National Public Health Advisory on State Preparedness for Bundibugyo Ebola Virus Disease (EVD)

Thursday, May 28, 2026

The Nigeria Centre for Disease Control and Prevention (NCDC) wishes to draw your urgent attention to the evolving Bundibugyo Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo and Uganda.

The World Health Organization has declared the outbreak a Public Health Emergency of International Concern, which underscores the seriousness of the regional threat and the need for Nigeria to strengthen preparedness before any suspected case is detected within the country.

The immediate objective of our national preparedness and readiness efforts is to ensure that every State and the FCT can reasonably detect, contain, and respond swiftly to any suspected case while protecting health workers and sustaining essential health services.

As you may be aware, Nigeria has no confirmed case of this outbreak at the time of this advisory. However, based on the Dynamic Risk Assessment conducted by NCDC and partners immediately after the PHEIC declaration, the overall risk of importation of the disease into Nigeria has been assessed as HIGH due to increasing on-going regional transmission, international travel, regional population movement, major airports, seaports, porous land borders, informal crossings, trade routes, and the overlap of early Ebola symptoms with common febrile illnesses such as malaria, Lassa fever, and other endemic infections.

Current Outbreak Situation

A total of 1,077 suspected cases and 247 deaths have been reported in the DRC and Uganda. Case fatality is as high as 24.6%, and the age group mostly affected is 14–45 years. Regional and national risk remain high.

Currently, there are no approved vaccines or specific treatments available for Bundibugyo Ebola virus disease. Control of the outbreak depends largely on rapid public health measures, including early detection, prompt isolation of suspected and confirmed cases, strict infection prevention and control (IPC) measures, contact tracing, safe burial practices, community engagement, and strong surveillance systems.

Suspected cases have been reported in India, while Canada has announced a “temporary pause” on travel applications by residents of DRC, Uganda, and South Sudan due to the outbreak. Very recently, Uganda also announced border closure measures.

Implications for Nigeria

The current Bundibugyo virus outbreak has no licensed vaccines or approved targeted therapeutics. Existing Ebola vaccines and monoclonal antibody treatments are primarily directed against the Zaire ebolavirus and should therefore not be relied upon as available countermeasures for this outbreak strain.

Ebola Virus Disease is not airborne. Transmission occurs through direct contact with the blood or body fluids of a symptomatic or deceased infected person, contaminated materials, or infected animals. The incubation period ranges from 2 to 21 days; therefore, travel and exposure history within the preceding 21 days remains essential in the assessment of any suspected case.

Early symptoms may be non-specific and include fever, fatigue, muscle pain, headache, sore throat, malaise, vomiting, diarrhea, abdominal pain, rash, hiccups, unexplained bleeding, bruising, or signs of shock. Health workers must not wait for bleeding before suspecting Ebola in any patient with compatible symptoms and relevant travel or exposure history (please find attached the most recent Case Definition released by NCDC).

Additionally, the absence of strain-specific vaccines and approved therapeutics for Bundibugyo virus makes early, aggressive, optimized supportive care especially important. Clinical management should include rapid assessment, fluid and electrolyte management, glucose monitoring, treatment of malaria or bacterial co-infections where clinically indicated, management of shock, symptom control, and humane care in designated isolation or treatment settings.

NCDC has activated its national Emergency Operations Centre, and it is currently in the alert mode, coordinating national preparedness with relevant federal and state institutions. State Governments, through your good selves, the Honourable Commissioners for Health are therefore requested to ensure immediate operational readiness across public and private health systems.

Accordingly, preparedness must focus on:

1. Early detection

2. Immediate isolation

3. Optimized supportive care

4. Strict infection prevention and control

5. Safe sample handling

6. Contact tracing readiness and safe referral systems

7. Risk communication and workforce protection.

8. Adequate provisions for medical countermeasures

Risk Stratification

While all States and the FCT must maintain Ebola preparedness, the pace of readiness should reflect each State’s importation and transmission risk. NCDC has therefore grouped States into three preparedness tiers:

a. High Risk: Known Trade/travel routes with international airports/seaports, porous borders and ground crossing (Lagos, FCT, Rivers, Kano, Enugu, Borno, Akwa Ibom, Cross River, Taraba, and Adamawa.)

b. Moderate Risk: Ogun, Nasarawa, Kaduna, Plateau, Kogi, Niger, Jigawa, Katsina, Bauchi, Ebonyi, Abia, and Bayelsa.

c. Baseline Preparedness: All remaining States.

This classification is intended to guide readiness prioritization while preserving the expectation that every State will act immediately on any suspected case. It is also important to note that this risk stratification may change as the situation evolves.

Required Actions for State Level Preparedness

In the spirit of shared national preparedness, Honourable Commissioners are requested to provide leadership for coordinated Ebola readiness across their respective States and the FCT, with technical support from NCDC.

NCDC will continue to provide national coordination, technical guidance, and escalation support, and we count on the leadership of Honourable Commissioners to translate this national posture into practical readiness across state health systems.

Commissioners are requested to prioritize the following actions:

1. Activate the State public health coordination structure for Ebola preparedness.

2. Conduct a rapid state risk assessment, with attention to points of entry (where applicable), population movement, high-density settings, and facilities most likely to receive suspected cases.

3. Engage public and private health providers to ensure early suspicion, safe separation of suspected cases, and immediate notification through approved public health channels.

4. Identify at least one functional holding or isolation facility for suspected cases and ensure a clear referral pathway for safe transfer and further management.

5. Strengthen facility readiness for screening, PPE use, infection prevention and control, safe sample movement, ambulance transfer, decontamination, and waste management.

6. Ensure frontline workers are rapidly oriented and protected with appropriate PPE, supervision, exposure management procedures, and psychosocial support.

7. Intensify traveller monitoring and surveillance in States with airports, seaports, land borders, transport hubs, migrant corridors, and other high-mobility settings.

8. Lead calm and consistent public communication that promotes early reporting, discourages stigma and rumours, protects health workers, and directs the public to verified information.

9. Maintain essential health services by ensuring that screening, triage, isolation, and referral arrangements do not unnecessarily disrupt routine care.

10. Plan for the provision of adequate quantities of medical countermeasures, as may be necessary.

11. Submit a State readiness update to NCDC within 72 hours of receipt of this advisory and notify NCDC immediately of any suspected case, high-risk exposure, unusual febrile cluster, or significant readiness gap.

To support rapid dissemination of this advisory, detailed operational tools will follow through the national and State EOC channels, including guidance on laboratory processes, PPE use, IPC, facility readiness, reporting formats, and public communication materials.

States are requested to use this advisory to commence immediate preparedness actions while the supporting tools are distributed through the established incident coordination mechanisms.

Nigeria’s successful containment of previous Ebola importation was made possible by early recognition, decisive leadership, rapid coordination, disciplined contact tracing, strict infection prevention and control, and public trust.

The window for preparedness is before the first suspected case is reported. I therefore urge all State Ministries of Health and Local Governments to treat this advisory as an immediate call to readiness, coordination, and disciplined public health action.

NCDC remains committed to working closely with all States and the FCT to protect Nigerians, support health workers, preserve essential services, and prevent importation or secondary transmission of Ebola Virus Disease.

Please accept the assurances of my highest consideration.

Dr. Jide Idris

Director-General

Nigeria Centre for Disease Control and Prevention

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