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Emergence of a Bundibugyo virus variant in the 2026 outbreak in the Democratic Republic of the Congo and Uganda.

Adrienne Amuri-Aziza·Gradi Luakanda-Ndelemo·Alisen Ayitewala·Daan Jansen·Pascal Adroba-Tandele·Andrew Tebba·Eddy Kinganda-Lusamaki·Stephen Kanyerezi·Pontiano Kaleebu·Christian Ngandu·Allan Muruta·Daudi Jjingo·Susan Nabadda·Raphael Lumembe-Numbi·Olga Ntumba-Tshitenge·Misaki Wayengera·Ibrahimm Mugerwa·John O Otshudiema·Judith Kyokushaba·Daniel J Kyabayinze·Prince Akil-Bandali·Ebola outbreak response consortium·NHLDS consortium·UVRI consortium·Uganda Ministry of Health consortium·ACE-Uganda consortium·Sentinel consortium·Henry Kyobe Bosa·Daniel Mukadi-Bamuleka·Charles Olaro·Princesse Paku-Tshambu·Ahidjo Ayouba·Sabue Mulangu·Aloysious Ssemaganda·Nick Loman·Anne W Rimoin·Atek Kagiria·Samuel Wilkinson·Benard Lubwama·Kevin K Ariën·Steve Ahuka-Mundeke·Áine O'Toole·Dieudonné Mwamba·Christian Happi·Martine Peeters·Laurens Liesenborghs·Piet Maes·Miles W Carroll·Jason Kindrachuk·Pierre Akilimali·Andrew Rambaut·Koen Vercauteren·Jean-Jacques Muyembe-Tamfum·Tony Wawina-Bokalanga·Isaac Ssewanyana·Placide Mbala-Kingebeni
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Abstract

In May 2026, an outbreak of Ebola disease caused by Bundibugyo virus (BDBV, species Orthoebolavirus bundibugyoense) was declared in the Democratic Republic of the Congo (DRC), with cases originating from DRC and locally transmitted cases reported in Uganda. Bundibugyo virus disease (BVD) outbreaks were previously recorded in 2007-2008 in Bundibugyo District, Uganda, and in 2012 in Isiro, DRC. Here, we generated 22 genomes from samples obtained from individuals with BVD in DRC and Uganda. These genomes form a well-supported phylogenetic cluster separate from BDBV variants associated with the 2007 and 2012 outbreaks, together with evidence for sustained human transmission. This is consistent with the emergence of a new zoonotic spillover event rather than resurgence from previously reported variants. Besides ongoing efforts in strengthening surveillance systems, community engagement, establishing Ebola treatment centers, and developing targeted medical countermeasures; our report advocates to specifically increase decentralized laboratory diagnostics capacity, with pan-Orthoebolavirus assays, including genomic sequencing capacity, for limiting further outbreak expansion, timely detection and control of future outbreaks.

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Adrienne Amuri-Aziza, Gradi Luakanda-Ndelemo, Alisen Ayitewala, Daan Jansen, Pascal Adroba-Tandele, Andrew Tebba, Eddy Kinganda-Lusamaki, Stephen Kanyerezi, Pontiano Kaleebu, Christian Ngandu, Allan Muruta, Daudi Jjingo, Susan Nabadda, Raphael Lumembe-Numbi, Olga Ntumba-Tshitenge, Misaki Wayengera, Ibrahimm Mugerwa, John O Otshudiema, Judith Kyokushaba, Daniel J Kyabayinze, Prince Akil-Bandali, Ebola outbreak response consortium, NHLDS consortium, UVRI consortium, Uganda Ministry of Health consortium, ACE-Uganda consortium, Sentinel consortium, Henry Kyobe Bosa, Daniel Mukadi-Bamuleka, Charles Olaro, Princesse Paku-Tshambu, Ahidjo Ayouba, Sabue Mulangu, Aloysious Ssemaganda, Nick Loman, Anne W Rimoin, Atek Kagiria, Samuel Wilkinson, Benard Lubwama, Kevin K Ariën, Steve Ahuka-Mundeke, Áine O'Toole, Dieudonné Mwamba, Christian Happi, Martine Peeters, Laurens Liesenborghs, Piet Maes, Miles W Carroll, Jason Kindrachuk, Pierre Akilimali, Andrew Rambaut, Koen Vercauteren, Jean-Jacques Muyembe-Tamfum, Tony Wawina-Bokalanga, Isaac Ssewanyana, Placide Mbala-Kingebeni. 2026-08-10. Emergence of a Bundibugyo virus variant in the 2026 outbreak in the Democratic Republic of the Congo and Uganda.. https://doi.org/10.1038/s41591-026-04628-8

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Effectiveness of high-dose versus standard-dose influenza vaccines against hospitalisation according to frailty risk: a prespecified analysis of the randomised trial DANFLU-2.

