Archived: Rapid risk assessment: Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda

In May 2026, an outbreak of the Ebola disease caused by Bundibugyo virus was declared in the Democratic Republic of the Congo and Uganda. The overall risk to the general population in Canada remains low at this time, in line with the risk assessment conducted on May 21, 2026 (now extended to July 2, 2026). If an infected person were to arrive in Canada, transmission is expected to be limited due to established public health measures, enhanced border screening measures and because the virus requires direct contact with body fluids or tissues of infected individuals.

The Public Health Agency of Canada (PHAC) is actively monitoring the outbreak in close collaboration with international partners, including the World Health Organization, as well as provincial and territorial public health authorities. PHAC will continue to assess the risk to Canada and provide updates if the situation or the level of risk changes.

Assessment completed: May 21, 2026 (based on information available up to May 20, 2026)

Reason for the assessment

Given the ongoing Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo (DRC) and Uganda, there is a need to assess the potential for importation and local transmission of Bundibugyo virus in Canada and overall risk to the population of Canada. This assessment will help guide appropriate public health actions, including border measures, contact tracing and risk communication, any additional preparedness measures (e.g. infection prevention and control) and a coordinated Federal, Provincial, Territorial response if needed.

Risk question

What is the likelihood and impact of Bundibugyo virus importation into Canada in connection with the ongoing outbreak in the DRC and Uganda within the next 2 weeks?

Risk statement

The overall risk level to the Canadian population of acquiring Bundibugyo virus from the ongoing outbreak in the DRC and Uganda is currently low (moderate uncertainty). Should a case be imported into Canada, transmission within Canada is expected to be limited due to established public health measures and characteristics of the virus, which is not transmissible before the onset of symptoms and requires close contact with body fluids or tissues of symptomatic or deceased cases to be transmitted.

The likelihood of importation of Bundibugyo virus into Canada in the next two weeks is low (moderate uncertainty), given the low travel volume between currently affected regions and Canada, and existing travel advisories that recommend against all travel to the outbreak-affected areas in the DRC due to ongoing safety and security concerns. The impact on an affected individual is estimated to be severe (low uncertainty), given the serious clinical manifestations of BVD, its high case fatality rate and lack of approved vaccines or antivirals.

If importation into Canada were to occur, the impact of BVD on the general population in Canada would be minor (low uncertainty), due to the limited number of secondary cases anticipated among close contacts, strong diagnostic and health system capacity, and existing protocols for outbreak response, case and contact management and infection prevention and control.

These risk levels could change if evidence were to emerge suggesting geographic expansion of the outbreak, including within currently affected countries and to countries with stronger travel links to Canada.

Event summary (current situation as of May 20, 2026)

On May 15, 2026, the Ministry of Health of the DRC declared an outbreak of Ebola disease caused by Bundibugyo virus in the northeastern province of Ituri^{Footnote 1}. The earliest known suspected case died in Ituri province on April 20, 2026. On May 17, 2026, the World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC)^{Footnote 2}, citing the potential for further international spread. The WHO currently assesses the overall public health risk posed by this outbreak as high at the national and regional levels, and low at the global level^{Footnote 3}.

As of May 20, 2026, 51 confirmed cases, nearly 600 suspected cases and 139 suspected deaths have been reported in the DRC across the provinces of Ituri and North Kivu, including in the cities of Bunia, Butembo, and Goma^{Footnote 3}, indicating that undetected transmission has been ongoing for several weeks. Additional cases have been reported in Kampala, Uganda. The circulating strain appears to be genetically distinct from previous BVD outbreaks (Uganda 2007–2008, DRC 2012)^{Footnote 4}, suggesting that this represents a separate zoonotic spillover event. There are currently no approved or licensed vaccines or specific antivirals available for Bundibugyo virus disease.

The affected region includes densely populated urban areas and has been affected by conflict, security concerns and humanitarian challenges in recent years; large mining operations in the area contribute to high population mobility. A previous Ebola disease outbreak in Ituri and North Kivu provinces, caused by Ebola virus (Orthoebolavirus zairense), involved more than 3000 cases and lasted nearly 2 years (2018-2020)^{Footnote 5}.

