Risk assessment: Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda (effective 2026-07-07 and extended to 2026-09-25)

Assessment completed: July 7, 2026 (based on information available up to July 2, 2026)

On this page

• Reason for the assessment
• Risk questions
• Risk statement
• Risk assessment summary
• Event summary (situation as of July 2, 2026)
• Considerations for pathogens with pandemic potential
• Risk assessment details
• Limitations, knowledge gaps, and uncertainties
• Proposed actions
• Reassessment
• Methods
• End notes
• References

Reason for the assessment

In response to the ongoing Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo (DRC) and Uganda, Public Health Agency of Canada (PHAC) completed a rapid risk assessment on May 21, 2026. Given the evolving situation, there is a need to further assess the potential for importation of Bundibugyo virus into Canada via specific population groups, as well as the overall risk to the population of Canada.

Risk questions

1. What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) via health care and humanitarian workers^{Footnote a} with potential for direct virus exposure in the outbreak-affected areas^{Footnote b} of the DRC?
2. What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) via other persons^{Footnote c} in the outbreak-affected areas^{Footnote b} of the DRC?
3. What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) from neighbouring regions with no known ongoing transmission (including other areas of the DRC, Uganda and South Sudan)?

Risk statement

The overall risk to Canada from importation of Bundibugyo virus within the next 7 weeks (until August 28, 2026) is low. Should a case be imported into Canada, onward transmission is expected to be very limited.

The likelihood of importation of Bundibugyo virus into Canada within the next 7 weeks via health care and humanitarian workers with potential for direct virus exposure in the outbreak-affected areas of the DRC is low (moderate uncertainty), given the low number of such personnel^{Footnote b} expected to be in these areas. Health care workers and other personnel have elevated risk of Bundibugyo virus exposure relative to the general population, but infection risk can be effectively reduced by appropriate use of personal protective equipment (PPE). Evidence from previous Ebola outbreaks indicates that importations to countries outside of Africa via health care and humanitarian workers are uncommon, and the majority have been medical evacuations of persons with known or suspected Ebola disease who had occupational exposure risk; no importations of Ebola disease have previously occurred in Canada.

The likelihood of importation via other persons in the outbreak-affected areas in the DRC is very low (moderate uncertainty). Travel volume between outbreak-affected areas in the DRC and Canada is expected to be very limited. Pre-travel health screening and other measures, including potential quarantine in the DRC, may further reduce the likelihood that potentially infected individuals will travel to Canada, although there is uncertainty regarding the implementation and effectiveness of these measures.

The likelihood of importation via travellers from currently unaffected areas is assessed as negligible (moderate uncertainty). Individuals in Uganda (no evidence of community transmission), South Sudan (no documented cases and very low travel volume to Canada), and in unaffected areas of the DRC have very low potential for acquiring BVD, if they have not visited outbreak-affected areas of DRC in the previous 21 days.

These likelihood of importation estimates could change if further geographic expansion of the outbreak occurs, including within currently affected countries and to countries with stronger travel links to Canada.

The impact on an affected individual is estimated to be severe (low uncertainty), given the serious clinical manifestations of BVD, the high case fatality rate, and lack of approved vaccines or antivirals. However, early treatment with good supportive care can improve survival. If importation into Canada were to occur, the impact of BVD on the general population in Canada would be minor (low uncertainty), reflecting the limited number of secondary cases that would be anticipated among close contacts as a result of both the characteristics of virus transmission and established public health measures. Bundibugyo virus transmission occurs only during the symptomatic phase of infection and is most likely following onset of 'wet' symptoms including diarrhea, vomiting and/or bleeding. Moreover, Canada has strong diagnostic and health system capacity, and existing protocols for outbreak response, case and contact management, and infection prevention and control.

Risk assessment summary

Event summary (situation as of July 2, 2026)

As of July 2, 2026, 1502 confirmed cases, including 473 deaths, and 229 recoveries have been reported in northeastern DRC across Ituri, North Kivu and South Kivu provinces, with ongoing community transmission^{Footnote 1}. In addition, 3 confirmed cases linked to the outbreak in Ituri have been reported following their detection in the neighbouring provinces of Haut-Uélé (n = 2) and Tshopo (n = 1)^{Footnote 2}. Two cases have been exported internationally among health care workers exposed in the DRC: a physician on a humanitarian mission who was medically evacuated to Germany on May 17, 2026^{Footnote 3}, and a physician participating in the Ebola response who tested positive upon arrival in France, reported on June 24, 2026^{Footnote 4}.

