Summary
The California Department of Public Health (CDPH) is closely monitoring an outbreak of Bundibugyo virus disease (BVD), a type of Ebola disease caused by Bundibugyo virus, in the Democratic Republic of Congo (DRC) and the Republic of Uganda. To date, no cases of BVD related to these outbreaks have been reported in the United States or other countries outside of the DRC and the Republic of Uganda. At this time, the CDC assesses the immediate risk to the general U.S. public as low.
On May 19, 2026, CDC released a
Health Alert Network (HAN) Advisory providing national-level information and guidance regarding the Ebola disease outbreak in the Democratic Republic of the Congo and Uganda. This CAHAN message supplements the CDC HAN by providing additional California-specific context and guidance for local health departments and healthcare partners.
Background
On May 5, the World Health Organization (WHO) was alerted of a high-mortality outbreak of unknown illness in the Ituri Province in northeastern DRC bordering Uganda and South Sudan, including deaths among health workers. On May 15, the first case was confirmed to be Bundibugyo virus disease (BVD), a disease caused by a species of Ebola virus, and DRC officially declared BVD outbreak. Uganda also confirmed an outbreak of BVD following the identification of two cases who separately travelled from DRC to Kampala, the capital of Uganda. On May 16, 2026, WHO declared the BVD outbreaks in DRC and Uganda to be a public health emergency of international concern.
As of May 18, 10 confirmed cases, 336 suspected cases and 88 suspected deaths have been reported in the DRC. On May 17, 2026, CDC confirmed 6 US citizens with known exposure to cases, including one high-risk exposed symptomatic U.S. citizen who has since tested positive for BVD. CDC is coordinating evacuation of this individual and 6 other high-risk contacts out of DRC to a quarantine facility on a U.S. airbase in Germany. On May 18, CDC and Department of Homeland Security (DHS) issued
travel restrictions in response to this outbreak, including entry restrictions on non-U.S. passport holders who have traveled in affected regions, public health screening and travel monitoring for travelers arriving from affected regions. As of May 18, CDC has issued a
Level 3 travel advisory (reconsider non-essential travel) for the DRC and
Level 1 (practice usual precautions) for Uganda. CDC also plans to cooperate with airlines, international partners and port of entry officials to identify and manage potentially exposed travelers along with enhancing port health response activities, contact tracing, laboratory capacity and hospital readiness nationwide. CDC personnel will be deployed to support outbreak containment in the region.
Bundibugyo virus disease is a type of Ebola disease. Symptoms of Ebola disease typically begin 8 to 10 days after exposure (range: 2–21 days) and initially include nonspecific “dry” symptoms such as fever, severe headache, muscle and joint aches, fatigue, and sore throat. After 4 to 5 days, illness progresses to more severe “wet” symptoms, including diarrhea, vomiting, and abdominal pain, which can be accompanied by bleeding and other complications. Case fatality rates in the past two Ebola Disease outbreaks caused by Bundibugyo virus have ranged from 25% to 50%. Like Ebola virus, Bundibugyo virus spreads through contact with the bodily fluids of an infected sick or dead person. There is no licensed vaccine or specific therapeutics against BVD, though early supportive case can be lifesaving.
Recommendations for Clinicians
- All California hospitals are expected to be able to serve as a National Special Pathogen System (NSPS) System of Care Level 4 facility (formerly referred to as “frontline hospitals") with the ability to identify, isolate, inform, and initiate stabilizing medical care for a suspect VHF patient; protect staff; and arrange timely patient transport to minimize impact to normal facility operations.
- Clinicians should suspect Ebola disease caused by Bundibugyo virus in a patient who has traveled to DRC or Uganda in the last 21 days, AND who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND has reported epidemiologically compatible risk factors within the 21 days before symptom onset. Refer to CDC website Clinical Screening and Diagnosis for VHFs for VHF triage and evaluation process, symptoms and risk factors.
- 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 personal protective equipment (PPE) while BVD test results are pending.
- Contact your hospital infection control and local health department immediately if Ebola disease is suspected and follow jurisdictional protocols for patient assessment. CDPH and CDC can assist healthcare providers and LHDs with evaluation of any symptomatic returned travelers of concern. Your LHD, CDPH, and CDC must approve testing before specimens are collected.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 California depending on their exposure-risk and public health recommendations at the time of return to California
See Recommendations for Organizations Sending U.S.-based Personnel to Areas with VHF Outbreaks.
Recommendations for Infection Prevention and Control Measures in Hospitals
Employ recommended infection prevention and control measures to prevent transmission of Ebola disease in hospitals. These infection prevention and control measures include, but are not limited to:
- Isolating patients in a private room with a private bathroom or covered bedside toilet if Ebola disease is suspected and limiting the number of personnel who enter the room for clinical evaluation and management. Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care.
