Unidentified and Highly Infectious Disease kills 3

[Solitaire]

Hospitals on alert for deadly infection

October 06 2008 at 07:03AM

By Lesego Masemola and Sapa

Pretoria's Steve Biko Academic hospital is one of several in the province which have been placed on high alert following the death of three people from a highly infectious disease.

On Sunday the Gauteng health department said three people had died in Johannesburg.

"We are on high alert following the confirmation of three cases of an unknown, highly infectious disease which has since led to three deaths," the department said in a statement.

Medical advisor for public health Dr Chika Asomugha said the first patient was a tourism manager from Zambia brought into the country for urgent medical treatment.

She had severe flu-like symptoms, diarrhoea and a rash. The unnamed woman was critically ill when she arrived on September 12 and died shortly afterwards at the Morningside Medi-Clinic.

"Blood samples were taken and the results were not conclusive of any particular disease, including the viral hemorrhagic fevers," the department said.

The second patient was a Zambian male paramedic who had accompanied the woman to South Africa. He was admitted on September 27 at the same facility with flu-like symptoms and treated for a variety of infections.

"His condition initially improved but later deteriorated on Wednesday, October 1 and he died the following day," the statement said.

Investigations for viral hemorrhagic fever and other formidable infectious diseases were conducted and the results were negative.

A nurse at Morningside Medi-clinic who came into contact with the first patient became ill with flu-like symptoms and was subsequently admitted to the Sir Albert Robinson hospital on the West Rand on Wednesday.

"Her condition deteriorated on Saturday and she passed away yesterday (Sunday). Viral hemorrhagic fever and other formidable infectious diseases were negative," said the statement.

According to the department, systems were in place to follow up on everyone who had contact with the deceased. Asomugha said it was crucial that any person who had come into contact with the deceased be medically examined at the nearest health facility.

"The disease is unlikely to spread throughout the province but it is important that those experiencing these symptoms or have come into contact with the deceased, go for a check-up.

"We have not yet got a complete diagnosis, but experts are running as many tests as possible," he said.

Health care workers and family members were being monitored for raised temperatures and flu-like symptoms for a period of 21 days.

Asomugha said symptoms to look out for were fever and flu-like symptoms, vomiting, diarrhoea, body aches and coughing.

"Steve Biko Academic and Charlotte Maxeke Academic hospitals are on high alert and ready to handle any cases related to this situation," said the statement.

Steve Biko Academic hospital spokesperson Fredah Kobo said the hospital's infection care unit and its staff were on high alert, although no cases have been reported.

"We are aware of the department's alert and the unit is on standby to handle any cases of the reported disease," she said.

The department's spokesperson Zanele Mngadi said the two hospitals had facilities and specialists to deal with the disease.

Members of the public who had travelled to Zambia during the last month, and who suffered from raised temperatures or flu-like symptoms were requested to report to the nearest health facility for examination.

http://www.iol.co.za/index.php?from=...5307810C468348

This article was originally published on page 1 of Pretoria News on October 06, 2008

[Solitaire]

Another dies of mystery disease
Gill Gifford and Solly Maphumulo
October 06 2008 at 10:07AM

A fourth person died of a highly infectious disease on Sunday night - and Gauteng health officials have admitted they have no idea what they're dealing with.

A woman brought to the Morningside Medi-Clinic in Sandton from Zambia, the paramedic who accompanied her, a nurse at the clinic and now one of the cleaning staff have all died of a mystery disease, sparking a crisis situation that has health authorities working hard to track everyone who has been in contact with them so that they can be monitored.

Dr Chika Asomugha of the Gauteng Health Department said everyone who may have been in contact with the patients has been alerted and, should they have a high fever or show flu-like symptoms, they would be quarantined immediately.


While a definite diagnosis of the disease has not yet been made, it appears to be similar to viral haemorrhagic fever. The patients' symptoms included fever, vomiting and diarrhoea.

