FAO calls for stronger prevention and global action as transboundary animal diseases spread across regions

 

How ASF Spreads

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Although this blog tends to focus more on animal diseases with major zoonotic potential (avian flu, Nipah, Ebola, Mpox, Q Fever, etc.) - due to their enormous impact on local and regional economies and on global food security - we've also spent a good deal of time discussing non-zoonotic animal disease threats like African Swine Fever, Classical Swine Fever, FMD, Porcine Epidemic Diarrhea (PED), etc.

There are also animal diseases that inhabit the middle ground, in that they can infect humans - but do so only rarely or have little or no epidemic or pandemic potential - such as the NWS screwworm, Newcastle disease, and Orf Virus (to name a few). 

But the line between zoonotic and non-zoonotic is not set in stone; there are some pathogens (canine influenza, Influenza D, bovine or porcine coronaviruses, henipaviruses, etc.) that appear to be near the cusp, and could someday acquire the ability to spillover into humans. 

Our health, and in many ways our fate, is inexorably intertwined with the global biosphere - making what happens in a Fruit bat in Bangladesh, or a Shrew in China - something that could change our world overnight.

Six months ago the FAO announced the creation of a new program ( Global Partnership Programme for Transboundary Animal Diseases (GPP-TAD)) focused on `. . . prevention, early warning, preparedness, anticipatory action and rapid response'.

Over the past 6 months a global consultation process has worked to finalize the program's design. 

Late last week the FAO published the following update.

FAO calls for stronger prevention and global action as transboundary animal diseases spread across regions

Animal diseases, including avian influenza, African swine fever, foot-and-mouth disease and New World screwworm, pose growing risks to food security, trade and livelihoods

Cattle in Italy.

©FAO/Alessandro Penso

11/06/2026

Rome – Countries around the world are facing a growing threat from transboundary animal diseases (TADs), including New World Screwworm, African Swine Fever, Avian Influenza, Foot-and-Mouth Disease, and Peste des Petits Ruminants, as well as other emerging zoonotic threats such as Andes hantavirus, Ebola, and Nipah. As diseases and pests move more rapidly across borders, countries are facing increasing pressure to strengthen prevention, preparedness and response systems.

The stakes are high. Livestock sectors support more than one billion livelihoods and contribute trillions of dollars in economic value each year. Protecting animal health is therefore critical not only for farmers and livestock keepers, but also for food security, trade, economic stability, and rural prosperity.

The factors driving disease spread are becoming increasingly complex. Increased movement of animals, people and products, changing production systems, environmental pressures and uneven veterinary and surveillance capacity are creating new opportunities for diseases and pests to spread across regions. Addressing these threats requires stronger surveillance, earlier detection, greater information sharing and closer international cooperation.

“The impacts of these outbreaks extend far beyond animal health. They disrupt agricultural production, trade, and tourism, threaten livelihoods, increase food security risks, and in some cases pose direct risks to human health,” said Dr Tiensin Thanawat, FAO Assistant Director-General, Director of the Animal Production and Health Division, and Chief Veterinarian.

The economic impacts of transboundary animal diseases are substantial. Avian influenza has resulted in the loss of more than 633 million poultry and threatens a $48 billion market, while foot-and-mouth disease causes $11.3 billion in annual losses and African swine fever has reduced pig herds by over 40 percent in some parts of Asia. These impacts underscore the importance of stronger surveillance, faster detection and coordinated international action.

Recent developments highlight the urgency of the challenge. New World Screwworm has now re-emerged in the United States of America after decades of successful containment, following its northward spread through Central America and Mexico. At the same time, the emergence and international spread of the SAT1 serotype of Foot-and-Mouth disease beyond its historical range in Africa has raised concern across parts of Asia, the Middle East and other regions. These developments demonstrate how quickly animal health threats can cross borders and create significant risks for food production, trade, and livelihoods.

Strong prevention and preparedness remain the most effective and least costly tools for reducing the impact of animal disease outbreaks. When outbreaks exceed national capacity, FAO acts as the Provider of Last Resort, rapidly deploying expertise, coordinating the response, and mobilizing resources to sustain action when national systems are overwhelmed or other actors cannot operate.

"Experience consistently shows us that prevention and preparedness are more effective—and less costly—than responding after an outbreak has taken hold,” said Beth Bechdol, FAO Deputy Director-General. “Investing in animal health systems is one of the most effective ways to protect livelihoods, support trade, strengthen food security and improve resilience across agrifood systems."

Building on more than 80 years of experience and programmes such as the Emergency Prevention System for Animal Health (EMPRES), the Emergency Centre for Transboundary Animal Diseases (ECTAD) and the Emergency Management Centre for Animal Health (EMC-AH), FAO is working with Members and partners to strengthen global capacity for prevention, preparedness and response to transboundary animal diseases.

As part of this effort, FAO is working with Members to develop the Global Partnership Programme for Transboundary Animal Diseases (GPP-TAD), a long-term, country-owned platform focused on prevention, early warning, preparedness, anticipatory action and rapid response. The objective is to help countries detect and contain outbreaks earlier, reduce disruptions to food production and trade, and minimize the need for costly emergency interventions.

The programme is being developed as a collaborative, multi-partner initiative—including with organizations such as the World Organisation for Animal Health (WOAH)—with a focus on strengthening national capacities, supporting sustainable financing approaches, and better linking country-level investments with regional and global support. Building on decades of experience, the initiative aims to strengthen existing international efforts and help countries move from reactive responses toward more durable systems for prevention and preparedness.

Whether it is possible we can learn to look beyond the profit margin for the next accounting period - and begin to make rational decisions based on a long-view - remains to be seen. 

But it is nice to see that some people are still trying. 

NJ & RI Both Report H5N1 in Live Markets

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Yesterday we looked at an H9 avian flu infection in a Hong Kong toddler who's only known risk exposure was visiting a live market. While not exactly a smoking gun, the CHP's epidemiological investigation stated `.  .  . It cannot be ruled out that the patient was infected through indirect contact with a contaminated environment at the wet market.'

The link between live bird markets and the spread (and potential reassortment of) avian flu strains has been long established. LBMs typically bring together birds of varying species (chickens, ducks, geese, quail, and others) - often imported from different farms - which are housed in cramped quarters.

Twelve years ago, in CDC: Risk Factors Involved With H7N9 Infection we looked at a case-control study conducted by an international group of scientists, including researchers from both the Chinese and the US CDC that concluded.

Exposures to poultry in markets were associated with A(H7N9) virus infection, even without poultry contact. China should consider permanently closing live poultry markets or aggressively pursuing control measures to prevent spread of this emerging pathogen. 

In 2016's Interventions in live poultry markets for the control of avian influenza: A systematic review Vittoria Offeddu , Benjamin J. Cowling, and J.S. Malik Peiris laid out the risks of avian influenza from live bird markets, reviewed some of the possible interventions, and concluded:

Highlights

• Avian influenza viruses (AIVs) can infect humans. Bird-to-human transmission is particularly intense in live poultry markets.
• Periodic rest days, overnight depopulation or sale bans of certain species significantly reduce AIV-circulation in the markets.
• Market closure would lastingly reduce the risk of animal and human infection.

In 2022 we looked at Zoonoses & Public Health: Aerosol Exposure of Live Bird Market Workers to Viable Influenza A/H5N1 and A/H9N2 Viruses, Cambodia, and we've seen cases whose likely exposures were cited as simply living near, or walking past an LBM (see J. Infection: Aerosolized H5N6 At A Chinese LBM (Live Bird Market)).

Two years ago the WHO published Interim Guidance to Reduce the Risk of Infection in People Exposed to Avian Influenza Viruses, which lists a number of `risk factors', including:

• keep live poultry in their backyards or homes, or who purchase live birds at markets;

• slaughter, de-feather and/or butcher poultry or other animals at home;

• handle and prepare raw poultry for further cooking and consumption;

Despite this tarnished reputation, and repeated calls to close them, LBMs flourish around the world. 

While most common in Asia and the Middle East, live are also found in Europe and the United States. Last March, in USDA Report 9 More Live Bird Markets Infected With HPAI H5 we looked at outbreaks in 3 states (New York, Florida, Pennsylvania).

Earlier this week the USDA reported a new outbreak at a live Market in Passaic, New Jersey.

Interestingly, Passaic was one of 3 wastewater monitoring sites in the U.S. that reported HPAI H5 positives in the latest CDC report.

All of which brings us to the second report this week, this time from Rhode Island, where a routine quarterly inspection found asymptomatic H5-positive poultry.  This press release from the Rhode Island Department of Environmental Management.

Avian Flu Confirmed at Live Bird Market in Providence

Published on Saturday, June 13, 2026

The Rhode Island Department of Health (RIDOH) and Rhode Island Department of Environmental Management (DEM) want to alert consumers that birds at Antonelli Poultry in Providence tested positive for the H5N1 strain of avian influenza during routine quarterly testing by the US Department of Agriculture (USDA). The infected birds, which included live chickens and ducks, did not come from Rhode Island farms. They were from out-of-state dealers.

Earlier today (June 13), the State Veterinarian oversaw the USDA-required humane euthanasia of about 445 asymptomatic birds at the market to prevent the spread of the disease to other birds. Per USDA regulations, Antonelli Poultry will be closed until 5 days after they have disposed of infected birds and have cleaned and sanitized all areas of the business. Antonelli Poultry is closely cooperating with DEM and RIDOH.

Because staff at Antonelli Poultry may have been exposed to avian influenza, and out of an abundance of caution, RIDOH is monitoring all staff for 10 days for symptoms of avian influenza. The overall risk of humans getting H5N1 remains low.

“Cooking poultry to the proper internal temperature of 165° kills bacteria and viruses, including avian influenza A viruses,” says Director of Health Jerry Larkin, MD. “RIDOH recommends that if anyone still has poultry they bought between June 9 and June 12 that was killed and dressed by Antonelli Poultry, they should double bag the poultry and dispose of it in their regular trash. If you have properly cooked and eaten chicken from Antonelli Poultry, the risk of becoming ill is very low; however, if you develop symptoms of avian influenza, you should seek medical care.”

Symptoms of avian influenza include eye redness, fever, cough, sore throat, runny nose, muscle or body aches, fatigue, shortness of breath or difficulty breathing, or pneumonia that requires hospitalization. People who get avian influenza can be treated with antivirals.

To prevent any foodborne illness, RIDOH recommends:

• Wash hands, utensils, and cutting boards before and after contact with raw poultry, meat, seafood, and eggs.
• Keep raw poultry and meat away from food that won’t be cooked—like fruits and vegetables.
• Cook food to the proper temperature and use a food thermometer to check the food’s internal temperature. You cannot tell by looking at food if it is cooked to the proper temperature.

Avian influenza infections in humans are rare. The best way to prevent avian influenza in humans is for people to avoid exposure.

• Avoid direct contact with birds or other animals infected with, or suspected to be infected with, avian influenza.
• Avoid direct contact with sick or dead wild birds, poultry, or other animals.
• Do not touch surfaces or materials contaminated with saliva, mucous, or animal feces from wild or domestic birds or other animals with confirmed or suspected avian influenza.
• Do not touch or drink raw milk (unpasteurized milk), especially from animals with confirmed or suspected avian influenza
• Do not handle any sick or dead wild birds or other animals without wearing personal protective equipment (PPE).

“DEM works closely with federal and State veterinary and public health officials to respond quickly to confirmed H5N1 cases in domestic birds,” said State Veterinarian Scott Marshall, DVM. “The USDA performs quarterly testing at live bird markets to ensure the public’s safety.”

This is Rhode Island’s first confirmed domestic bird case of avian influenza in 2026. Rhode Island has previously confirmed infections in noncommercial flocks in 2022 and in 2025.

To learn more about avian influenza in humans, visit RIDOH’s website. To learn more about avian influenza in animals, visit DEM’s website.
Date Sat, 06/13/2026 - 16:02

By my tally, this is the 20th Market outbreak in the United States in 2026, and 77th since HPAI H5 returned in early 2022. 

Notably, the press release stated that the birds had been imported from another (unnamed) state. Worth noting, we've not seen any commercial flocks reported by the USDA as H5 positive east of Indiana since early May.

Government agencies are quick to reassure the public that the risk of contracting avian influenza remains low in the United States, but exposure to live birds (via LBMs or raising poultry) is a known risk factor (see CDC graphic below).

And as we discussed three weeks ago in MMWR: Knowledge, Attitudes, and Practices Regarding Avian Influenza Among Owners of Backyard Flocks, many backyard poultry producers still have limited knowledge of avian flu symptoms and risks, and their biosecurity measures often fall short of recommendations. 

Over the past few years the threat from H5N1 has grown markedly in the Western Hemisphere. Things we used to do without much thought - like raising a few chickens the backyard or frequenting live markets - carry more risks today.

While those risks can be largely mitigated through improved biosecurity practices, four years after its arrival, we still seem to be tempting fate.  

USDA Screwworm Update (n=11) - FDA EUA For Drug to Treat Dogs & Cats

 

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The number of confirmed screwworm cases (NWS) continues to mount, and a 5th Texas county (Tom Green) has been added, in the latest update to the USDA's dashboard. 

Thus far, all confirmed detections have been in either livestock (cattle or goats), or in pets. While unknown, there are likely a far larger number of wildlife infections, as the NWS will infect just about any warm-blooded animal (including birds).

The CDC describes its life cycle as:

New World screwworm infestations begin when a female fly lays eggs on open wounds or other parts of the body in live, warm-blooded animals. Most infestations occur in animals, but they also occur in people. The smell of a wound or body opening such as the nose, mouth, eyes, ears, or genitals can attract female flies. Wounds as small as a tick bite may attract a female fly to lay her eggs. One female can lay 200 – 300 eggs at a time and may lay up to 3,000 eggs during her 10- to 30-day lifespan.

Eggs hatch into maggots that burrow into the wound to feed on the living flesh. After feeding for about 7 days, larvae drop to the ground, burrow into the soil, and emerge as adult screwworm flies.

Due to its recent return to U.S. soil, the FDA this week granted an Emergency Use Authorization (EUA) for a generic OTC drug to treat NWS infection in dogs and cats. 

FDA Issues Emergency Use Authorization for Generic Over-the-Counter Drug to Treat New World Screwworm in Dogs and Cats

Most dogs and cats in the U.S. are at low risk of NWS; risk is elevated for pets recently in areas with confirmed cases of NWS

For Immediate Release:June 11, 202

The U.S. Food and Drug Administration today issued an Emergency Use Authorization (EUA) for generic Nitenpyram Tablets (nitenpyram) for the treatment of New World screwworm (NWS) infestations (myiasis) in dogs, puppies, cats, and kittens that weigh at least two pounds and are at least four weeks old. This is the first generic animal drug authorized for use against NWS.

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While this provides a faster, and cheaper way for people to treat their pets, it also makes it easier for cases to go unreported.  Hopefully pet owners will still contact their veterinarian, and have their pet examined, after treatment has been initiated.

As the CDC warns, proper disposal of maggots is imperative in order to interrupt the life cycle of these parasites. 

Hong Kong CHP: Locally Acquired Case of H9 Infection - Notification Letter For Doctors

 

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While Mainland China leads the world in reported H9N2 infections, Hong Kong has only reported 10 since 1999, with just 4 of those locally acquired. The last non-imported HK case I can find (see FluTrackers H9N2 case list) was in early 2020. 

And that makes sense, given the nearly 200-fold difference in population pools, and the fact that H9N2 (and other) avian flu subtypes are poorly controlled in mainland poultry. 

Yesterday Hong Kong's CHP announced the detection of a locally acquired H9 case (likely H9N2) in a child without recent travel, and only limited indirect contact with poultry at a live market.  The epidemiological investigation is ongoing. 

Generally mild, H9N2 is closely monitored because it continues to evolve and accrue mammalian adaptations (see CCDC Weekly: Epidemiological and Genetic Characterization of Three H9N2 Viruses . . .).  Our CDC has designated 2 different lineages (A(H9N2) G1 and A(H9N2) Y280) as having at least some pandemic potential (see CDC IRAT SCORE).

While this is likely a one-off infection, Hong Kong's CHP is treating this seriously, and has published a detailed report (below), and has sent notification letters to local doctors. 

CHP investigates case of influenza A (H9) infection (with photo) 

     The Centre for Health Protection (CHP) of the Department of Health (DH) is today (June 12) investigating a case of human infection with influenza A (H9) in collaboration with relevant departments. The patient is a two-year-old boy. His condition has remained mild and he is currently in stable condition. The CHP will send a letter to all doctors in Hong Kong to update them on the latest developments regarding avian influenza A and to urge them to remain vigilant and report any suspected cases. 

Case information 

     The boy lives in Sha Tin District. He developed a fever and mild diarrhoea on June 9. On the following day (June 10), he was brought to Prince of Wales Hospital and was admitted for treatment. His clinical specimen tested positive for the influenza A (H9) virus by the Public Health Laboratory Services Branch (PHLSB) of the CHP. The subtyping result is pending. His clinical diagnosis was novel influenza. He is currently in stable condition and has been admitted to an isolation ward at Princess Margaret Hospital for treatment.      

     The CHP's preliminary investigation revealed that the patient had no travel history during the incubation period. The case has been classified as a locally acquired case. The patient does not attend school or receive daycare services. He is primarily cared for by his family members and spends most of his time at home or nearby. His household does not keep poultry. According to information provided by his family members, he has neither consumed undercooked poultry nor come into contact with any patients.

In early June, one of his family members took him to Wo Che Market on two occasions. During these visits, the patient stayed at a fresh provision shop in the market that sells live chickens to watch the poultry and touched the surroundings of the fresh provision shop. The CHP conducted an investigation with the Food and Environmental Hygiene Department (FEHD) and collected environmental samples from the shop concerned. The shop staff remained asymptomatic. The patient has six household contacts and they remain asymptomatic so far. The CHP has provided them with preventive medication and put them under medical surveillance.      

     The CHP is continuing to investigate the source of infection of the case and is conducting whole genome sequencing of the virus sample. The CHP will also report the case to the World Health Organization (WHO).      

     Humans are primarily infected with the influenza A virus through direct contact with infected poultry or through indirect contact with environments contaminated by their droppings. The CHP's epidemiological investigation indicated that the patient had visited a location where live poultry was sold. It cannot be ruled out that the patient was infected through indirect contact with a contaminated environment at the wet market. As young children have weaker immune systems and are incapable of maintaining good hand hygiene, the CHP advised parents to avoid taking young children to places where live poultry is sold. Transporting poultry may contaminate the ground and the surrounding environment. As young children are shorter in height and easy to be in contact with the surrounding environment, they are at greater risk of coming into contact with poultry droppings or contaminated areas.      

     In the past ten years, the WHO has received reports of a total of over 160 cases of human infection with influenza A (H9) worldwide. To date, most case of human infection with influenza A (H9) have presented with only mild clinical illness. According to the WHO's risk assessment, the influenza A (H9) virus has not acquired the ability for sustained human-to-human transmissions. 

Government's comprehensive follow-up actions

Novel influenza A infection, including influenza A (H9), is a notifiable infectious disease in Hong Kong. Compared to other highly pathogenic avian influenza strains such as H5N1 and H7N9, influenza A (H9) is a low-pathogenic avian influenza strain that causes milder illness. Excluding the aforementioned case, 10 cases of influenza A (H9N2) have been reported since 1999, including four locally acquired cases and six imported cases. No deaths have been recorded so far. In response to the latest local case, the CHP will issue a letter to all doctors in Hong Kong, reminding them of the latest situation of influenza A (H9), and urging them to remain vigilant and report any suspected cases.

Sporadic cases of human infection with avian influenza occur from time to time internationally. Although the current risk of an outbreak is low, the Hong Kong Special Administrative Region Government has consistently implemented preventive measures, including a disease surveillance system, the implementation of livestock control measures at farms, markets and ports, in order to prevent avian influenza.

The PHLSB of the CHP comprises laboratories with high biosafety standards, capable of conducting, testing for high-risk pathogens, and which also possess sufficient testing and genetic analysis capabilities and facilities. Hong Kong currently has sufficient reserve of antiviral medications.

Preventive measures to be taken by the public

Humans are primarily infected with the avian influenza A virus through contact with infected birds, poultry or other animals (whether alive or dead), or through surfaces or environments contaminated with saliva, mucous and animal faeces (such as wet markets and live poultry markets). The virus has very low transmissibility among humans. People who have close contact with live poultry are more susceptible to contracting avian influenza. The elderly, children and people with chronic illnesses have a higher risk of developing complications such as bronchitis and pneumonia, if infected. Members of the public should remain vigilant and take the following measures to prevent avian influenza: 

• Avoid contact with poultry, birds or their droppings. If contact has been made, thoroughly wash hands with soap and water;
• Poultry and eggs should be thoroughly cooked before eating;
• Perform hand hygiene at all times, especially before touching the mouth, nose or eyes; after contact with animals or their living environments; after touching public installations such as handrails or doorknobs; or when hands are contaminated with respiratory secretions, such as after coughing or sneezing;
• Cover the mouth and nose with tissue paper when sneezing or coughing. Dispose of soiled tissues into a lidded rubbish bin, then wash hands thoroughly;
• When having respiratory symptoms, wear a surgical mask, do not go to work or school, avoid crowded places and seek medical advice promptly;
• Avoid crowded public places or areas with poorly ventilated; high-risk individuals may consider putting on a surgical mask when staying in such places; and
• Travellers returning to Hong Kong from areas affected by avian influenza outbreaks should consult doctors promptly if they have flu-like symptoms, and inform the doctor of the recent travel history and wear a surgical mask to help prevent spreading of the disease.

     ​The public may visit the CHP's webpages for more information: Avian Influenza Webpage, Avian Influenza Report, Avian influenza statistics and affected areas around the world, Facebook page and Youtube channel. 

Ends/Friday, June 12, 2026

Issued at HKT 22:19

The CHP has also sent the following letter to doctors reminding them to remain vigilant, and how to report suspected cases. 

Complicating matters, Hong Kong is known for having a biphasic or `double peaked’ flu season, with most activity reported between February and April, but often seeing a less severe season in mid to late summer (see Seasonality of Influenza A(H3N2) Virus: A Hong Kong Perspective (1997–2006).

And, as the latest HK flu report indicates, they are beginning to see signs of a summer uptick in ILI. 

While this is likely an isolated incident, H9N2 is a legitimate zoonotic threat, and so we'll be watching Hong Kong carefully for any additional reports.  

U.S. Screwworm Detections Increase (n=9) as More States Ramp up Surveillance & Prevention Efforts

 

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Since Monday, the number of New World Screwworm (NWS) cases in the U.S. has more than doubled, with cases reported in 5 different counties (Texas=4, New Mexico=1). Although most have been reported in cattle, the screwworm parasite has also been detected in 2 goats and 1 dog. 

While these numbers are still small, the problem is the massive spread of the parasite in Mexico (see map below), which provides numerous opportunities for it to enter the U.S.

Not surprisingly, a number of southern tier states have raised their threat levels, and/or have strengthened their surveillance and prevention efforts, including:

• Alabama

• Florida 

• Georgia

• Louisiana 

• New Mexico

• Tennessee 

While the NWS has been eradicated before in the United States by releasing sterile NWS flies, the current supply isn't sufficient to combat a multi-state outbreak. The USDA is reportedly able to disperse between 4 and 8 million sterile screwworm flies per week into the known infested counties of Texas. 

New production facilities are being constructed, including a massive sterile fly production facility at Moore Air Base in South Texas, which is expected to produce 100 million sterile flies per week by November 2027 (increasing to 300 million a week by the end of 2028).

Meanwhile, much of the fly production from the COPEG facility in Panama is being used to suppress the spread in Northern Mexico, to try to prevent more incursions into the United States. 

Although there is a good chance of eradicating this pest once again in the United States, it isn't going to happen overnight.  The USDA's own risk analysis from 2025 reads:

In a worst-case scenario, the initial detection of NWS myiasis would not occur until 3 weeks or more after the initial introduction of NWS larvae into a United States location favorable for pupation and ongoing maintenance of the NWS life cycle.

In this scenario, a viable population of NWS flies would already exist in the United States at the time of myiasis detection in an animal or person. Releases of sterile NWS flies would be required for at least 9 to 12 weeks in order to control and eventually eradicate that population. The sterile fly releases would need to begin as soon as possible. During the 2016–2017 NWS outbreak in Florida, samples were not sent to the NVSL for identification until 84 days (4 life cycles) after presumptive positive identification by local veterinarians.

Complicating matters is the timing; with the initial outbreak detected in early June - we've 4 or 5 months of very hot weather ahead - conditions which are highly conducive to the spread of the screwworm.  

While the eradication of the NWS 60 years ago in the U.S. was a tremendous achievement, this is a somber reminder that such victories are often fleeting, and that nature always bats last.  

IJID: Regional Signals Preceding the 2026 Bundibugyo Virus Disease Outbreak

 

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When the Bundibugyo Ebola virus outbreak in the DRC was announced nearly 4 weeks ago, there were already 246 suspected cases and 65 deaths, which suggested the outbreak had been brewing - unrecognized - for several months.

Which isn't to say it went unnoticed, for in the 3 months prior there were a number of reports from the region of `suspected' hemorrhagic fever cases that were either never confirmed, or followed up on.