Considerations for pathogens with pandemic potential

At this time, Bundibugyo virus is not considered to be a pathogen with pandemic potential. WHO has declared this event a PHEIC but has noted that this event does not meet the criteria for a pandemic emergency^{Footnote 2}^{Footnote 3}. Previous outbreaks have typically been limited to a specific geographic area. Person-to-person transmission of Bundibugyo virus requires direct contact with tissue or bodily fluids from infected individuals, or contaminated surfaces. Transmission can be effectively prevented with adequate infection prevention and control measures.

Risk assessment details

Risk component: Estimate [Uncertainty]	Rationale
Likelihood of importation into Canada: Low [moderate]	The number of Canadian citizens or residents with potential for Bundibugyo virus exposure in the DRC is expected to be low; official advice recommends avoiding all non-essential travel to DRC, and avoiding all travel to Ituri and North Kivu provinces due to safety and security concerns^{Footnote 6}. An average of ~1000 people travel between DRC and Canada each month, of whom ~40% are Canadian citizens, and travel is highest between June and September (Canadian Border Services Agency, unpublished data). However, more than 95% of air travel from DRC to Canada originates from Kinshasa (International Air Transport Association, unpublished data), which is not easily accessed from the currently-affected areas. Cases connected to this outbreak have been reported in Kampala, Uganda, but at present there is no evidence of local transmission in this region. The likelihood of exposure could be higher for certain groups, including healthcare workers, humanitarian aid workers and armed forces personnel located in affected regions. To date, one case of a US doctor working in DRC has been linked to the ongoing outbreak. The number of humanitarian and medical workers from Canada based in DRC is expected to be very limited and processes are in place to enable notification of returning humanitarian workers from outbreak-affected areas. There are Canadian Armed Forces missions in the DRC, but the number of active personnel in outbreak-affected areas is expected to be small. Certain travellers, such as those visiting friends and relatives in outbreak-affected areas for extended periods, or those working with Canadian-owned businesses operating in the region, could also experience higher likelihood of exposure. There are migrants from the DRC and neighbouring countries (including Uganda, South Sudan, and Rwanda) with visas issued for Canada (including planned resettlements of refugees, visitors, workers). Given the range and diversity of immigration clients, the likelihood of their exposure to BVD is uncertain. However, Immigration, Refugees and Citizenship Canada (IRCC) has authority to put in place specific outbreak response measures, including for Canada-bound refugees when warranted. Importations from outbreak-affected settings to the US and Europe have occurred in the past, but are uncommon and primarily involve humanitarian and medical workers; historically Ebola disease outbreaks, including 16 previous outbreaks in the DRC, have not resulted in importations to Canada. Given the extended travel route from the affected countries to Canada, a window exists where an incubating individual may first develop symptoms en route, shifting their status to symptomatic prior to arrival. Although secondary transmission during air travel through close contact with a symptomatic case could theoretically occur, air travel is generally considered low risk for the transmission of Orthoebolaviruses^{Footnote 7}^{Footnote 8}.
Impact on infected individuals: Severe [low]	Similar to disease caused by other Orthoebolaviruses, BVD has a serious clinical presentation, typically lasting 2 to 21 days, with sudden onset of non-specific symptoms (fever, fatigue, muscle pain, headache, and sore throat) that can lead to gastrointestinal involvement, multi-organ failure and hemorrhagic manifestations^{Footnote 1}^{Footnote 9}^{Footnote 10}. Multi-system sequelae may persist for several years after recovery, including neurological and musculoskeletal complications, chronic inflammation, visual impairments (ocular deficits, blurred vision), and memory loss^{Footnote 11}^{Footnote 12}. There is currently no approved vaccine or specific treatment against Bundibugyo virus. Early supportive care (e.g., fluid supplementation, ensuring organ function, mechanical ventilation, symptom management) is critical to reduce mortality risk. The Ebola virus disease vaccine (ERVEBO^®) approved for use in Canada is not expected to provide protection against Bundibugyo virus or other Orthoebolaviruses^{Footnote 13}. The case fatality rate (CFR) of BVD is estimated to be between 30% to 50% based on previous outbreaks reported in Uganda (2007) and DRC (2012)^{Footnote 1}^{Footnote 9}. However, if cases were to occur in Canada improved outcomes would be expected due to increased access to supportive treatments^{Footnote 14}.
Population level impact for the general population in Canada: Minor [low]	Border screening and assessment of travellers with recent travel to the DRC or Uganda and any illness or potential BVD exposure is being implemented in Canada. Canada has specific requirements for detection and notification of suspected Ebola disease cases, including those caused by Bundibugyo virus, to facilitate prompt care and limit onward transmission: Under the Quarantine Act, travellers must self-identify to a Canada Border Services Agent on arrival in Canada if they suspect that they might have a viral hemorrhagic fever (VHF) or have been exposed to a VHF pathogen. VHFs, including BVD, are nationally notifiable and specific national and provincial guidelines exist for infection prevention and control, and case and contact investigation and management (including patient transportation), and public health response activities^{Footnote 15}^{Footnote 16}^{Footnote 17}. Should an imported case of BVD occur in Canada, any onward transmission is expected to be limited to a small number of secondary cases. Bundibugyo virus is transmitted through direct contact with body fluids of symptomatic or deceased individuals, limiting the number of potential exposed contacts (e.g., household members, healthcare workers without appropriate personal protective equipment). Canada has established contact tracing, infection prevention and control, diagnostics, and treatment protocols and capabilities, as well as access to appropriate personal protective equipment in healthcare settings. Canada has a VHF coordination plan that can be used to support FPT coordinated response for BVD should a case be imported into Canada. Canada has effective molecular assays and mobile diagnostic capabilities for rapid detection and confirmation of BVD. Should a locally-acquired case(s) of BVD occur, affected healthcare facilities and public health authorities would be notably impacted due to resources required for infection prevention and control and coordinated outbreak response. There is the potential for indirect impacts associated with an importation, including increased public concern and media attention.