'We are dealing with something we don't understand'
While the symptoms were in line with "viral haemorrhagic fever and other formidable infectious diseases", all tests conducted have returned negative for such diseases.
"We are not so very comfortable saying we are dealing with viral haemorrhagic fever. We are dealing with something we don't understand," Asomugha said, explaining that viral haemorrhagic fever is the term for a group of diseases including Ebola, yellow fever and Congo fever.

There was no treatment for these diseases, he said.

Symptoms included fever, nausea, vomiting, diarrhoea and bleeding.

The first victim was a 36-year-old South African woman who was airlifted from Zambia to the Morningside Medi-Clinic, where she died on September 12.

"Where she comes from we have no clue, but we are in the process of trying to contact her family to find out more," Asomugha said.

What is known is that the woman had been living in Zambia "for some time" and was working as a tourism manager.

She apparently often went horse-riding "into the bushes on adventures".

She fell ill and was admitted to a Zambian hospital, where doctors were unable to diagnose her ailment. She was transferred to two other hospitals, but her condition continued to deteriorate.

A decision was made to airlift her to South Africa and so, along with a paramedic, she was flown to Morningside Medi-Clinic.

"She was dead by the time she arrived, so we were not able to get any information from her directly," Asomugha said.

The 33-year-old paramedic returned to Morningside Medi-Clinic on September 27 with the same symptoms as the woman who had died. He died on October 2.

The third person to take ill was a nurse from the clinic who had come into contact with the first patient.

She took ill with flu-like symptoms and was admitted to the Sir Albert Robinson Hospital on the West Rand on October 1. She died there on Sunday.

On Monday morning a fourth person, a cleaner who had worked at the Morningside Medi-Clinic, died in the Charlotte Maxeke Johannesburg Academic Hospital.

Gauteng Health spokesperson Zanele Mngadi said the woman was initially admitted to Leratong Hospital. She was transferred to Charlotte Maxeke Johannesburg Academic Hospital because it is a specialised facility.

"We are still waiting for the clinical report to be completed," Mngadi said.

She said the department was trying to track down the woman's family so that they could be quarantined.

"They have to be monitored for 21 days," Mngadi said.

According to Asomugha, a room has been set up for patients to be quarantined and monitored at the Morningside Medi-Clinic.

"We need to keep these people separate from the public," he said, explaining that work was now being done to trace every possible contact each of the patients had after contracting the disease.

Morningside Medi-Clinic spokesperson Melinda Pelser said hospital staff who had been in contact with the deceased patients were being monitored.

"All the staff who had anything to do with the patients have been followed up. We contacted them by telephone. They are aware that they should notify us if there is any change in their temperature or if they have any flu-like symptoms," Pelser said this morning.


People who have visited Zambia during the last month and who are showing signs of fever or flu-like symptoms should report to their nearest health facility for a medical examination, say officials.

http://www.iol.co.za/index.php?from=...0707259C129521

This article was originally published on page 1 of The Star on October 06, 2008

[NBY]

Thanks for flagging this up, Solitaire. It's an horrific and salutory story; let's hope the outbreak turns out to be self-limiting to those poor folk whom it has attacked.

[Solitaire]

No travel alert to Zambia

October 06 2008 at 03:58PM

Johannesburg - Zambian authorities and the World Health Organisation (WHO) have mounted investigations into the unknown disease that has so far claimed four lives in South Africa.

Zambia's High Commissioner in Pretoria, Leslie Mbula, said on Monday reports from Zambia indicated that no other person in the country had contracted the "mysterious disease".

"Zambia has mounted an investigation and is working closely with the World Health Organisation. Apart from the two people who died at Morningside Medi Clinic, there have been no reports of anyone presenting with the illness in Zambia," Mbula said.

Mbula said he had spoken to the Permanent Secretary in the Ministry of Health, Simon Miti, who confirmed the situation.

Zambia's health minister Brian Chituwo was due to release a statement later on Monday.

Four people have died in South Africa of a highly infectious disease that has yet to be identified, the health department has said.

The first casualty was a woman from Zambia who was critically ill when she arrived in South Africa on September 12. She was treated for tick-bite fever and other potential infections at Morningside Medi-Clinic, but died two days later.

Blood tests were not conclusive for any disease.

The second victim was a Zambian male paramedic who had accompanied the woman. He was admitted on September 27 with flu-like symptoms and treated for a range of infections.

A nurse from the clinic also died following contact with the Zambian woman.

The fourth was a cleaner who had worked in the ward.

South Africa's foreign affairs spokesperson Ronnie Mamoepa said South Africa had not issued a travel alert to Zambia.

"We have not issued a warning to travellers. But speak to the department of health, they are dealing with the issue," Mamoepa said.

Mbula, however, said people should not be afraid of travelling to Zambia.

"Please continue travelling to Zambia. There is no danger," he said. - Sapa


http://www.iol.co.za/index.php?from=...4719501C877185

[Solitaire]

Mystery disease not airborne - Medi-Clinic

October 06 2008 at 12:56PM

The flu-like illness which has killed four people in Johannesburg is not airborne but is contracted through bodily fluids, said a spokesperson at the Morningside Medi-Clinic on Monday.

"The disease is transferable through bodily fluids and is not airborne. We want to ensure that there's no panic in the broader public... There is no outbreak at the hospital. We currently don't have patients with the same symptoms," said regional marketing manger Malinda Pelser.

Tests were not conclusive of any particular disease including viral haemorrhagic fevers.

Pelser said hospital staff who had been in contact with the four people who died of this illness were being continuously monitored.

"We are monitoring those who treated the four patients who passed away but it's in the hands of the department to trace and monitor families and other people," she said.

The latest victims at the hospital were a cleaner and a nurse - both died on Sunday. However, Pelser said, the cleaner was not employed by the hospital, but by an outsourcing company.

Another, a Zambian woman who arrived at Morningside Medi-Clinic with flu-like symptoms on September 12, was treated for tick bite fever and other potential infections. She died two days later.

A Zambian paramedic who accompanied her into the country died last week.

Pelser said the cleaner had been off work when she fell sick and the hospital called her home to enquire about her health.

"She fell ill off duty. She had been having problems with her health for months."

Although the woman had the same symptoms as three others who died, this could not be confirmed because of her health history.

The hospital would follow strict protocol and infection control measures, including isolation, if any other patient presented the same flu-like symptoms.

The health department said it would conduct tests and post mortems to establish the cause of these deaths.

Those who visited Zambia in the last month and were experiencing flu-like symptoms or raised temperatures were urged to immediately go to their nearest hospital for examination. - Sapa

http://www.iol.co.za/index.php?set_i...5240855C290858

[NBY]

Now that's reassuring, eh? 'Bodily fluids'....quantity, source, potential vectoring? 'Sick for months'' i.e. attentuated immune response?

I could buy all this with the Ebola or Marburg tag...but without a diagnostic source? Hmmm.

[ltow]

If it is airborne it will be hard to miss the growth.
If it is not - it will disappear like so many of these do.

[Solitaire]

Mystery virus: woman put into isolation
Published:Oct 07, 2008


A woman with symptoms similar to those of at least three people who have died of a mystery disease has been put into isolation at Chris Hani Baragwanath Hospital, reports Talk Radio 702.

http://www.thetimes.co.za/News/Article.aspx?id=857869

[Dutchy]

From ProMED mail:


Date: Mon 6 Oct 2008
From: Amy Cantlay <inka@iwayafrica.com>


I have just read the posting (Undiagnosed fatalities - South Africa
ex Zambia: RFI 20081005.3139) on your site, and it appears to be
rather misleading. 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 inka@iwayafrica.com
Veterinarian
Mkushi, Zambia

[ProMED-mail thanks Dr. Cantlay for her commentary, which contributes
some interesting detail. At this point, it would not be useful to
speculate further on the identity of the infectious agent responsible
for the deaths of the 4 Zambian patients. No doubt a firm diagnosis
will be available shortly from a South African reference laboratory.
Several different viruses cause viral hemorrhagic fever. Of these,
Ebola, Marburg, Lassa or Crimean-Congo hemorrhagic fever viruses have
not been recorded in Zambia up to the present. A comprehensive
account of these and other viruses responsible for hemorrhagic fevers
can be found at the US CDC website:
http://www.cdc.gov/ncidod/diseases/virlfvr/virlfvr.htm.

