The recent outbreak in the Democratic Republic of the Congo and Uganda is caused by the Bundibugyo species of the Ebola virus. It is highly transmissible and primarily spread through direct contact with the body fluids of infected individuals. Therapeutic treatments in the form of monoclonal antibodies and antivirals are still in the trial stage and there is not yet an approved vaccine, so strict infection prevention and control (IPC) protocols, performed by well-trained staff, are crucial to break the chain of human-to-human transmission, safeguard health-care workers and prevent spread within facilities.
On 22 July, a British resident humanitarian worker in the Democratic Republic of the Congo was medically evacuated to the United Kingdom of Great Britain and Northern Ireland for monitoring after a potential health-care related exposure to Ebola. At the time of arrival, the patient was asymptomatic.
Richard Pebody, Director of Epidemic and Emerging Infections at the UK Health Security Agency, said, “The risk to the general public remains low. This individual has been transferred out of an abundance of caution, and we’re pleased they remain well.”
Previously, on 13 July 2026, a citizen from the United States of America showing signs of Bundibugyo virus disease arrived through medical evacuation at the High-Level Isolation Unit (HLIU) at Frankfurt University Hospital, Germany. Bundibugyo virus disease was later confirmed. That case took the total confirmed cases in the WHO European Region to 3 – all people who were exposed to the virus in areas affected by the outbreak. How do hospitals prepare to receive patients exposed to such a high consequence disease? How do they contain transmission while sensitively caring for them? Following the safe discharge of the patients, what can we learn from their experiences?
Safe transportation to hospital
On 20 May, a doctor from the United States who had been exposed to Bundibugyo virus disease during the recent epidemic was transported to Prague, Czech Republic, following a request from the Embassy of the United States of America to the Ministry of Health of the Czech Republic. Although the likelihood of the doctor developing the disease was considered low and the individual showed no symptoms, it was important to ensure immediate access to highly specialized medical care should their condition change. The doctor was received by the National Centre for Isolation and Treatment of Highly Hazardous Infectious Diseases at Bulovka University Hospital, which has advanced IPC capabilities.
“The operation was carried out in accordance with established procedures that the Czech Republic has in place for managing similar situations,” says Zdeněk Kyselý from the Public Health Emergency Operations Centre of the Ministry of Health of the Czech Republic. “All standard precautionary measures for managing a person potentially exposed to a highly hazardous infectious disease were applied throughout the transport and subsequent hospitalization.”
The patient was transferred in a sealed capsule, known as a patient isolation unit, from where he was delivered to a plastic tent in the hospital for monitoring. The transfer involved specialists in infectious diseases, epidemiology, intensive care medicine, public health protection and emergency medical services. The Fire Rescue Service of the Czech Republic, the Police of the Czech Republic and Prague Airport also played important roles in the operation.
A key factor in the success of the mission was the long-term preparedness of all participating organizations.
“The Czech Republic regularly conducts exercises focused on the management of suspected highly hazardous infectious diseases, enabling all involved partners to respond quickly, effectively and in a well-coordinated manner,” affirms Zdeněk.
The patient stayed in strict isolation until the 21-day incubation period had safely passed, before he was discharged home to his family.
A confirmed case in Germany
When another health worker from the United States, infected with Bundibugyo virus disease in the Democratic Republic of the Congo, was transferred to the Joint Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine at Charité – Universitätsmedizin Berlin, the preparedness of hospital and staff was also put to the test. Safely and sensitively managing the care of the patient and his family while ensuring the security of other staff and patients brought together clinicians, preparedness leads and IPC specialists and drew on learnings from other high-consequence infectious disease outbreaks.
For Dr Alexander Uhrig, a senior physician in the intensive care unit, one mantra is central when it comes to managing highly infectious diseases: identify, isolate and inform. In the case of the Charité patient, the hospital was already aware that he had tested positive for Bundibugyo virus disease. However, in many cases, the first task of a hospital is recognizing and diagnosing a possible high-consequence infectious disease early enough to adapt the institution’s response. The second is separating the person from routine patient flows. The third is ensuring the right people are alerted quickly – clinical teams, IPC, laboratory services, hospital leadership – so that action is coordinated and the patient is treated while preventing the spread of the disease.
“Those 3 basic steps are needed to manage your IPC around a suspected case of high-consequence infectious diseases. But that doesn’t mean that it’s that easy,” says Alexander. “You have to think about your infrastructure at the hospital or the health-care setting you’re working in, because isolating expected cases from the rest of your patients isn’t that easy in every circumstance.”
Medical staff at Charité – Universitätsmedizin Berlin demonstrate how they cared for a patient with Bundibugyo virus disease. Credit: Charité
Training is a safety measure, not a one-off event
Dr Miriam Stegemann, senior physician and head of the Campus Virchow Klinikum site of the Department of Infectious Diseases and Intensive Care Medicine at Charité – where the HLIU is located – also cared for the sick patient. She emphasizes that safe care relies on trained staff, and that training needs to be continuous.
“At our high-level isolation unit in Berlin, we have a long-standing training programme where we train staff once per month, sometimes even more often, in the facility. It is this same facility in which we treated the patient and also isolated his family, who were high-risk contact persons.”
That repetition turns complex steps into routines, reduces hesitation under pressure and helps teams remain confident.
Dr Brar Piening is deputy head of the IPC team at Charité. “We have been planning for this since forever – I’ve been involved since 2006. There has been a lot of mental preparedness regarding all the procedures, but training is still an issue. Because you have some fluctuations in staff, you need a big part of the team to be mentally prepared for this and know about the procedures, so that you can activate them if you need them.”
Systems matter more than “maximum PPE”
To care for the patient, Charité staff wore the highest level of personal protective equipment (PPE) in the HLIU, including fully encapsulated suits with High Efficiency Particulate Air (HEPA) filtration and controlled donning and doffing areas with a decontamination shower – an additional safety layer for that specific setup. But the team stresses a critical point: PPE choices must fit the setting and the training.
Dr Alexander Uhrig cites lessons shared through collaboration with colleagues in outbreak-affected lower-resource settings. “We learned from our colleagues in Rwanda that even in other types of PPE – when you are in an environment where everyone is following the important steps of contact and respiratory isolation, with a special emphasis on eye protection – this kind of PPE is able to protect you from the dangers of high-consequence infectious diseases like Ebola and Marburg in the same manner as our expensive, fully-encapsulated suits are doing.”
During a webinar organized by WHO/Europe and the European Centre for Disease Prevention and Control that followed the safe discharge of the recovered patient, all 3 staff from Charité stressed the value of collaboration with partners with experience in managing outbreaks. The webinar aimed to share IPC considerations and key resources in the context of the Ebola outbreak.
Preparedness is ultimately a whole-system approach, with staff who are continuously trained, planned spaces, rehearsed procedures, clear communication and the ability of health facilities to adapt safely. The risk of Ebola in the Region is low, but when the next high-consequence infectious disease patient presents, whether expected or unexpected, investments in preparedness like those made at Bulovka University Hospital and Charité determine how quickly a facility can protect staff, maintain safe care and prevent onward transmission.