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Background  Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited.    Methods  We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number ( R   t  ) by health zone. We fit linear time-series regression to model the relationship.    Results  Average  R   t   was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in  R   t   of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission ( P  = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on  R   t  , Ebola-targeted events corresponded to  R   t   of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to  R   t   of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to  R   t   of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission.    Conclusions  Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo