An integrated paediatric component for the management ofBundibugyo virus disease: a proposed Patient–ProviderEnvironment model

Background. The Bundibugyo virus disease (BVD) outbreak declared in the Democratic
Republic of the Congo (DRC) in May 2026 is the largest ever documented for this virus. As
of 30 July 2026, children accounted for nearly one in four confirmed cases but almost one
in three deaths, and children under five had a case fatality rate more than twice that of
adults. No vaccine or specific treatment is licensed: survival depends on optimised
supportive care.
Problem. In children, BVD can progress rapidly from a non-specific febrile illness to multi
organ decompensation. Yet supportive care guidance is largely designed for adults and
assumes resources that many response facilities lack.
Proposal. We propose an integrated paediatric component built on two pillars: (1) a
systematic Patient–Provider–Environment (PPE) assessment, which considers together the
child’s condition, the actual capacity of the caregiver and the material conditions of care;
and (2) an individualised pharmaco-clinical approach, in which the choice, dose, route and
frequency of each medicine depend on age, weight, severity and complications.
Scope. This model does not replace World Health Organization (WHO) recommendations:
it translates them into an operational, reproducible and measurable paediatric framework.
We propose quality indicators and an evaluation framework to test its impact on mortality.