As the outbreak of Bundibugyo virus (BDBV) evolves rapidly in Democratic Republic of Congo and Uganda we draw attention to two studies that followed up survivors of a previous outbreak of BDBV in Uganda in 2007. In the first retrospective study from 2015 looking at patients 2 years after they had recovered from the infection, a total of 49 probable or laboratory confirmed adult patients were compared with 157 seronegative contacts of the recovered patients. After controlling for age and sex, the BDBV survivor group were found to have a significantly higher risk for a range of ongoing health issues, including ocular deficits, arthralgia and various constitutional symptoms such as fatigue, muscle pain, headache and difficulty sleeping. In particular, memory problems and confusion were 6 times more prevalent in the infected group than in the controls. Measurable IgG antibody was detectable in 78% of the cases, suggesting that antibody persisted for at least 2 years post-infection in most cases.
The second study, published in 2025, looked at 40 laboratory-confirmed BDBV survivors and compared the cases with 23 unexposed community controls. However, due to the demographics of the population the age of the controls averaged 10.5 years below the average age of the test population and gender was not evenly distributed between the two cohorts. The data analysis was adjusted to control for these anomalies. The BDBV survivors were found to have persistent post-disease symptoms up to 16 years after the infection. Neurological and musculoskeletal symptoms were most common with headaches, vision problems, fatigue and joint pain being reported most often. A significantly decreased respiratory rate in survivors compared to controls was seen. Hearing loss was not identified in this study, whereas it was weakly associated in the earlier study and has been reported from other Ebola survivor studies. Interestingly, the authors found that overall, the BDBV survivors showed considerable mental health resilience with low incidence of depression and anxiety. IgG was not measured in the second study on the assumption that after 16 years it would be undetectable.
These two papers are not directly comparable; the earlier study was limited to adults and the later to all identified survivors including some who contracted the virus at a young age. However, both show the long-term persistence of particular symptoms following recovery from BDBV. Most common are neurological and musculoskeletal pain. Both sets of authors argue that the long-term sequelae following BDBV must be recognized and support included in healthcare plans.
Original articles:
- Clark DV et al. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet Infect. Dis. 2015; 15:905-12 ( doi.org/10.1016/S1473-3099(15)70152-0 )
- Kaweesa et al. Resilience and residuals beyond containment – The hidden burden of Bundibugyo survivorship sixteen years on: A cross-sectional observational study. New Microbes and New Infections 2026; 69: 101685 ( https://doi.org/10.1016/j.nmni.2025.101685 )