Notes from the Field: Clinical Characteristics of Patients with Ebola Disease Caused by Bundibugyo Virus — Uganda, 2026

Investigation and Outcomes

Index Case and Identification of BVD Outbreak in Uganda

The index patient in Uganda was a man aged 59 years from Democratic Republic of the Congo (DRC) who traveled to Uganda seeking medical care. He was admitted to a private hospital in Kampala on May 11 with fever, respiratory distress, epigastric pain, and nausea. Despite receiving supportive care, he died in the intensive care unit on May 14.

At the time of his death, the BVD outbreak had not yet been identified in DRC. After the index patient’s death, a Congolese resident in Kampala contacted Uganda Ministry of Health officials to alert them about unexplained deaths occurring in DRC, prompting testing of a stored blood sample from the index patient for viral hemorrhagic fever. On May 15, the Central Emergency Response and Surveillance Laboratory in Kampala confirmed the presence of Bundibugyo virus by reverse transcription–polymerase chain reaction. The same day, DRC confirmed the BVD outbreak (5).

Characteristics of Patients with BVD

Among the 20 patients with confirmed BVD, the median age was 34 years (range = 1–59 years), and 12 (60%) patients were male. Fifteen (75%) confirmed cases occurred among Congolese nationals who entered Uganda while symptomatic and seeking health care, including 12 persons who were seeking care for suspected BVD. An additional probable case also occurred in a Congolese national. Four (20%) confirmed cases occurred among Ugandan health care workers exposed during the attempted resuscitation of a patient with probable BVD who died and was embalmed before diagnostic testing could be completed. One additional Ugandan case occurred in a driver exposed to the body of one of the Congolese nationals.

The most common signs and symptoms among 18 (90%) patients admitted to the Mulago Hospital Ebola treatment unit (ETU) were fever (100%), headache (83%), and myalgia (78%) (Table). During their initial evaluation, all 18 ETU patients had serum transaminitis with hypoalbuminemia and hyponatremia (Supplementary Table). Among all 21 cases, three patients died (including two with confirmed BVD [CFR = 10%] and one with probable BVD). Among all three patients who died, BVD was only suspected near or after the time of death. All patients who died were bleeding from multiple sites at the time of death; no other patients developed bleeding. Only one of the patients who died (a woman aged 33 years) reached ETU, by which time she was critically ill, and she died 2 days later. She was the only patient with a known comorbidity (decompensated hypertensive heart disease).

Compassionate Use of Remdesivir

Due to the lack of effective antivirals and remdesivir’s role as an inhibitor of viral RdRp in COVID-19, remdesivir is now used off-label for the treatment of BDBV in the ongoing outbreaks in DRC and Uganda. Uganda implemented compassionate use^† of remdesivir (an antiviral medication approved for treatment of COVID-19 and used off-label for BVD) as part of the clinical management of all 18 patients with Ebola virus disease admitted to ETU. One patient experienced severe skin rash and hepatorenal toxicity, resulting in discontinuation of remdesivir after 3 days, followed by resolution of signs and symptoms. The patient later recovered.

Preliminary Conclusions and Actions

The observed 10% CFR among confirmed patients with BVD in Uganda is lower than CFRs in previous BVD outbreaks (1,4), which might be a result of the patients who sought health care promptly. Communicating with the public about the benefits of seeking care promptly when BVD is suspected might improve patient outcomes. The universal findings of elevated liver enzymes, hypoalbuminemia, and hyponatremia at ETU admission suggest that these abnormalities might be characteristic features of early BVD; a routine laboratory assessment might help guide clinical management. In addition, the low CFR in Uganda (10%) during this outbreak compared with that in DRC’s 2026 outbreak (48% as of September 2, 2026) suggests that clinical trials of remdesivir for BVD patients might be warranted in addition to optimized supportive care. Enhancing Ebola disease surveillance in Uganda in border areas and in health care facilities frequented by persons from outbreak-affected communities could also help identify cases and provide early health care. Uganda’s response to the BVD outbreak underscores the importance of coordinated multisectoral activities to prioritize early diagnosis, rapid isolation, and infection prevention and control, as well as the potential benefit of remdesivir in treating BVD.

Uganda Ebola Response Team

Lilian Acen, Mulago National Referral Hospital; Night Anasia, Oli Health Centre III, Arua; Habib Atayo, Entebbe Regional Referral Hospital; Jackline Ayot, Gulu Regional Referral Hospital; Robert Gatama, Jinja Regional Referral Hospital; Adam Halima, Mubende Regional Referral Hospital; Atanus Isingoma, Kikuube Health Centre IV; Geoffrey Kagolo, Mityana General Hospital; Deogratious Kamulegeya, Ministry of Health; John Kigere, Kagando General Hospital; Rehema Kobusingye, Kabale Regional Referral Hospital; Ayub Maswaswa, Butabika National Referral Mental Hospital; Allan Mugarura, Mubende Regional Referral Hospital; Bernadette Namugema, Mulago National Referral Hospital; Anthony Nantume; Mulago Specialised Women, Neonatal Hospital; Susan Olupot, Mulago National Referral Hospital; Daniel Opio, Mulago National Referral Hospital; Andrew John Osiire, Mulago National Referral Hospital; Emmanuel Ssesazi, Kappapi Health Centre III; Onesmus Turyasingura, Bwera General Hospital; Daniel Wasswa, Mbale Regional Referral Hospital.

Uganda Case Investigation Team

Pauline Achom, Uganda National Institute of Public Health; Allan Amandu, Uganda National Institute of Public Health; Lillian Aliyinza, Uganda National Institute of Public Health; Ann Loy Alupo, Uganda National Institute of Public Health; Wilber Arinaitwe, Uganda National Institute of Public Health; Deborah Aujo, Uganda National Institute of Public Health; Chrispus Bakunda Musabe, Uganda National Institute of Public Health; Rodgers Kalanda, Uganda National Institute of Public Health; John Vianney Kigongo, Uganda National Institute of Public Health; Aman D. Kyomugisha, Uganda National Institute of Public Health; Maria Nakabuye, Uganda National Institute of Public Health; Amina Namwabira, Uganda National Institute of Public Health; Martha Dorcus Nalweiso, Uganda National Institute of Public Health; Winfred Nakaweesi, Uganda National Institute of Public Health; Mariam Nambuya, Uganda National Institute of Public Health; Prossy Nakito, Uganda National Institute of Public Health; Regina Nanyunja, Uganda National Institute of Public Health; Elizabeth Nshabohurira, Uganda National Institute of Public Health; Nasif Matovu, Uganda National Institute of Public Health; Justine Wobusobozi, Uganda National Institute of Public Health; Godfrey Tumwizere, Uganda National Institute of Public Health.