Posted on 10/13/2008 4:54:48 AM PDT by Mother Abigail
The mystery viral hemorrhagic fever which killed 3 people in South Africa has been provisionally identified as an arenavirus, the National Institute for Communicable Diseases [NICD] and the Department of Health said on Sunday [12 Oct 2008].
"The causative agent of the disease may be a rodent-born arenavirus related to the Lassa fever virus of West Africa," NICD's Dr Lucille Blumberg said at the Charlotte Maxexe Johannesburg Academic Hospital.
She said tests done by the NICD and the Centers for Disease Control [CDC] in Atlanta, USA indicated that the disease seemed to be a kind of arenavirus. The World Health Organisation has also been providing technical assistance.
Arenaviruses cause chronic infections in multimammatic mice, a kind of wild mouse, which excrete the virus in their urine, which can then contaminate human food or house dust.
Viruses similar to the Lassa fever virus have been found in rodents in Africa, but other than in West Africa have not been found to cause diseases in humans.
She said there was no indication arenaviruses that could cause disease in humans were present in South African rodents.
Blumberg said further tests still needed to be done.
"It needs to be determined whether it is a previously unrecognized member of the arenaviruses and what its distribution is," she said.
The NICD's Robert Swanepoel said there were viruses of this family in Southern Africa but that this could be an undiscovered kind. "Not every country has been thoroughly searched," he said. He said the kind of rodents that carried the virus were not generally found in urban areas. "They are out there but attracted (to human dwellings) if there is inadequate waste disposal."
Crop disposal and animal feed also sometimes attracted them, he said. He said the kinds of viruses could range from causing mild fevers to being lethal. There were only 3 cases to work with for the kind of arenavirus now discovered, but "it looks like it is very lethal," he said.
Head of the NICD's Special Pathogens Unit, Dr Janusz T Paweska, said the arenavirus diagnosis came about after a number of tests. [Biopsies] conducted on the last 2 victims in which infected tissues, skin, liver and muscles were tested were critically important in making a diagnosis. A blood sample obtained in Zambia from the 1st victim also confirmed test results. He said doctors were now waiting for the virus to grow in cell culture to conduct further tests to identify what strain it was.
Gauteng health MEC [Brian Hlongwa?] said the 1st victim of the virus was [a] 36-year-old [woman], who was airlifted from Zambia to the Morningside Medi Clinic in Sandton on [12 Sep 2008] in a critical condition.
She is known to have lived in a smallholding on the outskirts of Lusaka where she kept 3 horses, although the exact point of contamination has never been discovered.
She fell ill on [8 Sep 2008] and was treated in 3 different hospitals in Lusaka. Once in South Africa, she was treated for tick bite fever and other potential infections but died 2 days later. She was not tested for viral hemorrhagic fever.
On [27 Sep 2008], a Zambian paramedic who accompanied her into the country was admitted to the hospital with similar flu-like symptoms, fever and a skin rash, and viral hemorrhagic fever was queried.
He developed diarrhea, severe headaches, nausea and vomiting, and although he initially seemed to respond to treatment, he died on [2 Oct 2008] at the clinic. A 3rd victim of the virus was a nurse from Morningside Medi-Clinic who attended [the 1st case].
She became ill with fever 18 days after [the woman from Zambia] was admitted to the hospital, and consulted a general practitioner, receiving intravenous therapy. She was then referred to Robinson Hospital in Randfontein and was later transferred due to a bedding shortage to Sir Albert Clinic. There, she was treated for a suspected case of meningitis. Her condition deteriorated, and she died last Sunday [5 Oct 2008].
A 4th person, a [37-year-old female] contract cleaner working at Morningside Medi-clinic, died in Charlotte Maxeke Academic hospital. Earlier this week, the health department said her death was not related to viral hemorrhagic fever.
On Sunday [12 Oct 2008?], Blumberg said a female nurse and a male paramedic were currently in isolation after they were in contact with the deceased.
The paramedic had contact with [the 1st case, the female from Zambia], and after developing flu-like symptoms and a fever was admitted to Flora clinic. He was subsequently transferred to Morningside Medi-clinic and diagnosed with kidney stones. On Sunday [12 Oct 2008], Blumberg said it was "less likely" he had the virus.
The 2nd person in isolation is a nurse who had contact with a paramedic that died [the 2nd patient, the male paramedic that accompanied the 1st patient to South Africa]. She has developed symptoms similar to the 3 deceased and is receiving anti-viral medication called ribavirin. The department of health said she was presently stable. Blumberg said she is "highly suspect" to have contracted the virus and could not say further how her condition was likely to progress.
This week, 3 other people who had been hospitalized after contact with the deceased were discharged. On Friday morning [10 Oct 2008], the 11-year-old son of the nursing sister who died [case number 3] and his 23-year-old nanny were discharged [presumably discharged from quarantine].
A cleaning supervisor at Morningside Medi-Clinic who had been admitted to the Chris Hani Baragwanath Hospital on Monday [6 Oct 2008] with symptoms of viral hemorrhagic fever was also released. On Sunday [12 Oct 2008], Hlongwa said she was currently "well." All 3 continued to be monitored as part of the disease surveillance system currently tracking 151 people who had contact with the deceased.
Blumberg said arenaviruses could cause a disease which spreads from human to human through contact fluids. In hospital settings, special precautions were needed when nursing patients.
People in contact with those who have contracted the virus must be monitored for 21 days following their last contact with the patient. Their body temperature is monitored, and those who develop fever or illness are admitted to an isolation ward in the hospital.
