Viral Hemorrhagic Fevers

Ebola and Marburg viruses are part of a diverse group of enveloped RNA viruses that cause Viral Hemorrhagic Fevers. Ebola disease is caused by orthoebolaviruses that affect humans and nonhuman primates.  There are four orthoebolaviruses including Bundibugyo that causes Bundibugyo virus disease (BVD).  Transmission to humans occurs from infected animals such as infected fruit bats or through intermediate hosts such as nonhuman primates. The incubation period is 2-21 days after exposure.  Patients are only contagious after symptoms appear. Spread is via direct contact through broken skin or mucous membranes with body fluids (blood, urine, feces, saliva, semen or other secretions) of a person who is sick or has died from BVD.  There is no spread via airborne transmission.

Current Situation

On May 5, 2026, the World Health Organization (WHO) was alerted of a high-mortality outbreak of unknown illness in the Ituri Province, Democratic Republic of the Congo (DRC), including deaths among health workers. On May 15, 2026 laboratory analysis confirmed Bundibugyo virus disease (BVD), a species of Ebola. On May 15, 2026, DRC, officially declared the 17th Ebola Disease outbreak; concurrently, Uganda confirmed an outbreak of BVD following the identification of one imported case from DRC. On May 17, 2026, WHO determined that the Ebola disease caused by BVD in DRC and Uganda constitutes a public health emergency of international concern. There is no vaccine for BVD, and treatment consists of supportive care. There have been 2 previous outbreaks of BVD, one in Uganda (2007) and one in DRC (2012), with death rates of 32% and 55%, respectively. The current outbreak is now the largest caused by BVD.

​​No Ebola cases associated with this outbreak have been reported in the United States.

• “All General Acute Care Hospitals should maintain the capability to serve as a National Special Pathogen System (NSPS) Level 4 facility with the ability to rapidly identify, isolate, inform and manage a suspected high-consequence infectious disease.  Ensure appropriate infection control policies and practices are in place to isolate an individual with a high-consequence pathogen until they can be assessed.
• Routinely elicit and document patients’ recent travel history (both international and domestic). In individuals with history of travel to the Democratic Republic of the Congo (DRC), South Sudan, or Uganda in the previous 21 days, AND with compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms or unexplained bleeding) AND epidemiologic compatible risk factors within 21 days before symptom onset, suspect viral hemorrhagic fever, call Alameda County Public Health and refer to Clinical Screening and Diagnosis for VHFs for VHF triage and evaluation process, symptoms and risk factors.
• Review Health Care Facility Viral Hemorrhagic Fever (VHF) Preparedness Checklist · NETEC Resource Library
• Consider more common diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in an ill patient with recent international travel and consider the possibility of a concurrent infection. Travel to or from DRC or Uganda in the past 21 days should not be a reason to defer routine laboratory testing or other measures necessary for standard patient care.
• Isolate and manage patients with exposure risks and symptoms compatible with BVD in a healthcare facility, with personnel wearing appropriate PPE while BVD test results are pending.
  • If a patient tests positive, they may be transferred to a Regional Emerging Special Pathogens Treatment Center (RESPTC)​ or another appropriate facility. Cedars-Sinai Medical Center is currently the RESPTC for HHS Region IX which includes California.
• Contact your hospital infection control and ACPHD immediately if Ebola disease is suspected and follow jurisdictional protocols for patient assessment. ACPHD, CDPH, and CDC must approve testing before specimens are collected.
• Each hospital laboratory in Alameda County should have someone trained in Category A packaging and shipping.
• Follow CDC’s Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF) and CDPH’s Interim Guidance on Personal Protective Equipment (PPE) to Be Used by Healthcare Personnel (HCP) in the Inpatient Hospital Setting During Management of Patients Suspected or Confirmed to Have Selected Viral Hemorrhagic Fevers (VHFs) in California.
• Counsel healthcare workers traveling to Ebola disease outbreak-affected countries for work in clinical settings of their potential increased risk of VHF exposure, the importance of following recommended infection prevention and control precautions, and the possibility of symptom monitoring and work-restriction after their return to Alameda County depending on their exposure-risk and public health recommendations at the time of return”

More information about this outbreak:

• Ebola Information for Health Professionals
• CDC Ebola Disease: Current ​Situation
• Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda
• Update PHD | Public Health Department | Alameda County Health
• Ebola Disease

Resources

• All Facilities Letter: Ebola Disease Information and Preparedness – June 26, 2026
• CDC VHF guidance
• National Emerging Special Pathogens Training and Education Center
• National Special Pathogens System (NSPS): System of Care Overview
• Free Webinar: Identify, Isolate, Inform: Assessment, Management, and Placement of PUI – NETEC