Ebola virus disease - Democratic Republic of the Congo

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of Ebola virus disease (EVD) in the Bulape Health Zone, Kasai Province, DRC. The first known index case was a pregnant woman who presented at Bulape General Reference Hospital on 20 August 2025 with symptoms of high fever, bloody diarrhoea, haemorrhage and extreme weakness. She died on 25 August from multiple organ failure. On 4 September 2025, following confirmatory laboratory testing, the Ministry of Health declared an outbreak of EVD. Ebola virus disease is a serious, often fatal illness in humans. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission. As of 4 September 2025, 28 suspected cases, including 15 deaths (case fatality ratio (CFR): 54%), have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. Among the deaths, four are health-care workers. About 80% of the suspected cases are aged 15 years and older. Six samples were collected from five suspected cases and one probable death from Bulape health zone and arrived on 3 September at the National Public Health Laboratory (INRB) in Kinshasa for confirmation testing. All five samples tested positive for Ebola virus (EBOV) through GeneXpert and Polymerase Chain Reaction (PCR) assays on 3 September 2025. The Ministry of Health, with support from WHO and partners, is implementing public health response measures to contain the outbreak. WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of EVD in the Bulape Health Zone, Kasai Province, DRC. The first known suspected index case was admitted to the Bulape General Reference Hospital on 20 August 2025. The patient was a pregnant woman at 34-weeks of gestation who presented with symptoms of fever, bloody diarrhoea,  haemorrhage, vomiting, asthenia, followed by multiple organ failure. She died on 25 August 2025. Two of the health-care workers that had initially been in contact with this first case also developed similar symptoms and died.

As of 4 September 2025, a total of 28 suspected cases, including 15 deaths, of which four are health-care workers (case fatality ratio (CFR): 54%) have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. About 80% of the suspected cases are aged 15 years and older. Five blood samples from five suspected cases and a  naso-pharyngeal swab from a probable death were collected from the three health areas and shipped to the National Public Health Laboratory (INRB) in Kinshasa for testing.

On 3 September 2025, the laboratory testing conducted at INRB confirmed Ebola virus (EBOV)^[1] through GeneXpert and Polymerase Chain Reaction (PCR) assays.

The results obtained from whole genome sequencing suggest that the outbreak is a new zoonotic spillover event and is not directly linked to the 2007 Luebo or 2008/2009 Mweka EVD outbreaks.^[2]

Figure 1. Map of suspected cases and deaths of Ebola virus disease by health zone, as of 4 September 2025

Ebola virus disease is a severe disease caused by the Ebola virus (EBOV). The virus belongs to the species Orthoebolavirus Zairense. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission by direct contact with bodily fluids, organs, or contaminated surfaces and materials.

The incubation period, the time between infection with the virus and the onset of symptoms, ranges from 2 to 21 days, but typically is 7–11 days. People are not infectious during the incubation period; they become contagious with early symptoms, therefore, transmission risk begins at the onset of clinical signs and increases with disease severity.

The average case fatality ratio is 50%; case fatality ratios ranging from 25% to 90% have been reported in previous outbreaks. The disease is characterised by an acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. Severe illness may include haemorrhagic manifestations (e.g., bleeding), encephalopathy, shock/hypotension, multi-organ failure, and spontaneous abortion in infected pregnant women. Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis, sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., central nervous system, eyes, testes). Family members, health and care providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk. 

Health authorities are implementing public health measures, including but not limited to the following:

• A crisis committee was activated at both the local and provincial levels.
• Risk communication and active surveillance activities are ongoing.
• All cases are isolated, and Infection Prevention and Control (IPC) measures have been implemented.
• Patients are receiving intravenous medication.
• Contact isolation and tracing are continuing.
• Investigations are ongoing. 
  