Risk component: Estimate [Uncertainty]

Rationale

Likelihood of importation into Canada: Low [moderate]

The number of Canadian citizens or residents with potential for Bundibugyo virus exposure in the DRC is expected to be low; official advice recommends avoiding all non-essential travel to DRC, and avoiding all travel to Ituri and North Kivu provinces due to safety and security concerns^{Footnote 6}.
An average of ~1000 people travel between DRC and Canada each month, of whom ~40% are Canadian citizens, and travel is highest between June and September (Canadian Border Services Agency, unpublished data). However, more than 95% of air travel from DRC to Canada originates from Kinshasa (International Air Transport Association, unpublished data), which is not easily accessed from the currently-affected areas.
Cases connected to this outbreak have been reported in Kampala, Uganda, but at present there is no evidence of local transmission in this region.
The likelihood of exposure could be higher for certain groups, including healthcare workers, humanitarian aid workers and armed forces personnel located in affected regions.
- To date, one case of a US doctor working in DRC has been linked to the ongoing outbreak. The number of humanitarian and medical workers from Canada based in DRC is expected to be very limited and processes are in place to enable notification of returning humanitarian workers from outbreak-affected areas.
- There are Canadian Armed Forces missions in the DRC, but the number of active personnel in outbreak-affected areas is expected to be small.
- Certain travellers, such as those visiting friends and relatives in outbreak-affected areas for extended periods, or those working with Canadian-owned businesses operating in the region, could also experience higher likelihood of exposure.
There are migrants from the DRC and neighbouring countries (including Uganda, South Sudan, and Rwanda) with visas issued for Canada (including planned resettlements of refugees, visitors, workers). Given the range and diversity of immigration clients, the likelihood of their exposure to BVD is uncertain. However, Immigration, Refugees and Citizenship Canada (IRCC) has authority to put in place specific outbreak response measures, including for Canada-bound refugees when warranted.
Importations from outbreak-affected settings to the US and Europe have occurred in the past, but are uncommon and primarily involve humanitarian and medical workers; historically Ebola disease outbreaks, including 16 previous outbreaks in the DRC, have not resulted in importations to Canada.
Given the extended travel route from the affected countries to Canada, a window exists where an incubating individual may first develop symptoms en route, shifting their status to symptomatic prior to arrival. Although secondary transmission during air travel through close contact with a symptomatic case could theoretically occur, air travel is generally considered low risk for the transmission of Orthoebolaviruses^{Footnote 7}^{Footnote 8}.