Admittedly, outbreaks in the DRC are notoriously difficult to manage, as much of the region is a conflict zone, is plagued by a wide variety of infectious diseases, and has only limited public health capacity.  Also, the Ebola PCR test commonly used in the region was Zaire-specific, and would not have detected the much rarer Bundibugyo virus.  

But gaps in surveillance and reporting extend far beyond Central Africa.

As we've discussed often (see Flying Blind in the Viral Storm), over the past few years we've seen a noticeable decline in surveillance and reporting of infectious diseases around the world.

In 2005 the World Health Organization adopted updated IHR (International Health Regulations) which – among other things - required countries to develop mandated surveillance and testing systems, and to report certain types of disease outbreaks and public health events to WHO.

Member states had until mid- 2012 to meet core surveillance and response requirements, but many nations failed to meet that deadline, which has forced the WHO to grant repeated extensions.  

A report 3 years ago (see Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries), found many member nations still lack the capability to fully investigate cases.

And of course, some nations - for political or economic reasons - simply choose to ignore the IHR whenever convenient, since there are few tangible penalties for doing so (see From Here To Impunity).

Today we've a fascinating look at early signals - and missed opportunities - in the DRC going back to early March of this year. 

While not a long report, I've only posted the Abstract. Follow the link to read the full report.  

Regional Signals Preceding the 2026 Bundibugyo Virus Disease Outbreak

Nahid Bhadelia1,2 ∙ Isaac Gikandi1 ∙ Britta Lassmann1,2

Highlights

• Bundibugyo virus circulated undetected for months prior to outbreak declaration.
• Four earlier regional hemorrhagic fever clusters flagged by open surveillance are unresolved.
• These clusters warrant urgent reanalysis due to concern for regional spread.

Abstract

Background

 The May 2026 Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo was declared a Public Health Emergency of International Concern after substantial undetected community transmission. We describe regional surveillance signals detected by the Biothreats Emergence, Analysis, and Communications Network (BEACON), our open access event based surveillance program, in the weeks preceding outbreak declaration.

Methods

We reviewed BEACON reports of VHF-compatible illness clusters detected in the transboundary DRC-Uganda-Burundi-South Sudan region during March–April 2026, prior to the May 15 laboratory confirmation of BDBV.

Results

BEACON detected four temporally proximal VHF-compatible illness signals:

• (1) March 9, North Kivu Province—suspected Ebola case under investigation with unresolved laboratory results;
• (2) March 10, Kasaï Province—fatal hemorrhagic illness with secondary cases and negative Ebola PCR;
• (3) March 30, Burundi—35-case undiagnosed cluster near the DRC border with 5 deaths, negative testing for major filoviruses and >200 pathogens, pending metagenomic sequencing;
• (4) April 22, South Sudan—three suspected VHF cases with negative initial testing. 

All four signals shared a similar diagnostic phenotype: VHF-compatible presentation, mobilization of investigation teams, negative initial testing, and no publicly reported confirmed etiology. None were formally reported to have been resolved.

Conclusions

Our detection of four unresolved VHF signals preceding the confirmed BDBV outbreak highlights gaps in formal follow-up mechanisms for negative cases and fragmented regional diagnostic coordination. In light of confirmed BDBV circulation and Africa CDC's identification of 10 countries at high risk for spread, these preceding signals warrant urgent retrospective investigation and laboratory.

When the World Health Organization (WHO) declared the Bundibugyo disease outbreak in the Democratic Republic of the Congo (DRC) and Uganda a Public Health Emergency of International Concern on May 17, 2026, the epidemiology was already telling us we were late [1,2]. Eight of the first thirteen samples submitted to the Institut National de Recherche Biomédicale (INRB) returned positive for Bundibugyo virus.

By May 23, 746 suspected cases, 83 confirmed cases, 176 suspected deaths, and 9 confirmed deaths have been reported in DRC’s Ituri, North Kivu and South Kivu provinces, with spread to multiple urban centers. Uganda has 5 confirmed cases with direct epidemiological links to DRC [3].

There remains significant uncertainty about the true number of infections and how far the virus has spread. Healthcare worker deaths in clinical contexts consistent with viral hemorrhagic fever (VHF) had been reported in multiple sites. The official investigation was anchored, in retrospect, to the death of a nurse in Bunia on April 24, 2026, and to funeral-related exposures that followed. Recent data shows the outbreak began well before this date.

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