A map of Zambia can be accessed at
http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg,
and a map of South Africa at
http://www.lib.utexas.edu/maps/afric...a_pol_2005.jpg.
- Mod.CP]

http://www.promedmail.org/pls/otn/f?..._ID:1000,74261

[Solitaire]

Mystery virus: ‘Don’t panic’
Werner Swart Published:Oct 07, 2008

At least three dead, but ‘don’t panic’


Health department clueless about killer virus, but tells the public:

THE department of health has warned against panic at the news that a mystery virus has killed at least three people — and possibly a fourth — as experts frantically try to identify the disease.




•Lethal mystery virus ‘not airborne’



•Zambia investigates mystery virus



•Hospital cleaner dies of mystery fever



•All four victims died at hospitals in and around Johannesburg in the last four weeks;


•The outbreak of the disease was sparked on September 12 with the arrival in South Africa of a patient from Zambia. The patient was admitted to the Morningside Medi-Clinic, in Sandton, and came into direct contact with two people who have since died;


•Surveillance has been heightened at the Lanseria and OR Tambo International airports, and the health department’s outbreak response team has been working to contain the disease;


•The virus appears to be transmitted through contact with body fluids and is not airborne. It might be a new form of viral haemorrhagic fever.


South African-born Zambian citizen Cecilia van Deventer, 36, was the first victim of the virus. She died two days after being admitted to the Sandton hospital.

The next victim was the paramedic who assisted Van Deventer on her emergency airlift from Zambia, 33-year-old Hannes Els, from Brakpan on the East Rand.

An unnamed nurse has died after coming into contact with Van Deventer in hospital.

There is uncertainty over the cause of death of a cleaner who worked in Van Deventer’s hospital ward.

Fidel Hadebe, the department of health spokesman, urged people “not to panic”.

Hadebe said: “Blood samples of three of the cases are negative for any particular disease, including viral haemorrhagic fevers.

“The department is, at this stage, unable to link the death of the fourth patient [the cleaner] to the initial three cases, given the fact that she was admitted for an unrelated health condition and did not develop similar symptoms . Further tests will be conducted to ascertain the cause of death.”

Gauteng health department spokeswoman Zanele Mngadi said the department continued to suspect some form of viral haemorrhagic fever, perhaps one not encountered before, as the cause of the deaths.

Hadebe said the results of further tests on blood taken from all the deceased were awaited.

The Times has learnt that blood samples have been sent to the Centres for Disease Control, in Atlanta in the US.

Hadebe said all health facilities are required to comply with universal infection-control measures. These include the washing of hands and the use of gloves to ensure that health workers avoid contact with the body fluids of those suspected of having a communicable disease.

He said everyone who had been in contact with those who died was being monitored.

“At this stage, the department cannot confirm speculation linking the deaths to Ebola or any of the other viral haemorrhagic fevers,” he said.


Van Deventer, who reportedly worked in tourism in Zambia, was airlifted to South Africa by Speciality Emergency Services, a Zambian medical emergencies service, most of whose employees are South African paramedics. Its website describes it as an advanced life-support service and boasts of its “extensive contacts in South Africa”, which ensure “quick admission and treatment of our patients into the finest A-grade facilities”.


Els, who returned to Zambia after Van Deventer was admitted to the Morningside Medi-Clinic, subsequently became ill and was also airlifted to the Sandton hospital.

He died on Thursday.

Shortly after his death, a nurse and a cleaner at the hospital also became ill. Both died, in different hospitals, on Sunday.

