Nigeria confirmed its first Ebola case in over a decade on October 20, after a woman who had travelled from Uganda to Abuja tested positive for the Bundibugyo strain of the virus. The patient developed symptoms on October 7, was admitted to a private hospital on October 11, and received a positive diagnosis nine days later. Nigerian health authorities identified 44 contacts and activated the country's national incident management system. The confirmation came almost exactly 12 years after the WHO declared Nigeria free of Ebola in 2014.

Kenya, which reported its first imported case on October 6 in a man who had travelled from the Democratic Republic of Congo via Uganda, has since grown its cluster to nine confirmed cases including one death. All nine cases are linked to the original patient, and Kenyan authorities say there is no evidence of wider community transmission beyond known contacts. Investigators have quarantined 134 of 135 identified contacts.

The epicentre remains the DRC, where as of October 20, 9,704 confirmed cases and 4,687 deaths had been recorded across 66 health zones in eight provinces — a crude case fatality ratio of 48.3%. The WHO has described the situation as a "more complex" outbreak and is urging neighbouring countries to strengthen border surveillance, rapid detection capacity, and cross-border coordination. The Bundibugyo virus strain, while related to the more widely known Zaire strain, has its own epidemiological characteristics and has now been detected in at least five countries across the region.