Objective:

To evaluate evidence supporting current recommendations on Bundibugyo virus (BDBV) transmission, infectiousness, and survivor management during the ongoing 2026 outbreak and to identify key knowledge gaps and research priorities.

Approach:

• Transmission dynamics and presymptomatic infectiousness: This perspective reviews evidence from previous BDBV outbreaks, particularly the 2007–2008 Uganda outbreak, to characterize transmission routes and assess the possibility of transmission before symptom onset.
• Post-recovery viral persistence: The article evaluates the limited BDBV-specific evidence on viral persistence and survivor management and considers evidence extrapolated primarily from Zaire ebolavirus, including persistence in immune-privileged sites and delayed transmission after recovery.

Key Findings:

• BDBV transmission occurs primarily through direct contact with the blood or body fluids of symptomatic or deceased individuals, including contact during burial-related activities.
• No human cases of presymptomatic BDBV transmission have been documented, although limited outbreak data prevent this possibility from being definitively excluded.
• No BDBV-specific evidence is available on post-recovery viral persistence, duration of infectiousness, or transmission from survivors; current guidance therefore draws largely on findings involving Zaire ebolavirus.

Interpretation:

Available evidence supports symptom-based surveillance, contact monitoring, prompt isolation of symptomatic individuals, and safe burial practices. Recommendations concerning survivor follow-up and risk reduction remain based predominantly on extrapolation from other orthoebolaviruses, particularly Zaire ebolavirus.

Limitations:

• BDBV-specific epidemiological evidence is limited because few outbreaks have been documented.
• Direct evidence is lacking on presymptomatic transmission, post-recovery viral persistence, duration of infectiousness, and transmission from BDBV survivors.

Conclusion:

The ongoing outbreak provides an opportunity for prospective epidemiological, clinical, and laboratory studies, including longitudinal survivor follow-up, to clarify BDBV transmission, viral persistence, and recrudescence and support species-specific public health recommendations.