Blumberg said there was a drug which showed promising results in treating patients if their illness is recognized early.
Those who have been in contact with patients but are well do not spread infection.
On Sunday [12 Oct 2008], Gauteng health MEC Brian Hlongwa said the diagnosis of the virus was a step forward. "We are now a step further because we know specifically what we are dealing with." However, it was still vital to conduct more tests to find out what kind of arenavirus it was, he said.
Director General Thami Mseleku cautioned South Africans not to now fear that every mouse that came their way contained the virus.
Since the virus 1st broke out, medical officials have been at pains to emphasize that the general public is not at risk, as only people who were in direct contact with the bodily fluids of a person who had a confirmed case of the virus could be infected. --
As are the hantaviruses, each arenavirus is principally associated with rodents of a single or a very few species, thus the basis for their geographic distributions. An unusual exception may be Tacaribe virus, which has been isolated from bats and mosquitoes.
Most New World arenaviruses are not known to cause human illnesses but others cause severe illnesses: Machupo virus (Bolivian hemorrhagic fever), Junin virus (Argentine hemorrhagic fever), Guanarito virus (Venezuelan hemorrhagic fever), Sabia virus (Brazilian hemorrhagic fever), and Chapare virus.
Lassa virus has been shown to cause severe, often fatal, hemorrhagic fevers in human in a wide area of West Africa.
It is now recognized that this virus causes numerous illnesses each year. It will be enlightening when we have news of the identity of the viruses causing these illnesses in Zambia, and now in South Africa.
The investigations are in the hands of the world's most competent people for such studies, Dr. Robert Swanepoel of South Africa's National Institute for Communicable Diseases and collaborating investigators at the U.S. Centers for Disease Control and Prevention.
Therefore, definitive information regarding whether this is a hitherto unrecognized arenavirus or a variant of a recognized arenavirus should be forthcoming relatively soon. Meanwhile, clinical practices to control further spread should suffice.
If the etiologic agent is in fact an arenavirus, ribavirin is presently used for the treatment of Lassa fever.
Absolutely fascinating. Thank you.
Thank You,
FYI
Thanks for the ping. At least we know what it is. Lassa fever’s pretty nasty stuff and its cousin sounds even nastier. BTT.
Thank you, Mother Abigail.
Ping.
Wow, wow, wow. Thanks for the update.
Another nursing sister has contracted the haemorrhagic fever that has killed at least three other people.
She was admitted to Sandton’s Morningside Medi-Clinic last week for closer observation and has now been diagnosed with the virus.
On Monday, Dr Lucille Blumberg of the National Institute for Communicable Diseases (NICD) said tests by the institute had confirmed on Sunday night the case of arenavirus infection.
Earlier on Sunday, the NICD and the Centres for Disease Control in Atlanta, US, released test results that classified the previously unidentified virus as a rodent-borne member of the arenavirus family, related to Lassa fever.
The infected sister attended to the second person who died, paramedic Hannes Els, and was placed on the list of people who had close contact with those who contracted the disease.
Their temperatures are being monitored daily.
On Friday, after showing changes in temperature, the nurse was admitted to the hospital and placed in an isolation ward.
Her condition is said to be stable, and she is being treated with ribavirin.
Blumberg said they didn’t know how well ribavirin would work for the virus, because they didn’t yet have a lot of information about the virus.
She said further tests were being done to find out more, and results would be available within two weeks.
The infected nursing sister’s family had been placed on the list of contacts being monitored by Morningside. It now numbers 91 people.
A West Rand hospital previously said it was monitoring another 66.
Those on the list are being monitored for 21 days after their last close contact with an infected person.
Meanwhile, a second Morningside Clinic nursing sister was admitted on Monday after showing fluctuations in temperature. She is being closely monitored.
A male paramedic, admitted last week, is also under close observation. He is not thought to have the disease.
Three other people under out-of-hospital observation were admitted and discharged since the list was first established.
Experts say haemorrhagic fevers are passed between humans through contact with bodily fluids.
On Monday, a Gauteng department of health spokesperson said tests had confirmed that two of those who died had the virus - paramedic Els and Morningside Medi-Clinic nursing sister Gladys Mthembu.
Samples were not taken from the first person who died, Zambian tour operator Cecilia van Deventer.
She is believed to be the index case, or first person infected with the virus.
The spokesperson said the results of tests for a fourth person who died, Morningside Medi-Clinic contract cleaner Maria Mokubung, were still awaited. These were expected before the end of the week.
Although Morningside officials said Mokubung was ill for months with another unrelated illness, her death is being treated as related to the others until tests prove otherwise.
Her funeral on Sunday was conducted as if she was contagious, and her body was placed in three plastic bags, a coffin and an outer layer of thick white plastic.
Mokubung cleaned the ICU where Van Deventer lay.
Now her colleagues are too scared to clean the isolation room where the ill nursing sisters are being treated.
One of the cleaners said: “I am no longer comfortable cleaning the wards, especially Section A. The two patients are there. I am very scared. What if I die? I am not going to enter that ward. It’s too risky.”
Said another: “All the sisters who were working at Section A were wearing gowns, but the cleaner was wearing normal clothes.
“We know that working there is dangerous, but there is not much we can do. The cleaner there was aware of the situation but could not say no.”
Morningside spokesperson Melinda Pelser said there was no reason for cleaners or employees to be scared - provided they had no direct contact with the patients.
Thanks , Mother Abigail for the info !
One of the very few times a man can count his blessings to have kidney stones.
Thanks for the update ping.
Thanks for the update.
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