Posted on 10/07/2008 1:40:25 AM PDT by Mother Abigail
Deadly virus not airborne
Mass hysteria is not necessary in this case
Disease transmitted via bodily fluids
THE deputy director of the National Institute for Communicable Diseases has assured the public that there is no need to panic, despite the fact that four people have been killed by an unknown, highly contagious virus.
Doctor Lucille Blumberg, who also heads up the NICD's epidemiology unit and consults to its special pathogens unit, referred to the death of Cecilia van Deventer, 36, as an "isolated case" and said test results were not yet available.
But experts at the University of Stellenbosch believe the mystery virus is "most likely haemorrhagic fever".
A paramedic, Hannes Els, 33, who treated the critically ill Van Deventer in Zambia, and brought her to the Morningside Medi-Clinic in Sandton on September 12, died last Thursday after being infected with the highly contagious disease.
On Sunday a nurse and a cleaner, who had possibly been exposed to the disease, died.
Blumberg said: "The cause of death of the cleaner is still being investigated. We are busy conducting tests on all four deceased. The cleaner might not have been killed as a result of the virus.
"This is an isolated case. There have been no other reported cases in Lusaka, Zambia.
"We do not have an issue with people travelling there."
She said the Els family are being "closely monitored".
Dr Jantjei Taljaard, of the division of infectious diseases at the University of Stellenbosch, said the cases were most probably haemorrhagic fever. He said: "This is one of the most contagious viruses . It has an 80 percent or higher chance of being transmitted. Transmission occurs through bodily fluids, like being exposed to the person's blood."
The virus, he said, causes multiple organ failure.
"However, it is difficult to speculate and the families of the people who have died are being closely monitored by the health authorities. Mass hysteria is not necessary in this case."
Eileen Brannigan, Netcare's director for nursing, said yesterday that all Netcare units, specifically casualty departments, have been placed on high alert for any of the symptoms indicated by the deceased individuals.
The special pathogens unit of the NICD is primarily responsible for the diagnosis and investigation of biohazard Class 4 viruses. Class 4 viruses known or considered likely to occur in Africa include Marburg, Ebola, Rift Valley fever, Crimean-Congo haemorrhagic fever, Lassa fever- related arenaviruses, and hantaviruses.
Marburg disease first appeared in Europe in 1967 in association with monkeys imported from Africa, and again in 1969 when the rodent-borne Lassa fever first appeared as a fatal disease affecting missionary nurses in West Africa.
In 1975, two young Australian tourists became sick in South Africa with what proved to be Marburg haemorrhagic fever after visiting Zimbabwe.
In 1996, 46-year-old theatre nurse Marilyn Lahana was infected by a Gabon doctor with the deadly Ebola virus. Lahana and the doctor died
About five or six cases of Congo fever are reported a year in the Northern Cape and Free State.
Will they be good enough to inform us when mass hysteria does become necessary?
The chronological order of events (as I can gather) is as follows (None of this information has yet been confirmed.):
4 Sep 2008 - Index Case - female South African, (living in Zambia for many years) begins to suffer from flu-like symptoms.
9 Sep 2008 - She is slowly deteriorating. She sees multiple doctors in Lusaka.
11 Sep 2008 - She is admitted to hospital and deteriorates over night.
12 Sep 2008 - Paramedic is called in to evacuate her to South Africa. He does the transfer, along with another Dr assisting.
13 Sep 2008 - Index Case dies.
14 Sep 2008 Paramedic starts to develop flu-like symptoms.
14-27 Sep 2008 - Paramedic slowly deteriorates.
27 Sep 2008 - Paramedic is diagnosed as very sick and medivaced to South Africa. Nurse who treated Index case begins to get flu-like symptoms.
30 Sep 2008 - Paramedic dies.
1 Oct 2008 - Nurse who treated Index Case is admitted to hospital.
5 Oct 2008 - Nurse who treated Index Case dies.
The information that I can gather is the following:
1. Incubation period is as little as 2 days (paramedic), but as long as 14 days (nurse).
2. Disease course is generally 4-7 days of flu-like illness with patient only becoming critically ill in 2nd week of disease.
3. Further information is that Index Case reportedly had an eschar on one of her feet, thought to be from a tick-bite. She had also been in contact with horses from Congo in the weeks preceding her illness. Transmission is hypothesized to be by 2 means: tick-borne 1st (which may have brought the disease into the human population from the animal population) followed by direct contact with bodily fluids (resulting in human to human transmission).
4. It appears further hospital staff are now critically ill in Zambia, though this has not been confirmed.
5. If the incubation period is as long as 2 weeks, then we should still be closely watching all “contact-cases” for any signs of the disease. Those in contact with the Index case should be in the clear by now, while those in contact with the paramedic and the nurse (as well as any hospital staff who are currently sick) are still at high risk. One should probably work on a 21-day incubation period/quarantine period to be safe.
6. Chances are this is a new virus (or new subtype of virus) in the [family _Filoviridae_]. The only 2 known viruses in this group are Ebola and Marburg. It looks as though [the infection] may have entered Zambia from the Democratic Republic of the Congo (DRC) through a tick (carried on a horse), but again this cannot be confirmed.
This comment assumes that labs in South Africa have already tested all known VHFs. It is unlikely to be pneumonic plague, as this would have been discovered in South Africa; however, it is still a possibility that this [putative] viral disease has been in the Southern Province of Zambia (and that the 4 reported cases seen there were not diagnosed or wrongly called pneumonic plague).
7. The important steps in control are 1. effective quarantine of sick patients, and 2. monitoring of all “in-contact” cases, with quarantine as soon as any signs of flu or fever are noted. The government should also ideally make a statement to calm the panic and prevent people from fleeing the capital (potentially carrying the disease countrywide). This disease only spreads to people who are in very close contact with sick individuals. Those family members who are potentially incubating the disease should be encouraged to stay around Lusaka, so that signs can be picked up quickly and treatment issued rapidly. Early treatment of most “viral hemorrhagic fevers” with ribavirin has been proven to reduce the fatality rate significantly. The country needs to import ribavirin if there is not enough in stock.
—
Communicated by:
Dr Amy Cantlay BVSc.MRCVS
Thank you for the information. I have a dreaded feeling that along with this bad economy we’ll end up with something else (like bird flu, etc.) to compound the problems - just like 1929 and then the Dust Bowl. The whole “Biblical Proportions” thing. (Now to bed and a prayer).
Nurse’s family members under observation
Two family members of the Morningside Medi-Clinic nurse who died of a viral disease have been put into isolation as a precautionary measure, the hospital said on Tuesday.
“We admitted them for observation under strict isolation regulations but none of them have shown any symptoms,” said regional marketing manager Melinda Pelser.
She said it had been confirmed that the three people who died of a “mysterious disease” at the clinic had suffered from a viral haemorrhagic fever but the cause of the disease was not yet known.
The Centre for Disease Control and Prevention in Atlanta was working with health officials in South Africa to investigate the cause, she said.
Thanks.
Quix ping.
H5N1?
h mmmm
The Statue of Liberty sonnet needs to be updated:
“bring us your tired, your homeless, your unemployed, your collectivists, your SICK”
The more I read that inscription on the SoL, the more I'm convinced it needs to be sandblasted away.
NO
God help us all if any of these strains ever become airborne.
Thank you for the ping. I still recall the Angola Marburg outbreak during which 400+ died, officially, and likely many more unofficially. It seemed rather remote, until we realized that there was a daily flight direct to Houston from one of the cities that had active cases. Also in that instance, there were dreadful conflicts between UN health officials, and Doctors Without Borders as they attempted to treat the afflicted.
The incredible problems created by the “space suits” worn by the UN officials, the cultural violation of burial customs and the lack of care for the victims all combined to paint the picture of a near-apocalyptic event.
I recall that the outbreak began with pediatric cases, and the death of a woman pediatrician who finally succeeded in alerting authorities, shortly before she herself died of Marburg.
At the end, I seem to recall that Canada had come up with a potential vaccine, but did not hear what became of that vaccine...
Of all the bugs lurking in Africa, the filoviruses are most worrisome to me...
“bring us your tired, your homeless, your unemployed, your collectivists, your SICK”
S/B
“bring us your tired, your homeless, your unemployed, your collectivists, your CONTAGIOUS”
bump
If Ebola Zaire ever becomes airborn, we’re screwed.
Thankfully it sticks to body fluids that get into the system of humans by eating monkeys (I think they’re appropriately called “Ebola Monkeys”) that aren’t properly cooked.
I share your sentiment.
the 4 horsemen....economic collapse, war, famine and pestilence, wide spread death!
Thank you for the ping.
... but will be encouraged by the media at an undisclosed date.
I'll hold the hysteria, but dang it, you owe me one...
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