Risk assessment considerations: Person under quarantine who develops symptoms during the 2026 Ebola disease outbreak caused by the Bundibugyo virus

Last updated: August 28, 2026

On this page

• Purpose
• Overarching principles
• Risk assessment considerations
  • Infection prevention and control
  • Detailed assessment
  • Testing
  • Reporting of persons under investigation (PUI)
• Appendix 1: Ebola disease-compatible symptoms and signs
• Appendix 2: Known, likely or possible exposure to Bundibugyo virus
• Footnotes

Purpose

The following resource is intended to assist health care professionals and public health officials conducting a multidisciplinary risk assessment of a person in quarantine who presents with symptoms to help guide testing for orthoebolavirus during the 2026 Ebola disease outbreak caused by the Bundibugyo virus. The risk assessment to inform the testing decision requires collaborative clinical and public health judgement that integrates: factors related to the person's clinical presentation and clinical assessment; epidemiology in the area where the person was in the 21 days preceding the onset of their first symptom; and their activities and potential exposures. The risk assessment may require re-evaluation as more information becomes available and/or the clinical status of the patient evolves.

Overarching principles

Infection prevention and control

The Public Health Agency of Canada's (PHAC's) Infection prevention and control measures for Ebola disease in acute care settings and Infection Prevention and Control Measures for Prehospital Care and Ground Transport of Persons Under Investigation for Ebola Disease or with Confirmed Ebola Disease documents outline infection prevention and control (IPC) measures for people under investigation (PUIs). Similar precautions should also be followed for those who do not meet a PUI definition but who are in quarantine under the Government of Canada Order in Council and develop symptoms compatible with Ebola disease. Individuals for whom Bundibugyo virus disease (BVD) is no longer considered a plausible diagnosis should be managed with the appropriate IPC precautions according to their symptoms and/or diagnosis, in consultation with the facility's IPC practitioner.

Timely communications among local public health officials, emergency services (if the patient requires transportation to a health care facility), accepting treating physician, infectious disease consultant and the facility's IPC practitioner are essential to initiate a coordinated, cascading IPC response and ensure rapid information sharing.

Detailed assessment

In assessing a person with symptoms who has been in quarantine, it is important to conduct a thorough clinical assessment and obtain detailed epidemiologic information (e.g., travel, exposure and activity history).

Clinical assessment

The clinical assessment should involve the appropriate clinical care team, including an infectious disease specialist. The assessment should consider: the current and past medical history; physical examination; and any testing done to date. Testing for illnesses that occur commonly among returning travellers (e.g., malaria) should be considered in addition to determining the need for orthoebolavirus testing.

Epidemiologic information

Information should be obtained directly from multiple sources, including the patient, their travel companions and family members, as possible and appropriate, and may need to be obtained more than once. It is important to ensure that communications are done in a manner that is easy to understand, in the patient's preferred language or with appropriate translation services, and are culturally informed. Visual aids, like maps and calendars, can assist with obtaining a travel history.

Documentation on the travel and exposure histories should also be reviewed as appropriate and available, including:

• documents provided by Quarantine Officers to provinces and territories
• any information obtained by local public health officials upon entry into quarantine
• travel documents and itineraries from the patient and/or their travel companions
• personal communications written during travel by the patient and/or their travel companions (e.g., emails, text messages, and social media posts) that provide information on itineraries, activities and timelines.

Testing

RT-PCR testing for orthoebolaviruses should proceed based on discussion among those involved in the risk assessment (e.g., clinicians, local and provincial/territorial public health authorities). This approach supports the effective use of system-wide resources, balancing the pre-test probability of Bundibugyo virus disease (BVD), appropriate use of laboratory resources for testing and safe handling of specimens, and alignment with public health guidance. Testing for orthoebolaviruses and other potential pathogens should follow facility/laboratory protocols and IPC practices.

A negative orthoebolavirus RT-PCR result obtained 72 hours or more after symptom onset makes the symptoms unlikely to be related to orthoebolavirus disease if the risk of exposure is considered low; higher-risk exposures can still warrant caution and repeat testing. Viral loads are variable in early infection and may be below the limit of detection of current assays in the first 72 hours after symptom onset. If a negative result is obtained within the first 72 hours after symptom onset, a second test performed 72 hours or more after symptom onset should be strongly considered. Retesting earlier than 72 hours after symptom onset may be clinically indicated, but a negative result during this time period should not be used to preclude the possibility of Ebola disease. If the symptoms are considered unlikely to be due to BVD, it is important to remember that the patient may still be within the incubation period (up to 21 days from the last exposure), and the risk assessment may need to be repeated if new or evolving symptoms develop.

