 October, 335 occurred in communities and 177 in treatment centres, WHO said. Deaths in the community suggest that many patients are not reaching care in time, which also raises the risk of transmission during home care and burials.
Ituri province has the most cases, with 7,485 cases and 3,532 deaths. Nord Kivu has 2,593 cases and 1,422 deaths, with the highest provincial case fatality rate at 54.8 per cent. Haut-Uélé and Tshopo have smaller counts.
Contact follow-up averages 86 per cent, below the 95 per cent target, and is lowest in Tshopo at 71 per cent, according to WHO. Missing contacts means some new cases are not detected early.
The scale of the DRC largest Ebola outbreak has stretched health teams in Ituri and Nord Kivu, where insecurity, population movement and distrust of authorities have complicated response efforts in past outbreaks. Community engagement and local leaders are central to encouraging early reporting and safe burials.
Two new vaccine candidates
WHO expert groups have recommended two additional vaccine candidates designed against the Bundibugyo virus for clinical evaluation in the DRC, Premium Times reported on 6 November. They are ChAdOx1, developed by the University of Oxford with the Serum Institute of India, and mRNA-1469, developed by Moderna. Both still require national approvals.
The candidates would be tested in the Tumaini trial, a Phase 2/3 study that began on 23 October in Bunia. It is led by the DRC’s Institut National de Recherche Biomédicale (INRB) with support from WHO and the University of Antwerp, and collaborators including Epicentre, Médecins Sans Frontières, the Institute of Tropical Medicine in Antwerp and Africa CDC. The Coalition for Epidemic Preparedness Innovations (CEPI) funded the rapid development of the candidates.
The trial uses ring vaccination, offering vaccine to contacts of confirmed patients and their contacts. Four rings are already in place. Ervebo, the vaccine licensed against the Zaire strain, is the first being evaluated in the trial for protection against Bundibugyo. Results of the vaccine trial are expected in early 2027.
Treatment trials
The PARTNERS trial, launched in July, is testing treatments for confirmed patients, including the monoclonal antibody MBP134, the antiviral drug remdesivir and a combination of both. Maftivimab will be added soon, and obeldesivir is being studied for post-exposure prevention, according to the report. Initial findings are expected in the coming months.
There are currently no approved vaccines or specific treatments for Bundibugyo virus disease, WHO said. Supportive care, including fluids, oxygen and treatment of complications, remains the main treatment.
The need for vaccines and treatments that work against Bundibugyo has been a recurring theme in the response. The DRC largest Ebola outbreak is caused by a strain against which existing licensed tools have not been proven, which is why the trials are running in the middle of the epidemic.
Spread beyond the DRC
WHO’s report also covered Kenya, which has nine confirmed cases and two deaths and no new cases since 19 October, and Nigeria, which confirmed one imported case in Abuja on 20 October. That patient was evacuated to Switzerland and 62 contacts were identified. Outbreaks in Uganda and France have been controlled since August.
WHO’s risk assessment from 14 August rated the risk as very high in the DRC, high for neighbouring countries and low for the rest of the African region and globally. The assessment is being revised. WHO continues to advise against travel or trade restrictions with affected countries.
A British national who tested positive in the DRC last week was evacuated for treatment, and WHO noted that the person is a health and care worker. Health workers continue to face high risks across affected areas.
The DRC largest Ebola outbreak is placing heavy pressure on health workers, treatment centres and communities in Ituri and Nord Kivu, where insecurity has long complicated outbreak response. Improving contact tracing, getting patients to care early and safe burials remain priorities while vaccine and treatment trials continue.
Why it matters: With no approved vaccine and many deaths at home, faster contact tracing and the new trials are critical to stopping the epidemic.
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