BACKGROUND: Frailty is a major risk factor for influenza-related complications and can influence vaccine effectiveness. We aimed to assess the relative vaccine effectiveness (rVE) of high-dose (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) in older adults aged 65 years or older according to frailty risk. METHODS: This study was a prespecified analysis of DANFLU-2, an open-label, individually randomised trial, conducted in Denmark during three consecutive influenza seasons (2022-23, 2023-24, and 2024-25). Adults aged 65 years or older were randomised (1:1) to the HD-IIV or SD-IIV group. The primary endpoint was hospitalisation for influenza or pneumonia. Frailty was defined according to the validated Hospital Frailty Risk Score (HFRS) based on ICD-10 codes within 10 years before randomisation. Participants were stratified into three HFRS categories, namely low (<5 points), intermediate (5-15 points), and high (>15 points) frailty risk. The rVE of HD-IIV versus SD-IIV against the primary endpoint was assessed across prespecified HFRS categories and treating HFRS as a continuous variable. Pearson's chi-square test was used to compare safety events across frailty risk groups and randomisation groups. FINDINGS: Among 332&#x2009;438 randomised participants (mean age 73&#xb7;7 years [SD 5&#xb7;8]; 161&#x2009;538 [48&#xb7;6%] were female), 276&#x2009;173 (83&#xb7;1%) had low frailty risk, 52&#x2009;395 (15&#xb7;8%) had intermediate frailty risk, and 3861 (1&#xb7;2%) had high frailty risk. The primary endpoint of hospitalisation for influenza or pneumonia occurred in 1424 (0&#xb7;5%) of 276&#x2009;173 participants with low frailty risk, 761 (1&#xb7;5%) of 52&#x2009;395 with intermediate frailty risk, and 163 (4&#xb7;2%) of 3861 with high frailty risk (relative risk [RR] for intermediate vs low frailty risk 2&#xb7;8 [95% CI 2&#xb7;6-3&#xb7;1]; RR for high vs low frailty risk 8&#xb7;2 [7&#xb7;0-9&#xb7;6]). HFRS as a continuous variable significantly modified the effect of HD-IIV versus SD-IIV against the primary endpoint with higher rVE estimates with increasing HFRS (pinteraction=0&#xb7;020). The rVE was 0&#xb7;2% (95% CI -10&#xb7;8 to 10&#xb7;2) among those with low frailty risk, 13&#xb7;1% (-0&#xb7;4 to 24&#xb7;8) among those with intermediate frailty risk, and 19&#xb7;9% (-10&#xb7;3 to 42&#xb7;1) among those with high frailty risk. No significant interaction was observed when HFRS was assessed according to the prespecified categorical frailty groups (pinteraction=0&#xb7;17). The proportion of participants with at least one serious adverse event increased across frailty risk groups (13&#x2009;366 [4&#xb7;8%] of 275&#x2009;795 for low frailty risk, 5475 [10&#xb7;5%] of 52&#x2009;315 for intermediate frailty risk, and 777 [20&#xb7;2%] of 3850 for high frailty risk; p<0&#xb7;0001), with similar proportions of serious adverse events in the HD-IIV and SD-IIV groups for each frailty risk group. INTERPRETATION: Among adults aged 65 years or older in Denmark, frailty risk might modify the effects of HD-IIV versus SD-IIV against hospitalisation for influenza or pneumonia, with higher rVE estimates with increasing frailty risk. These findings might support considering high-dose influenza vaccines for frail older adults. However, effect modification was not evident when frailty was assessed using prespecified categorical subgroups, and subgroup-specific estimates were imprecise, with 95% CIs crossing the null. These results should be considered exploratory, warranting further investigation. FUNDING: The DANFLU-2 trial was funded by Sanofi.

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