New research says blood disorder expertise is crucial to treating Ebola patients, with WHO expanding its response and Australian authorities maintaining the local risk is low.
An expanding Ebola outbreak in Central and East Africa is exposing a critical gap in the world’s ability to respond to deadly viral diseases, with researchers warning that blood disorder specialists and greater investment in haematology research are essential to improving survival and preparing for future epidemics.
The outbreak, caused by the Bundibugyo virus species of Ebola, has spread across the Democratic Republic of the Congo (DRC) and into neighbouring Uganda, prompting the World Health Organization (WHO) to declare it a Public Health Emergency of International Concern.
As of June 27, health authorities had confirmed 1274 cases across 34 health zones in the DRC, while Uganda had recorded 20 confirmed infections in two districts, all linked to cross-border transmission from eastern DRC.
The escalating outbreak has prompted WHO’s Regional Office for Africa and the Africa Centres for Disease Control and Prevention (Africa CDC) to establish a Continental Incident Management Support Team (IMST) based at Makerere University’s Infectious Diseases Institute in Kampala, Uganda.
The incident management team, which became operational on June 29, brings together technical experts from WHO, Africa CDC, and partner organisations under a single command structure to coordinate surveillance, laboratory testing, case management, emergency logistics, risk communication, and partner engagement.
It will also strengthen preparedness activities in 10 neighbouring priority countries, reflecting growing concern that the outbreak could spread further across the region.
Ugandan Health Minister Dr Chris Baryomunsi said hosting the continental coordination hub demonstrated Africa’s collective commitment to containing the outbreak.
WHO Regional Emergencies Director Dr Marie-Roseline Belizaire said the response would operate as one unit to reduce duplication and ensure resources were directed where they were needed most.
“This IMST is our commitment to one plan, one budget, one response – not as a slogan, but as an operating discipline,” said Dr Belizaire.
“One plan to align our priorities. One budget to direct resources where they are most needed. One response to ensure that every partner, every country and every team is moving in the same direction: stopping transmission and saving lives.”
The operational hub will work alongside a regional logistics platform in Entebbe to accelerate the deployment of medical supplies, personal protective equipment, laboratory capacity, and specialist personnel into affected areas.
While the outbreak continues to intensify overseas, Australia’s Centre for Disease Control says the risk to Australia remains low.
While no person has ever been diagnosed with Ebola disease in Australia, they stressed that even a single imported case would trigger an immediate public health response.
Ebola virus disease and other viral haemorrhagic fevers are classified as listed human diseases under Australian legislation, allowing the Federal Government to use emergency powers to prevent their introduction into the country and respond rapidly if cases are detected.
Border screening for listed human diseases remains in place and additional public health measures can be introduced during significant international outbreaks, including monitoring travellers arriving from affected regions.
The Australian CDC is advising anyone who develops symptoms within 21 days of arriving from the DRC or Uganda to immediately contact a healthcare provider, report their travel history, and avoid presenting to a medical clinic or hospital without first calling ahead to minimise the risk of exposing others.
Symptoms typically appear between two and 21 days after infection, most commonly after eight to 10 days.
Early illness resembles many common viral infections, with sudden fever, severe headache, muscle pain, weakness, and sore throat before progressing to vomiting, diarrhoea, abdominal pain, and rash.
In severe cases, patients develop bleeding from the gastrointestinal tract, gums, nose, eyes, or other mucosal surfaces before progressing to shock, multiple organ failure and, in many cases, death.
Around half of all people infected with Ebola die, although mortality varies between outbreaks depending on the virus strain and access to supportive medical care. Survivors frequently experience long-term health complications that can persist for months or years.
Unlike the better-known Zaire strain of Ebola, for which licensed vaccines and antiviral treatments are available, Bundibugyo virus remains poorly understood.
There are currently no approved vaccines or targeted antiviral therapies for Bundibugyo virus disease, making rapid diagnosis, patient isolation, contact tracing, infection control, and supportive hospital care the primary tools for reducing deaths.
In an editorial published in The Lancet Haematology, researchers argued that one of the most overlooked aspects of Ebola care was the profound disruption the virus caused to the body’s blood and immune systems.
Rather than simply causing bleeding, Ebola triggers a complex cascade of immune activation, inflammation, and coagulation abnormalities.
The virus infects immune cells, causing an overwhelming inflammatory response while simultaneously damaging the lining of blood vessels.
It activates clotting pathways throughout the body while also stimulating mechanisms that break down blood clots, creating a dangerous imbalance that leaves patients vulnerable to both uncontrolled bleeding and widespread microvascular thrombosis that can contribute to organ failure.
Laboratory findings in severe Ebola cases frequently show markedly elevated D-dimer levels, indicating intense activation of the body’s clotting and fibrinolytic systems.
The editorial authors said this explained why patients require careful monitoring for disseminated intravascular coagulation and why supportive treatment often involved aggressive fluid replacement, blood products, and clotting factor replacement, with anticoagulant therapy considered in selected patients to balance the competing risks of thrombosis and haemorrhage.
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The authors said these complications placed classical haematology squarely at the centre of Ebola management, yet the specialty remains under-recognised in epidemic preparedness planning.
“Although haematology does not sit at the centre of epidemic preparedness frameworks, it becomes fundamental in practice once outbreaks reveal haematological features,” they wrote.
“By addressing gaps in knowledge, resources, and capacity, we can improve high-quality supportive care, including haematological-focused management, and strengthen our resilience to future outbreaks.
“Expanding standardised single-subspecialty haematology training programmes, pursuing deeper sub-specialisation within classical haematology, and increasing targeted research funding could translate mechanistic uncertainty into practical protocols, making supportive care more systematic, reproducible, and patient-centred.”
The editorial noted that only about 4-5% of haematology-oncology trainees in the US pursued careers in classical haematology, while a Europe-wide survey found almost one-third of trainees reported deficiencies in core classical haematology competencies.
Limited funding for research into non-cancer blood disorders has compounded the problem, restricting advances in understanding the mechanisms driving coagulation disorders during viral haemorrhagic fevers.
The authors said the covid pandemic similarly demonstrated how infectious diseases could profoundly affect blood clotting and immune function, exposing significant gaps in scientific knowledge that remained relevant to Ebola and other emerging pathogens.
They called for expanded specialist training, greater investment in classical haematology research, and the development of standardised supportive care protocols that can be rapidly implemented during outbreaks.
Better understanding of the biological pathways underlying Ebola-associated clotting disorders could also lead to new therapies capable of preventing bleeding, reducing organ damage, and improving survival.
“The Bundibugyo virus outbreak is a reminder that epidemics not only test the limits of public health logistics, but also progress across disciplines,” they wrote.
“No medical specialty can afford to look away: this calls for research, and its rapid translation, at the interplay of infectious diseases and haematology.”
Meanwhile, Australian health authorities continue to advise travellers to avoid outbreak areas wherever possible, avoid contact with infected people, contaminated materials, and wild animals such as fruit bats and primates, practise meticulous hand hygiene and safe sex, and seek immediate medical advice if symptoms develop after travel.