- Following 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.
- Being prepared to implement CDPH's guidance for waste management for Ebola Virus Disease if a patient tests positive for BVD.
- Ensuring that healthcare personnel caring for patients with VHFs have received comprehensive training and demonstrated competency in performing VHF-related infection control practices and procedures.
- Having an onsite manager supervise personnel providing care to these patients at all times. A trained observer must also supervise each step of every PPE donning/doffing procedure to ensure established PPE protocols are completed correctly.
- Healthcare personnel can be exposed through contact with a patient's body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nose, or mouth) are particularly hazardous
- Minimize procedures that can increase environmental contamination with infectious material, involve handling of potentially contaminated needles or other sharps, or create aerosols.
Recommendations for Local Health Departments
As of May 18, 2026, CDC has not issued any interim recommendations to health departments for post-arrival risk assessment and monitoring of travelers who have been to DRC, Uganda, or South Sudan in the last 21 days.
- Returning travelers should be advised to self-monitor for symptoms for 21 days after leaving the affected countries. If an individual with a high-risk exposure is identified, LHDs should notify CDPH. See Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures.
- LHDs should notify CDPH if they are aware of any organizations sending California-based personnel to VHF-affected areas. LHDs should notify CDPH immediately if any individual in California develops symptoms within 21 days after leaving the affected area. See Recommendations for Organizations Sending U.S.-based Personnel to Areas with VHF Outbreaks.
- As of May 18, CDC has not provided any recommendations on monitoring of returned travelers from DRC or Uganda. If returned traveler monitoring is recommended in the future, CalCONNECT and CalREDIE can be used to support daily symptom monitoring of returned travelers. Contact CDPH for any needed assistance in using these data platforms for this purpose.
- CalREDIE: Use the "Viral Hemorrhagic Fevers (Ebola, Marburg) Traveler Monitoring" form.
- CalCONNECT: Use the “Ebola or Marburg Monitoring" condition, which includes the automatic text messaging capability available through CalCONNECT's virtual assistant.
If a patient with clinical and epidemiologic history concerning for Ebola disease is identified in your jurisdiction, contact the CDPH Infectious Diseases Branch (510-620-3434) during business hours, or the CDPH Duty Officer (916-328-3605) after hours or on weekends/holidays.
- Coordinate patient management, sample referral, and Ebola virus testing with CDPH, CDC, and the clinical team. Ebola testing must be approved by CDPH and CDC.
- CDPH will work with you to contact CDC's Viral Special Pathogens Branch (VSPB) 24/7 for consultations about Ebola virus disease or other viral hemorrhagic fevers.
Recommendations for Clinical Laboratory Biosafety and Testing
Have a written Exposure Control Plan in place to eliminate or minimize employees' risk of exposure to blood, body fluids or other potentially infectious materials per Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard. A laboratory should have dedicated space, equipment for handling and testing specimens from ill patients, and plans for minimizing specimen manipulation.
- Laboratories should conduct extensive risk assessments to identify and mitigate hazards associated with handling Ebola specimens. The proper PPE needs to be identified, available, and staff trained to properly don and doff their PPE. Staff need to be specially trained, have passed competency testing, and attended drills to safely receive, handle, and process these specimens.
- A waste management plan needs to be in place for laboratory reagents, consumables, and Category A waste, including PPE and sample material.
Be aware that early symptoms associated with Ebola disease are similar to other illnesses associated with fever in recent international travelers.
- The decision to test for Ebola must be made in conjunction with the patient's clinical care team, the LHD, CDPH, and CDC's Viral Special Pathogens Branch (VSPB). Local health departments are responsible for coordinating specimen collection; this may involve working with the attending healthcare provider or facility. CDPH is available to consult on collecting, packaging, and shipping specimen, including which laboratory should receive the samples.
- The specimen type required for the tests that are available (e.g., the Biofire Warrior panel or Biofire Global Fever and Special Pathogens panel) is EDTA whole blood. These Biofire test panels are able to detect multiple VHF viruses and is currently available at four public health laboratories in California. See CDPH's Ebola testing page for more information.
- Follow CDC guidance on safely performing common diagnostic testing for patients with suspected Ebola disease.
- All personnel handling specimens from patients with suspected Ebola disease should adhere to recommended infection control practices to prevent infection and transmission among laboratory personnel.
If a facility does not have the appropriate risk mitigation and testing capabilities, forward the specimen using appropriate packing and shipping requirements to your local public health laboratory or another facility that does.
If a laboratory opts to test, please be aware that Title 17, California Code of Regulations (CCR), Section 2505 (PDF) requires the laboratory to immediately report all results (positive and negative) inclusive of molecular and pathologic, to your local public health department.