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Medically Verified By: Dr. Joshi Divya Rakesh
Ebola outbreak 2026: Over 4,000 cases as Congo battles its deadliest surge yet (Image created using AI)
The Democratic Republic of the Congo (DRC) has recorded 15 declared Ebola virus disease (EVD) outbreaks since the virus was first identified near the Ebola River in 1976, but the recent ones have raised new red flags among global health experts. While the country has advanced greatly in surveillance, immunisation, and treatment, there remain numerous virological, epidemiological, and health-systems reasons for the fast spread of the virus in the affected regions. Knowing these issues is crucial for improving outbreak response and avoiding future transmission.
In an exclusive interaction with TheHealthSite.com, Dr. Joshi Divya Rakesh, Consultant Infectious Disease & Infection Control, KIMS Hospitals, Mahadevapura, Bengaluru, explained that ebola virus disease (EVD) is a severe, often fatal illness caused by viruses of the genus Ebolavirus, family Filoviridae.
"Six species are currently recognised: Zaire ebolavirus, Sudan ebolavirus, Bundibugyo ebolavirus, Ta Forest ebolavirus, Reston ebolavirus, and the more recently described Bombali ebolavirus. Of these, Zaire ebolavirus is the species responsible for the majority of DRC outbreaks, including the current one, and carries the highest case fatality rate historically, reported between 25% and 90% depending on outbreak and access to supportive care". Here are some other details about the ebola virus:
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Talking about the symptoms of Ebola, he said: "At the onset of the disease, a patient experiences these common symptoms:
And in severe cases, haemorrhagic manifestations, with case fatality closely tied to viral load and timeliness of supportive care rather than bleeding alone.
The difficulty comes from outbreaks occurring in areas of higher population density and greater cross-border mobility. Unlike earlier epidemics, which took place mainly in remote, forested locations, current outbreaks are increasingly reported from peri-urban and transit hubs where population movement is high. This increases the effective reproduction number (R) of the outbreak, as chains of transmission are harder to trace and interrupt through contact tracing alone.
A major driver of continued spread is delay in diagnosis. Early EVD symptoms overlap significantly with malaria, typhoid fever, and other endemic febrile illnesses, making syndromic differentiation difficult without a high index of suspicion or point-of-care nucleic acid testing. Consequently, patients often present late or are empirically treated for the wrong diagnosis, which gives the virus time to spread to household contacts and, critically, to healthcare workers through nosocomial transmission and superspreading events, both well-documented amplifiers in prior West African and DRC outbreaks.
In parts of eastern Congo (notably North Kivu and Ituri provinces), armed conflict and insecurity persist, complicating outbreak response efforts. Health workers often find it difficult to reach the affected population, resulting in delays to ring vaccination and contact tracing activities. Displacement of people due to violence raises the probability of onward transmission across administrative and international borders.
The limited state of the healthcare system compounds these difficulties. Shortages of trained personnel, functional BSL-3/4-capable laboratory capacity, personal protective equipment, and dedicated Ebola treatment units/isolation facilities cause delays in diagnosis confirmed by RT-PCR or rapid antigen assays such as GeneXpert Ebola, and in initiation of supportive and targeted therapy.
Public cooperation is among the most important determinants of successful Ebola control. Misinformation and mistrust of health authorities discourage the population from reporting symptoms, seeking treatment, or participating in contact tracing and vaccination activities and have historically been linked to concealment of cases, unsafe traditional burials, and attacks on response teams, all of which independently prolong outbreaks.
Dr Joshi explains that despite the hurdles, experts remain cautiously optimistic. An effective recombinant vesicular stomatitis virus-based vaccine (rVSV-ZEBOV, brand name Ervebo ), deployed through a ring-vaccination strategy targeting contacts and contacts-of-contacts of confirmed cases, automated point-of-care diagnostic tests, and monoclonal antibody therapeutics such as REGN-EB3 (Inmazeb ) and mAb114 (Ebanga ), both shown in the PALM trial to reduce mortality when given early, are improving the global response to the disease. International health organisations, including WHO and Africa CDC, continue to support DRC health authorities with surveillance, vaccination, laboratory diagnostics, and public awareness.
To contain Ebola, rapid case detection, prompt isolation of patients, ring vaccination of contacts, safe and dignified burial practices, and strong community engagement are essential. Although the disease still poses a serious public health threat, coordinated efforts combined with early intervention would significantly reduce viral spread and help prevent future outbreaks.
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