Marianthi Noble, manager of Speciality Emergency Services, in Zambia, said Els accompanied the first patient on a medical charter flight from Lusaka. She could not say where the plane had landed.

Noble said Els had worked for her company for eight months, adding: “He was a very nice person and a good paramedic.

“This is a great loss to us.”

Melinda Pelser, spokeswoman for Morningside Medi-Clinic, said no other staff or patients at the hospital were at risk because the virus was not airborne.

Her advice was: “Please don’t panic.

“If this were an airborne disease, we would have had hundreds of patients by now.”

Pelser said the disease was contracted through contact with body fluids.

But Pelser was able to confirm that the unnamed cleaner had worked in the ward to which Van Deventer was admitted.

Mngadi said: “We have advised [family members and hospital staff who might have come into contact with those infected] to monitor their temperature twice a day for 21 days.

“We will be looking for the acute onset of fever that is greater than or equal to 38 degrees.”

Symptoms of the disease are vomiting, nausea, a high temperature and a rash.


•The Democratic Nurses’ Union said the risk of exposure to new outbreaks of the mystery disease cannot be understated and the deaths so far show the dangers to which healthcare professionals are exposed.

“It is sad indeed that these professionals should die while in pursuit of their conviction and commitment to selfless service to their countrymen,” said the union’s general secretary, Moeketsi Mohai.

“We hope and pray that no further health professionals, workers, patients and ordinary citizens become casualties of this outbreak.”

http://www.thetimes.co.za/News/Article.aspx?id=857551

[Solitaire]

South African Killer Disease May Be Congo Fever, Star Says

By Nasreen Seria

Oct. 7 (Bloomberg) -- A mystery infectious disease that killed four people in Johannesburg may be Congo fever, the Star reported, citing Lucille Blumberg of South Africa's National Institute for Communicable Diseases.

The viral hemorrhagic disease was most likely Congo fever, which is carried by a species of tick, because the first victim, Cecilia van Deventer, had contracted the disease in Zambia, the Johannesburg-based newspaper said.

The second victim was a paramedic who had flown with the victim from Zambia on Sept. 12, and the other two were a nurse and a cleaner at the Johannesburg hospital where van Deventer had died, the Star said. The victims had suffered flu-like symptoms as well as fevers, diarrhea, a rash and bleeding, the newspaper added.


Last Updated: October 7, 2008 01:46 EDT

http://www.bloomberg.com/apps/news?p...4&refer=africa

[Solitaire]

CONGO FEVER FACT SHEET

[Solitaire]

Mystery virus: three people in isolation
Sapa Published:Oct 07, 2008


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 today.


"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.


Pelser also said it had been confirmed that the cleaner who worked for a contract company at the hospital did not die from the viral fever.


"She died of a neurological illness. It has been established that she was not near the patient," said Pelser.


The first casualty who succumbed to the viral disease was a 36-year-old woman who was airlifted from Zambia to the Morningside Medi-Clinic in Sandton on September 12.


Radio Talk 702 reports that the woman, Cecile van Deventer, is the cousin of former Springbok captain Corne Krige.


She was treated for tick-bite fever and other potential infections but died two days later.


A Zambian paramedic who had accompanied her into the country died last week and a nurse at the Morningside Medi-Clinic died on Sunday.


The cleaner also died on Sunday.


Pelser said the incubation period for the disease was between 72 hours and 21 days.


"We know that it is not airborne and is contracted through the bodily fluids of the infected person," she said.


Symptoms include high fever, muscle aches and pains, diarrhoea and a rash.


Meanwhile, Talk Radio 702 reports that a third person has been placed in isolation at the Chris Hani Baragwanath Hospital

http://www.thetimes.co.za/News/Article.aspx?id=857869

So 3 people have died, 1 in isolation with similar symptons and 2 in isloation as a precaution.

[Solitaire]

This might be the patient in isolation with similar symptons

"Chituwo said unconfirmed reports indicated that an ambulance driver who had driven the first patient from Lanseria Airport to the hospital was in a critical condition"

http://www.redorbit.com/news/health/...ource=r_health

[vince08]

would an ambulance driver get close enough to get,bodily fluids on him/her....?

[Dutchy]

Cleaner's supervisor isolated

October 07 2008 at 11:07AM

At least nine people have been isolated or put under observation after the deaths of four people from a mystery disease.

On Monday, health authorities finally traced the families of Maria Mokubung, 37, from Slovoville, who died on Sunday night at Charlotte Maxeke Johannesburg Academic Hospital, and nursing sister Gladys Mthembu, 34, of Westonaria, who died on Saturday.

Both worked at Morningside Medi-Clinic Private Hospital in Sandton, where the first two victims died. Mokubung was a cleaner and Mthembu a nurse, and both had contact with the first victim.

In a dramatic development on Monday afternoon Mokubung's supervisor went to Chris Hani Baragwanath hospital and was put in an isolation ward.

Zanele Mngadi, spokesperson of the Department of Health, said the woman checked herself in at the hospital yesterday after hearing about Mokubung's death.

The woman told the hospital staff that she had been feeling ill for a few days, had flu-like symptoms as well as fever.

"Her blood samples have been taken and we are waiting for the results," Mngadi said.

At the moment, the only people who have access to her are medical staff in protective gear.

Morningside Medi-Clinic spokesperson Melinda Pelser said the disease had been identified as a viral haemorrhagic fever, the exact strain had not been identified as tests for ebola, Congo fever and other likely possibilities had all returned negative.

"Congo fever is most likely the suspect, and a viral haemorrhagic fever is high on the list," said Dr Lucille Blumberg, of the National Institute for Communicable Diseases (NICD).

Blumberg said tests on samples from victims were continuing, but the fact that the first person to be infected came from Zambia meant that of all the haemorrhagic fevers, Congo was the most likely. The Congo fever virus is carried by a species of tick and is found throughout Southern Africa.

"They haven't had Ebola or Marberg outbreaks in Zambia, and you even get Congo fever here in South Africa," explained Blumberg.

She said that so far there were no other known cases of the mystery illness in Zambia.

"What we are doing is following the trail of possible exposure, looking for contacts that person had, trying to find the pieces of the puzzle."

National Health Department spokesperson Fidel Hadebe said the department could not confirm speculation linking the deaths to haemorrhagic fevers.

The NICD is conducting a battery of tests, some of which could take days to complete. The priority, explained Blumberg, was to isolate the patient.

Samples might be sent to the US for further tests.

Symptoms have included flu-like illness, fever, diarrhoea, rash and bleeding.

Health authorities urged people not to panic and warned those who developed such symptoms who had been in Zambia, or had contact with the deceased, to get help.

The first victim was tourism operator Cecilia van Deventer, 36, who was flown to the Morningside clinic on September 12 from Zambia in a critical condition after being ill for three weeks. She died two days later.

On September 27, the paramedic who had flown with her from Zambia, Hannes Els, 33, of Speciality Emergency Services in Lusaka, returned to SA and was admitted to the Morningside clinic with similar symptoms, said Morningside manager Jaco Erasmus. Els died on October 2.

Dr Nivesh Sewlal, who was treating Els at the Morningside clinic, said he had diarrhoea, high fever and a rash.

Blood samples were taken from Els and Van Deventer, 36.

"The results have been negative for viral haemorrhagic fever. However, they have died of what of what seems to be a viral illness," Sewlal said.

The NICD was alerted last Monday night and began investigating a possible outbreak of West Nile haemorrhagic fever.

By then, two people who worked at the Morningside clinic had fallen ill - but they ended up in hospitals that did not know they had been in contact with someone who had died from an unknown infectious disease.

Mthembu fell ill on October 1 and was admitted to a general ward with four other patients at Sir Albert Robinson Hospital on the West Rand.

She had not told the Sir Albert Robinson Hospital she was ill, but it was only the following day before Morningside alerted the hospital to the problem and Mthembu was put in isolation. She died on Saturday.