Impact on infected individuals:

Severe [low]

Similar to disease caused by other Orthoebolaviruses, BVD has a serious clinical presentation, typically lasting 2 to 21 days, with sudden onset of non-specific symptoms (fever, fatigue, muscle pain, headache, and sore throat) that can lead to gastrointestinal involvement, multi-organ failure and hemorrhagic manifestations^{Footnote 1}^{Footnote 9}^{Footnote 10}. Multi-system sequelae may persist for several years after recovery, including neurological and musculoskeletal complications, chronic inflammation, visual impairments (ocular deficits, blurred vision), and memory loss^{Footnote 11}^{Footnote 12}.
There is currently no approved vaccine or specific treatment against Bundibugyo virus. Early supportive care (e.g., fluid supplementation, ensuring organ function, mechanical ventilation, symptom management) is critical to reduce mortality risk. The Ebola virus disease vaccine (ERVEBO^®) approved for use in Canada is not expected to provide protection against Bundibugyo virus or other Orthoebolaviruses^{Footnote 13}.
The case fatality rate (CFR) of BVD is estimated to be between 30% to 50% based on previous outbreaks reported in Uganda (2007) and DRC (2012)^{Footnote 1}^{Footnote 9}. However, if cases were to occur in Canada improved outcomes would be expected due to increased access to supportive treatments^{Footnote 14}.

Population level impact for the general population in Canada:

Minor [low]

Border screening and assessment of travellers with recent travel to the DRC or Uganda and any illness or potential BVD exposure is being implemented in Canada. Canada has specific requirements for detection and notification of suspected Ebola disease cases, including those caused by Bundibugyo virus, to facilitate prompt care and limit onward transmission:
- Under the Quarantine Act, travellers must self-identify to a Canada Border Services Agent on arrival in Canada if they suspect that they might have a viral hemorrhagic fever (VHF) or have been exposed to a VHF pathogen.
- VHFs, including BVD, are nationally notifiable and specific national and provincial guidelines exist for infection prevention and control, and case and contact investigation and management (including patient transportation), and public health response activities^{Footnote 15}^{Footnote 16}^{Footnote 17}.
Should an imported case of BVD occur in Canada, any onward transmission is expected to be limited to a small number of secondary cases.
- Bundibugyo virus is transmitted through direct contact with body fluids of symptomatic or deceased individuals, limiting the number of potential exposed contacts (e.g., household members, healthcare workers without appropriate personal protective equipment).
- Canada has established contact tracing, infection prevention and control, diagnostics, and treatment protocols and capabilities, as well as access to appropriate personal protective equipment in healthcare settings.
- Canada has a VHF coordination plan that can be used to support FPT coordinated response for BVD should a case be imported into Canada.
Canada has effective molecular assays and mobile diagnostic capabilities for rapid detection and confirmation of BVD.
Should a locally-acquired case(s) of BVD occur, affected healthcare facilities and public health authorities would be notably impacted due to resources required for infection prevention and control and coordinated outbreak response.
There is the potential for indirect impacts associated with an importation, including increased public concern and media attention.

Limitations, knowledge gaps, and uncertainties

The overall uncertainty in this assessment is moderate. Historically, outbreaks of similar VHFs have not resulted in importations into Canada and the potential for exposure among the population of Canada is currently low. However, there is considerable uncertainty regarding the current magnitude of the outbreak and its trajectory in the coming weeks, given that transmission has likely been ongoing for several weeks prior to detection.