For additional information on testing, consult National Microbiology Laboratory (NML) Laboratory testing for Orthoebolavirus, 2026 June, which includes information on notification and shipping requirements.

Reporting of persons under investigation (PUI)

Clinicians should ensure local public health officials are aware of any person meeting the PUI definition or for whom a diagnosis of Bundibugyo virus is being considered. To assist with meeting requirements to assess and potentially report under International Health Regulations, provinces and territories are required to notify the PHAC Health Portfolio Operations Centre (HPOC) at 1-800-545-7661 of a person meeting the PUI definition and for any person for whom orthoebolavirus testing is being ordered. For information on reporting, consult Ebola disease: For health professionals and humanitarian aid workers.

Risk assessment considerations

The following outlines considerations on assessing people with symptoms or signs (as listed in Appendix 1) in three risk groupings:

1. People WITH known, likely or possible exposure to Bundibugyo virus (as outlined in Appendix 2)

   Given the high risk for an individual with known, likely or possible exposure to Bundibugyo virus in the preceding 21 days, in most circumstances if an individual in this group develops symptoms or signs (as listed in Appendix 1), RT-PCR orthoebolavirus testing is indicated.

2. People WITHOUT known, likely or possible exposure to Bundibugyo virus who HAVE BEEN in a Bundibugyo virus outbreak-affected area (consult Appendix 1 of the person under investigation case definition for the 2026 Bundibugyo virus disease outbreak)

   For these individuals, the risk is expected to be lower than for those with known, likely or possible exposure to Bundibugyo virus, but given that the current outbreak is not yet under control, exposure remains possible and careful consideration is required to determine the need for testing. Table 1 outlines factors to consider in the risk assessment of people in this group who develop symptoms or signs (as listed in Appendix 1).

3. People WITHOUT known, likely or possible Bundibugyo virus exposure who have NOT BEEN in a Bundibugyo virus outbreak-affected area but are in quarantine under the current Government of Canada Order in Council

   Individuals WITHOUT known, likely or possible exposure to Bundibugyo virus who have been in the countries listed in the Order in Council (i.e., Democratic Republic of Congo, Uganda or South Sudan) but have NOT BEEN in any of the Bundibugyo virus outbreak-affected areas listed in Appendix 1 of the person under investigation case definition for the 2026 Bundibugyo virus disease outbreak are at very low risk of BVD. However, if there is a clinical concern of BVD, the factors in Table 1 should be used to assist the multidisciplinary team in the risk assessment to determine if orthoebolavirus testing is indicated.

Table 1: Factors to consider when assessing a symptomatic person under quarantine who did NOT have known, likely or possible exposure to Bundibugyo virus

Consult Section a of the risk assessment considerations for those with known, likely or possible Bundibugyo virus exposure.

Appendix 1: Ebola disease-compatible symptoms and signs

• fever
• malaise, weakness, or fatigue
• myalgia or arthralgia
• headache 
• loss of appetite 
• conjunctival redness 
• difficulty breathing
• sore throat 
• chest pain 
• cough
• abdominal pain 
• vomiting 
• diarrhoea
• confusion of recent onset
• hemorrhagic manifestations or unexplained bleeding
• hiccups
• skin rash
• jaundice

Appendix 2: Known, likely or possible exposure to Bundibugyo virus^{Footnote 1 Footnote 2}

• Percutaneous (i.e., piercing the skin), mucous membrane (e.g., eye, nose or mouth), sexual or skin contact with blood or other body fluids (e.g. semen^{Footnote 3}, breastmilk) from a person with confirmed BVD or who is considered likely to have BVD, including through objects contaminated by that person
• Cared for a person with confirmed BVD or who is considered likely to have BVD (with or without personal protective equipment)
• Close contact with a person with confirmed BVD or who is considered likely to have BVD (with or without personal protective equipment)
• Physical contact with any human remains of a person who had confirmed BVD or who was considered likely to have had BVD (with or without personal protective equipment)
• Lived in the same household as a person with confirmed BVD or who is considered likely to have BVD
• Laboratory or other worker who handled Bundibugyo virus or processed body fluids and/or tissues from a person with BVD or who is considered likely to have BVD (with or without personal protective equipment)
• Healthcare or humanitarian worker who worked in a Bundibugyo virus outbreak-affected area (consult Appendix 1 of the person under investigation case definition for the 2026 Bundibugyo virus disease outbreak)

Footnotes