Retrospective review of open-source surveillance signals detected by the BEACON event-based surveillance program in the DRC-Uganda-Burundi-South Sudan transboundary region during March–April 2026, prior to the May 15, 2026 laboratory confirmation of Bundibugyo virus disease (BVD).
BEACON identified 4 unresolved VHF-compatible signals in the 10 weeks before outbreak declaration: a suspected Ebola case in North Kivu (Mar 9), a fatal hemorrhagic illness cluster in Kasaï with secondary cases and negative Ebola PCR (Mar 10), a 35-case cluster in Burundi near the DRC border with 5 deaths and negative testing for >200 pathogens (Mar 30), and 3 suspected VHF cases in South Sudan with negative initial testing (Apr 22). None were formally resolved prior to BDBV confirmation.
Retrospective descriptive design with no confirmatory laboratory linkage between the 4 prior signals and the confirmed BDBV outbreak; reliance on open-source/media reports may miss signals or introduce reporting bias; causal connection between preceding signals and the outbreak remains unproven.
Clinicians and public health teams in regions flagged by Africa CDC as high-risk for BDBV spread should treat unresolved VHF-compatible clusters as potential filovirus events and push for rapid retrospective specimen testing. Gaps in formal follow-up for 'negative' VHF investigations need urgent systems-level attention.
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