Specific sources of uncertainty and knowledge gaps include:

Information regarding the exact number of Canadian citizens and residents in outbreak-affected areas is not available. This number is expected to be small due to ongoing conflict in the country and existing advisories against travel to the DRC.
The extent of transmission and geographic spread is currently not well understood. Given evidence of undetected transmission for several weeks, case numbers are expected to continue to increase in the coming weeks until sufficient control measures, including effective contact tracing, are implemented. If expansion of the outbreak into new geographic areas occurs, particularly to areas with stronger travel links to Canada, this could increase the level of risk.
Canada has high capacity for VHF diagnostics and existing protocols for case and contact management and public health response, but there is some uncertainty regarding the ability to promptly detect an importation, as BVD cases have not been imported into Canada before and the clinical presentation in the early phase of disease can be non-specific.
The clinical profile, epidemiological characteristics of BVD is expected to be similar to disease caused by other Orthoebolaviruses, although data on this specific strain is more limited as there have only been two previous outbreaks documented.
Candidate vaccines and treatments may be deployed during this outbreak as part of clinical trials, but their impact on clinical outcomes and/or control of transmission remains uncertain.

Proposed actions

Continue timely coordinated risk communications informing people in Canada of the Ebola disease outbreak caused by Bundibugyo virus, the level of risk, actions taken by public health authorities, concrete actions individuals can take to protect themselves if travelling to the region and what they should do if they feel sick or experience any symptoms of Ebola disease prior to or during their flight, as well as upon or after arrival in Canada.
Continue targeted communications to healthcare professionals for awareness and readiness to support early detection, diagnosis/testing, management, and notifying public health authorities as per their protocols.
Continue regular information sharing and discussion with Federal, Provincial, Territorial public health partners to support coordinated readiness in event of BVD importation to Canada.
Conduct timely assessment of international Requests for Assistance to proactively identify feasible, risk-managed options for Canada to support the response and contribute to mitigating escalation and international spread, in line with Canada's global health commitments.
Continue scientific activities to investigate the therapeutic efficacy of novel monoclonal antibody treatments and other experimental countermeasures, including drugs, vaccines, and diagnostic tests.

Reassessment

This situation is rapidly evolving and PHAC will continue to monitor the outbreak. The risk assessment team will reconvene to review new evidence suggesting a possible increase in risk for Canada or to Canadian residents in the DRC, Uganda or neighbouring countries. Examples of factors that could indicate an increased risk may include, but are not limited to, geographic expansion of the outbreak within currently affected countries and to countries with stronger travel links to Canada.

Methods

This assessment was completed by the Public Health Agency of Canada. The rapid risk assessment (RRA) methodology is based on the World Health Organization (WHO) Member State RRA tool^{Footnote 18}. Likelihood, impact, and overall risk were estimated using previously described scales and risk matrix (see risk assessment methods page), and capacity to respond was estimated using the WHO tool^{Footnote 18}. The overall risk level for the general population was obtained using the overall population impact estimate, as it contains the driving component of risk for the general population.

References

Footnote 1

World Health Organization. Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda. Accessed May 19, 2026. https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON602

Return to footnote 1 referrer

Footnote 2

World Health Organization. Epidemic of Ebola Disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda determined a public health emergency of international concern. Accessed May 20, 2026. https://www.who.int/news/item/17-05-2026-epidemic-of-ebola-disease-in-the-democratic-republic-of-the-congo-and-uganda-determined-a-public-health-emergency-of-international-concern

Return to footnote 2 referrer

Footnote 3

World Health Organization. WHO Director-General's opening remarks at the media briefing on Ebola outbreak in DRC and Uganda – 20 May 2026. Accessed May 20, 2026. https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing-on-ebola-outbreak-in-drc-and-uganda-20-may-2026

Return to footnote 3 referrer

Footnote 4

Initial genomes from May 2026 Bundibugyo Virus Disease Outbreak in the Democratic Republic of the Congo and Uganda - Ebolavirus / Bundibugyo ebolavirus. Virological. May 18, 2026. Accessed May 19, 2026. https://virological.org/t/initial-genomes-from-may-2026-bundibugyo-virus-disease-outbreak-in-the-democratic-republic-of-the-congo-and-uganda/1032

