Kenya records its first imported Ebola death, a Bundibugyo case in Nairobi

Kenya confirmed its first imported Ebola case on Tuesday after a Kenyan citizen who had lived in the Democratic Republic of Congo died in Nairobi. Health minister Aden Duale said the man died on Monday night. Laboratories in Nairobi found Ebola Bundibugyo virus.

Duale told a news conference that the patient had lived in Congo for seven years. He fell ill about a month ago and was treated in several hospitals there. He then travelled by road from Congo to Kampala. From Kampala he boarded Jambojet flight 8523 and landed at Jomo Kenyatta International Airport at 1.10pm on Saturday, 3 October. He passed the ordinary public health screen at the port health desk and the immigration desk.

A relative and a friend drove him from the airport to Nairobi Hospital. Staff isolated him in a separate room in the accident and emergency department, then moved him to the hospital's East Wing isolation facility. A doctor suspected a viral haemorrhagic fever because of the symptoms and the travel history. Samples tested positive at the National Virology Reference Laboratory and again at the Kenya Medical Research Institute. He was given supportive care and died. Duale said the burial was planned for later on Tuesday under the safe and dignified burial protocol used for Ebola.

Health authorities have listed 28 people he met in Kenya, including relatives and healthcare workers. They are also looking for 27 people who were on the flight. Those two lists are the practical edge of the response. Bundibugyo virus spreads by direct contact with bodily fluids of a sick person or a body. It does not spread through casual contact in a terminal. The risk sits with the people who handled him while he was ill, and with anyone on flight 8523 who had close contact if he was already shedding virus.

The screening gap is specific. He had been ill for about a month, he crossed a land border into Uganda, and he still cleared the airport screen in Nairobi. Duale said Kenya had kept a high alert for Ebola since the Congo outbreak began in May. A high alert that lets a symptomatic traveller through a major airport is a process failure, not a slogan. The useful question is which symptoms were asked about, whether a temperature was taken, and whether the Congo travel history was recorded before he left the arrivals hall.

Kenya is the third country to record a case linked to the current epidemic in eastern Congo. Reuters described that epidemic as the second largest on record, with more than 8,000 people infected and more than 4,000 dead. Uganda reported 20 cases and two deaths earlier in the year and was declared free of the outbreak in August. A death in Nairobi reopens a route that Uganda had just closed: road from eastern Congo, a capital-city airport, then a regional jet.

Bundibugyo is one of several Ebola virus species. It is less familiar to the public than the Zaire strain that drove the large West African epidemic, and case fatality in past Bundibugyo outbreaks has been lower than in Zaire outbreaks. Lower is not low. There is no licensed treatment specific to this species in ordinary hospital use, which is why isolation, contact tracing and a controlled burial are the tools Duale named on Tuesday.

For Nairobi Hospital, the immediate task is the staff who moved him from the emergency room to the East Wing, and the relatives who drove him from the airport. For the ministry, it is the 27 people from flight 8523 who have not yet been found. For travellers, the fact that matters is narrower than a national panic: one imported death, a named flight, a named hospital, and a contact list that is still incomplete on the day of the announcement.

Jambojet is a Kenyan carrier. The flight number and the landing time give contact tracers a passenger manifest and a seat map. If those 27 people are found quickly, the Nairobi event can stay a single imported death. If they are not, the next case will not be a surprise. It will be the cost of a screen at Jomo Kenyatta that did not stop a man who had already been ill for a month.