In Uganda, 20 confirmed cases, including 2 deaths and 16 recoveries, have been reported as of July 2, 2026^{Footnote 2}. The last confirmed case was reported on June 21, 2026^{Footnote 2}. All cases were importations from the DRC or secondary cases among close contacts of these imported cases. To date there is no evidence of sustained transmission within Uganda. As of July 2, 2026, no cases have been reported in South Sudan.

In response to the ongoing outbreak, Canada has introduced temporary border measures for travel from the DRC, Uganda, and South Sudan (up to August 28, 2026)^{Footnote 5}. The DRC and Uganda have implemented exit screening at international airports in Kinshasa and Kampala, respectively. In the DRC, Bunia airport in Ituri province remains closed to commercial flights (with humanitarian flights permitted) and a 21-day quarantine requirement was announced on June 24, 2026, for individuals leaving outbreak-affected areas prior to both domestic and international travel^{Footnote 6}.

Considerations for pathogens with pandemic potential

Bundibugyo virus is not considered to be a pathogen with pandemic potential. Person-to-person transmission of Bundibugyo virus requires direct contact with tissue or bodily fluids from infected individuals or contaminated surfaces. Transmission risk can be substantially reduced when the infection is recognized, and appropriate infection prevention and control measures are implemented.

Risk assessment details

A previous PHAC rapid risk assessment completed on May 21, 2026, assessed the impact on individuals infected with Bundibugyo virus (severe, low uncertainty) and on the general population in Canada if an importation were to occur (minor, low uncertainty)^{Footnote 7}. These impact assessments remain unchanged and are not expected to be influenced by the likelihood of importation via the different population groups considered below. The overall risk for the population of Canada therefore remains low at this time.

The following focuses on the likelihood of importation of Bundibugyo virus into Canada via three different population groups, defined for the purposes of this risk assessment by their potential for exposure and infection within the DRC, Uganda and South Sudan, and subsequent travel to Canada. These groups are:

• Personnel deployed in outbreak-affected areas of the DRC^{Footnote b} who are involved in outbreak response activities with potential for occupational exposure to Bundibugyo virus through contact with BVD patients; biological samples, body fluids or deceased bodies of BVD patients; or other materials contaminated with Bundibugyo virus, regardless of whether PPE was used. This includes health care and humanitarian workers, laboratory staff and other personnel who may subsequently travel to Canada or be medically evacuated or repatriated if they become infected (Group 1).
• Other persons (not in the above category) in outbreak-affected areas of the DRC, including those who may have visited outbreak-affected areas in the 21 days prior to travelling to Canada (Group 2).
• Other persons in Uganda, South Sudan and non-outbreak-affected areas of the DRC who have not visited outbreak-affected areas in the 21 days prior to travelling to Canada (Group 3).

Note that these definitions may differ from risk groups defined in other documents for different purposes, such as case management activities.

Question 1: What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) via health care and humanitarian workers (Group 1) with potential for direct virus exposure in the outbreak-affected areas of the DRC?

The likelihood of importing Bundibugyo virus into Canada via health care and humanitarian workers exposed to the virus in the outbreak-affected areas of the DRC is estimated to be low with moderate uncertainty.

Health care workers and other personnel with potential for occupational exposure are recognized to have elevated risk of contracting Ebola disease relative to the general population^{Footnote 8Footnote 9}. Appropriate use of PPE reduces infection risk, but infection through needlestick injuries, self-contamination during removal of PPE, or other unrecognized PPE breaches are known potential risks^{Footnote 10Footnote 11Footnote 12Footnote 13}. However, infections among international personnel involved in outbreak response have historically been uncommon. Prior to the current outbreak, 24 importations outside African countries had been documented, most of which were evacuations or repatriations of those with known illness, all linked to the 2014-16 Ebola virus disease outbreak in West Africa^{Footnote 14}. Of these, 21 were in health care workers and laboratory technicians, with all but two involving nosocomial exposure. A study of 268 personnel (including 216 doctors, nurses and laboratory staff) returning to the UK following deployment in response to the 2014-16 West Africa epidemic found no conclusive serological evidence of infection in this cohort; 86% of personnel worked in PPE and only 1 instance of high-risk exposure was documented^{Footnote 15}.

The number of health care and humanitarian workers from Canada in outbreak-affected areas in the DRC is unknown but expected to be very low. Between May 31 and July 1, 2026, fewer than 20 travellers arriving in Canada reported recent travel to the DRC for health care or humanitarian purposes, of which only a subset reported working directly with Ebola patients (PHAC, unpublished data). While health care and humanitarian workers involved in outbreak response may represent the most likely source of importation, historically most of these (20 of 24) have been medical evacuations due to Ebola disease^{Footnote 14}, which are expected to pose a lower risk of onward transmission if protocols and infection prevention and control measures are adequately followed during transportation and case management. Importation during the incubation (pre-symptomatic) period has previously been documented in 4 instances, with 1 (not in a health care or humanitarian worker) resulting in secondary transmission to 2 nurses who subsequently provided critical care^{Footnote 14Footnote 16}. In the current BVD outbreak, 1 health care worker involved in response activities tested positive for BVD upon returning to France. The individual developed mild, non-specific symptoms three days before boarding the flight, and was considered non-infectious during the flight. Although transmission during air travel through close contact with a symptomatic case could theoretically occur, air travel during the 'dry' phase of symptoms is generally considered low risk for the transmission of orthoebolaviruses^{Footnote 17Footnote 18}. Transmission occurs only during the symptomatic phase of infection and is most likely following onset of 'wet' symptoms including diarrhea, vomiting and/or bleeding^{Footnote 19}. No confirmed cases of Ebola disease resulting from transmission during air travel have been documented.

Question 2: What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) via other persons (Group 2) in the outbreak-affected areas of the DRC?

The likelihood of importing Bundibugyo virus into Canada via other persons in the outbreak-affected areas of the DRC is very low, with moderate uncertainty.

Approximately 3000-3500 individuals would typically be expected to travel to Canada from the DRC during July and August (Canadian Border Services Agency, unpublished data). Current travel restrictions are expected to reduce this number to under 1200 individuals. PHAC models indicate that the probability of importation of at least 1 BVD case for the 2-week period between July 5-18 is less than 1% under current border measures (3.3% without border measures), assuming a worst-case scenario in which 10% of cases in outbreak-affected areas are reported. The following considerations suggest that the importation probability is likely to be considerably lower. More than 95% of air travel from the DRC to Canada originates from Kinshasa (International Air Transport Association, unpublished data), which is not easily accessed from the currently-affected areas; the main regional airport in Bunia is closed to commercial flights; and available mobility data from mobile phone networks indicate that travel between the outbreak-affected areas in the DRC and Kinshasa is limited^{Footnote 20}. Among incoming travellers from the DRC between May 31 and July 1, 2026 who were not involved in health care or humanitarian work (fewer than 450), none were assessed to have possible exposure to Bundibugyo virus (PHAC, unpublished data). Exit screening measures, including symptoms and exposure assessment, are in place for travellers departing from Kinshasa^{Footnote 21}. On June 24, 2026, the DRC additionally announced a 21-day quarantine requirement for individuals leaving outbreak-affected areas prior to travel within DRC or internationally^{Footnote 6}, although there is uncertainty regarding the implementation and effectiveness of this measure. There are no direct flight routes between DRC and Canada, and the long transit time increases the chances that symptomatic travellers would be identified en route prior to arrival in Canada.

Question 3: What is the likelihood and impact of Bundibugyo virus being imported into Canada within the next 7 weeks (through August 28, 2026) from neighbouring regions with no known ongoing transmission (Group 3) (including other areas in the DRC, Uganda and South Sudan)?

The likelihood of importing Bundibugyo virus via travellers from currently unaffected areas with no history of travel to outbreak-affected areas within the 21 days prior to travel is assessed as negligible, with moderate uncertainty.

The World Health Organization (WHO) currently assesses the risk for countries with land borders adjoining countries with documented Bundibugyo virus detection as high, but to date, transmission has been concentrated within the DRC, which currently accounts for over 98% of reported cases^{Footnote 22}. As of July 2, 2026, Uganda has reported 20 confirmed BVD cases^{Footnote 4}. These have been cases with travel links to the DRC (n = 15) and a limited number of secondary cases (n = 5) among contacts and health care workers^{Footnote 23}; to date, there is no evidence of community transmission within Uganda. Current measures include a complete closure of the DRC-Uganda border, but the effectiveness of this measure for reducing importation potential into Uganda is uncertain. Travel volume between Uganda and Canada during July and August is expected to be low (fewer than 2000 estimated travellers under current Canada border measures). The potential for exposure to Bundibugyo virus among travellers from Uganda is expected to be very low.

In line with WHO's risk assessment, a published modelling analysis has suggested a high probability of introduction of Bundibugyo virus from the DRC into South Sudan^{Footnote 24}. However, as of July 2, 2026, no BVD cases have been reported in South Sudan. Additionally, travel between South Sudan and Canada is very limited, with approximately 50 travellers expected during July and August given current Canada border measures.

Limitations, knowledge gaps, and uncertainties

The overall uncertainty in this assessment is moderate. Historically, outbreaks of similar viral hemorrhagic fevers (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.

Specific sources of uncertainty and knowledge gaps include:

• Information regarding the exact number of Canadian citizens and residents in outbreak-affected areas, including health care and humanitarian workers and individuals working in Canadian-owned mining operations, is not available. Based on available information, and due to ongoing conflict in the country and existing advisories against travel to the DRC, this number is expected to be small.
• There is uncertainty regarding the exposure potential among health care and humanitarian workers involved in the outbreak response, including through unrecognized breaches of PPE and access to appropriate PPE.
• 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 Ebola disease has not previously been imported into Canada and the clinical presentation in the early phase of disease can be non-specific and travel and exposure histories may not be reliable.
• The clinical profile, epidemiological characteristics of BVD are expected to be similar to disease caused by other orthoebolaviruses that cause disease in humans, although data on this specific strain is more limited as there have only been two previous outbreaks documented.
• Clinical trials of candidate vaccines and treatments are being initiated during this outbreak, but their impact on clinical outcomes and/or control of transmission remains to be determined.

Proposed actions

• Continue timely coordinated risk communications informing people in Canada of the Ebola disease outbreak caused by Bundibugyo virus, the level of risk to travellers, actions taken by public health authorities, concrete actions individuals can take to protect themselves if travelling to the affected area 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 engagement with humanitarian and other organizations that may be deploying personnel from Canada to outbreak-affected areas.
• Continue targeted communications to health care 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 the event of BVD importation to Canada.
• Conduct timely assessment of international Requests for Assistance to identify 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 efficacy of novel monoclonal antibody treatments and other experimental countermeasures, including antivirals, vaccines, and diagnostic tests.
• Continue to assess guidance and recommendations and work with partners to align Canada's public health response with evidence and risk-informed approaches.

Reassessment

This situation is 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 PHAC. The methodology is based on the WHO Member State Rapid Risk Assessment tool^{Footnote 25}. 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 25}.

The likelihood scale has been modified to add a 'negligible' category, defined as "the likelihood of the situation described in the risk assessment question is virtually zero"^{Footnote 26}. The overall risk level for the general population in Canada was obtained using the overall population impact estimate, as it contains the driving component of risk for the general population.

Throughout the report, where appropriate, references have been included; where references are not included, the evidence was informed by internal data, expert opinion, or personal communication.

Estimates for numbers of cases arriving at Canadian borders are made using a PHAC disease importation model based on historic Canadian Border Services Agency and International Air Transport Association data on travel volumes from the DRC for the coming two weeks (July 5-18). Forecast numbers of outbreak cases (and thus prevalence of infection in travellers) are obtained from a model-based forecast of the outbreak in the eastern DRC. Importation analyses are conducted at country level and do not consider specific groups such as health care and humanitarian workers, or the location of origin of travellers within the source country.