Return to footnote 4 referrer

Footnote 5

Centers for Disease Control and Prevention. Ebola Disease Outbreaks by Species and Size, Since 1976. Ebola. January 27, 2026. Accessed May 20, 2026. https://www.cdc.gov/ebola/outbreaks/index.html

Return to footnote 5 referrer

Footnote 6

Global Affairs Canada. Travel advice and advisories for Democratic Republic of Congo (Kinshasa). Travel.gc.ca. May 21, 2026. Accessed May 19, 2026. https://travel.gc.ca/destinations/congo-kinshasa

Return to footnote 6 referrer

Footnote 7

World Health Organization. Air travel is low-risk for Ebola transmission. Accessed May 21, 2026. https://www.who.int/news/item/14-08-2014-who-air-travel-is-low-risk-for-ebola-transmission

Return to footnote 7 referrer

Footnote 8

Regan JJ, Jungerman R, Montiel SH, et al. Public health response to commercial airline travel of a person with Ebola virus infection - United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(3):63-66.

Return to footnote 8 referrer

Footnote 9

Roddy P, Howard N, Van Kerkhove MD, et al. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One. 2012;7(12):e52986. doi:10.1371/journal.pone.0052986

Return to footnote 9 referrer

Footnote 10

Public Health Agency of Canada. Ebola disease prevention, monitoring and surveillance recommendations. February 27, 2024. Accessed May 19, 2026. https://www.canada.ca/en/public-health/services/catmat/ebola-virus-disease-preventive-measures-monitoring-surveillance-travellers.html

Return to footnote 10 referrer

Footnote 11

Kaweesa RE, Katende JS, Wayesu RR, et al. Resilience and residuals beyond containment - The hidden burden of Bundibugyo Ebola virus survivorship sixteen years on: A cross-sectional observational study. New Microbes New Infect. 2026;69:101685. doi:10.1016/j.nmni.2025.101685

Return to footnote 11 referrer

Footnote 12

Clark DV, Kibuuka H, Millard M, et al. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. The Lancet Infectious Diseases. 2015;15(8):905-912. doi:10.1016/S1473-3099(15)70152-0

Return to footnote 12 referrer

Footnote 13

Public Health Agency of Canada. Ebola disease: For health professionals, humanitarian aid workers. January 27, 2025. Accessed May 21, 2026. https://www.canada.ca/en/public-health/services/diseases/ebola/health-professionals-ebola.html

Return to footnote 13 referrer

Footnote 14

Uyeki TM, Mehta AK, Davey RT, et al. Clinical Management of Ebola Virus Disease in the United States and Europe. New England Journal of Medicine. 2016;374(7):636-646.

Return to footnote 14 referrer

Footnote 15

Public Health Agency of Canada. Infection prevention and control measures for Ebola disease in acute care settings. June 22, 2023. Accessed May 19, 2026. https://www.canada.ca/en/public-health/services/diseases/ebola/health-professionals-ebola/infection-prevention-control-measures-healthcare-settings.html

Return to footnote 15 referrer

Footnote 16

Public Health Agency of Canada. National case definition: Viral hemorrhagic fever. January 27, 2020. Accessed May 19, 2026. https://www.canada.ca/en/public-health/services/diseases/viral-hemorrhagic-fever/health-professionals/national-case-definition.html

Return to footnote 16 referrer

Footnote 17

Public Health Agency of Canada. Infection Prevention and Control Measures for Prehospital Care and Ground Transport of Persons Under Investigation for Ebola Disease or with Confirmed Ebola Disease. June 22, 2023. Accessed May 19, 2026. https://www.canada.ca/en/public-health/services/diseases/ebola/health-professionals-ebola/ebola-guidance-patient-transport.html

Return to footnote 17 referrer

Footnote 18

World Health Organization. User manual for the Member State Rapid Risk Assessment (MS-RRA) tool. Accessed May 19, 2026. https://www.who.int/southeastasia/internal-publications-detail/WHE2602262

Return to footnote 18 referrer

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