Past lessons for the 2026 Bundibugyo virus outbreak: filovirus infection prevention in conflict-affected settings.

In May 2026, the World Health Organization (WHO) declared a Public Health Emergency of International Concern after Bundibugyo virus disease (BVD) re-emerged in Ituri Province, Democratic Republic of the Congo (DRC), with cross-border transmission to Uganda. The suspected index case was a healthcare worker (HCW), and at least four HCWs had died before the outbreak was confirmed. The outbreak is unfolding in a region characterised by armed conflict, mass displacement, fragile governance and disrupted clinical infrastructure - a setting in which the high-containment infection prevention measures developed for filovirus disease in well-resourced facilities are difficult to implement reliably. In this narrative, evidence-informed review, we propose an achievable infection prevention bundle for filovirus outbreaks in conflict-affected settings, framing personal protective equipment (PPE), training, supervised doffing, supply chains, staffing, environmental controls and facility organisation as interdependent components of a single coherent system rather than as alternatives. We summarise outbreak situation reports, operational documentation and simulation evidence; identify operational failure modes in austere conditions; and propose an eight-element bundle prioritised by implementation urgency. The bundle is anchored in WHO core infection prevention and control (IPC) programme guidance. Most of the available evidence base is filovirus-general or Zaire Ebola virus-derived; extrapolation to Bundibugyo virus is reasonable but limited, and the bundle should be understood as a framework for decision-making rather than as a validated intervention package.