WHO is supporting the national authorities, including through:

• Risk assessment and investigation.
• Providing operational, financial and technical support to the Ministry of Health to ensure swift response.
• Provision of essential supplies (Personal Protective Equipment (PPE), medical supplies and infrastructures support)
• The approved Ervebo vaccine is available with a stock of 2000 doses located in Kinshasa expected to be shipped shortly to the affected area, to vaccinate contacts of confirmed or suspected cases,  frontline and health workers.

This is the 16^th EVD outbreak in the DRC since 1976. The current outbreak occurs after almost three years without a confirmed EVD outbreak in the country. The last EVD outbreak in the country was declared on 15 August 2022 in Beni city, North Kivu province, with one single case reported who later died, and the MoH declared the end of the outbreak on 27 September 2022. In the Bulape district, the epicentre of the current outbreak, the last EVD outbreak was recorded in 2007.  

This outbreak is occurring in a complex epidemiological and humanitarian context. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the current outbreak are therefore limited. 

The epicentre of this outbreak is in the proximity of the Tshikapa city, the capital city of the Kasai province, and the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa.

In addition, epidemiological investigations are ongoing with transmission chains, and the source of the outbreak has not yet been identified; therefore, additional infected people cannot be ruled out.  The date of symptom onset for the first case is not yet known, as well as the therapeutic itinerary prior to health facility consultation, which further increases the likelihood of an ongoing community transmission with further risk of spread to other health districts.

WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level. 

Effective outbreak control relies on the application of a set of interventions, namely clinical management, IPC & Water, sanitation and hygiene (WASH), surveillance and contact tracing, good laboratory service, safe and dignified burials, community engagement, and social mobilization. The Ebola virus can persist in some body fluids of people who have recovered from EVD. In a limited number of cases, secondary transmissions resulting from exposure to the body fluids of people who have recovered from EVD have been documented. Therefore, maintaining collaborative relationships with survivor associations while monitoring survivors is a priority to mitigate any potential risks.

Early diagnosis and initiation of optimized supportive clinical care can reduce mortality from EVD. In addition, monoclonal antibodies active against a 3-antibody combination of atoltivimab, maftivimab and odesivimab [Inmazeb®] or a single antibody ansuvimab [Ebanga®].  Ebola treatment centres should be designed and managed to ensure safe care is provided with appropriate biosecurity and infection prevention and control intervention, and allow optimized care, allowing direct visualization of patients in the red zone as much as possible. WHO and partners have worked to develop these innovative solutions. 

There is a need to strengthen surveillance and other response activities, including at relevant points of entry and borders, to contain the possibility of exponential spread. Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definitions should be considered suspects and cared for and treated in designated treatment facilities with appropriate biosecurity, infection prevention and control and be offered testing in a timely fashion and advised not to travel. Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real time. Surrounding countries should enhance readiness activities to enable early case detection, isolation and treatment. Critical infection prevention and control measures should be implemented and/or strengthened in all health care facilities, per WHO's Infection prevention and control guideline for Ebola and Marburg disease.   Health workers caring for patients with confirmed or suspected Ebola should apply transmission-based precautions in addition to standard precautions, including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patients’ blood and other body fluids, and with contaminated surfaces and objects. Waste generated in health-care facilities must be safely segregated, safely collected, transported, stored, treated and finally disposed. National guidelines should be followed on rules and regulations for safe waste disposal or WHO’s guidelines on safe waste management.

Patient-care activities should be undertaken in a clean and hygienic environment that facilitates practices related to the prevention and control of health-care-associated infections, as outlined in Essential environmental health standards in health care. Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package.

In accordance with the recommendations of the Strategic Advisory Group of Experts on immunization, the Ervebo vaccine is recommended during an EVD outbreak due to EBOV for ring vaccination, for contacts and potential contacts of confirmed/suspected EVD cases, as well as for frontline workers. A global stockpile has been established and is being coordinated by the International Coordination Group for vaccine procurement.

WHO advises against any restrictions on travel and/or trade to the Democratic Republic of the Congo based on available information for the current outbreak.

Citable reference: World Health Organization (5 September 2025). Disease Outbreak News; Ebola virus disease in the Democratic Republic of the Congo. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON580