Innovative Strategies and Adaptations for Containment of the 2025 Sudan Virus Disease Outbreak in an Urban Setting in Uganda: Lessons for Preparedness and Response to Future Filovirus Outbreaks

Le résumé fourni par la source

Urban outbreaks of Ebola present heightened risks of rapid amplification and cross-regional spread. On 30 January 2025, the Uganda Ministry of Health declared an Ebola Sudan virus disease (SVD) outbreak first identified in a fatal case at a national referral hospital in Kampala, one of East Africa’s most densely populated and highly connected urban centres. The source of the index infection, presumed to be a zoonotic spillover event, was not established. Despite high transmission risk and major disruptions in global health financing, the outbreak was rapidly contained. We analysed the response to identify innovations and system adaptations that enabled control and to derive lessons for future preparedness in resource-constrained settings. We conducted a retrospective implementation analysis using a structured review of national and district response plans, situation reports, laboratory and surveillance summaries, early and after-action review reports, policies, and standard operating procedures generated during the 2025 SVD response. Data were analysed using a framework-based thematic analysis organised around the World Health Organization (WHO) Strategic Preparedness and Response Plan (SPRP) response pillars, to identify innovations and intensified adaptations of existing approaches. The outbreak was limited to 14 cases (12 confirmed, 2 probable) across seven districts, with two deaths among confirmed cases (confirmed-case fatality rate 16.7% (2/12; 95% CI 4.7–44.8)) and all confirmed cases admitted to Ebola Treatment Units survived. Key implementation innovations included institutional quarantine of all identified contacts; decentralisation and early deployment of mobile laboratory services and district laboratory response teams; rapid deployment of candidate therapeutics and vaccines through pre-approved research readiness platforms; use of a real-time digital 4 W (who, what, where, and when) coordination and partner mapping dashboard; and intensified mortality surveillance linked to rapid laboratory confirmation. Despite mobilising only 29% of the estimated response budget (USD 16 million of an estimated USD 56 million required), coordinated resource allocation enabled rapid interruption of transmission. Preparedness investments, aggressive contact containment, intensified mortality surveillance, research readiness, and digital coordination enabled rapid control of an urban SVD outbreak in a resource-constrained setting. These findings support institutionalising mortality-led surveillance, domestic emergency financing, research readiness, and establishing institutional quarantine of contacts as default policy for filovirus outbreaks in dense urban settings.

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