Sir Albert Robinson spokesperson Marion van der Walt said eight people, including staff who had contact with Mthembu, were put in isolation for observation.

"We're confident that none of those patients were affected," Van der Walt said.

By then, Morningside clinic was trying to trace all staff who had contact with Van Deventer or Els.

The clinic and Health Department emphasised Mokubung had been ill for months before she had ever been in contact with Van Deventer.

Pelser said there was "a very low possibility", that her case was linked to the others.

http://www.iol.co.za/index.php?set_i...4101304C470799

[Dutchy]

Mystery S.Africa killer disease may be Congo fever

Tue 7 Oct 2008,

By Michael Georgy

JOHANNESBURG (Reuters) - A mystery disease that has killed three people in South Africa and put medical authorities on high alert may be Crimean-Congo hemorrhagic fever, a health official said on Tuesday.

"We suspect that it may be Congo hemorrhagic fever but we have not made a diagnosis yet," Frew Benson, the South African Health Department's deputy director of communicable diseases, told Reuters.

South African health officials said on Monday they were closely monitoring the illness, which causes external and internal bleeding, but called on the public not to panic. There were no signs it was airborne.

South African authorities were due to send blood samples to the U.S. Centers for Disease Control and Prevention in Atlanta on Tuesday, Benson said.

The first fatality from the mystery disease was a patient from Zambia flown to South Africa for treatment. A paramedic who accompanied her later died from the same symptoms, health authorities said. A third person also died from the illness.

A cleaner at Johannesburg's Morningside Clinic who was suspected of contracting the disease died of an unrelated condition, said the hospital's spokeswoman, Melinda Pelser.

CCHF, which causes death in around 30 percent of hospitalised patients, is carried by domestic animals and can be transmitted by ticks. It is found in Africa, Eastern Europe and Asia. The first patient was originally treated for tick bite fever.

TREATMENT POSSIBLE

CCHF first appeared in Crimea in 1944 and was later identified in 1956 as the cause of an illness in what is now Democratic Republic of Congo.

Cases have been recorded in Kosovo, Albania, Iran, Pakistan and South Africa. Symptoms include headaches, back pains, vomiting, severe bruising and nose bleeds.

According to the World Health Organisation, CCHF can be treated but recovery is slow. If treatment is not provided in time, death can occur in the second week of illness.

There are several other strains of hemorrhagic fever, including Ebola and Marburg, which have killed hundreds of people in outbreaks in Africa. These diseases cause bleeding from multiple sites and can have very high death rates.

Ebola is rare, but there is no known cure and the virus usually kills between 50 and 90 percent of its victims.

It is spread through contact with bodily fluids of a patient. As with other hemorrhagic fevers, patients die from dehydration, bleeding, and shock.

The latest outbreak, which ended in February in Uganda, was unusually mild, killing 37 people out of 149 infected.

http://africa.reuters.com/top/news/usnJOE4960DK.html

[bobm]

Originally Posted by russell family

would an ambulance driver get close enough to get,bodily fluids on him/her....?

No, not if he was only the driver.
Yes, if he helped to put the patient in the car or cleaned it afterwards.
It still bears watching.

[andy]

Have'nt had a new disease thingy to look at in a while.... have'nt even been to FC ina couple of months.....

Think I will check out Niman....


.... nothing there?!....

[Dutchy]

Outbreak: 121 under observation

7 October 2008,

About 121 people who came into contact with three people who died of an unknown kind of viral haemorrhagic fever remain under observation although all appear fine, Joburg doctors said on Tuesday.

Doctor Lucille Blumberg of the National Institute of Communicable Diseases said while the illness was currently "controlled", doctors would have to wait for 21 days before they could possibly declare it contained.

Twenty one days is the period doctors believe the illness could still move from exposure to incubation to manifestation.

A list of 121 people who came into contact with the deceased has been compiled and those people were having their temperatures taken every six hours for the three-week period.

"If we are not sure of their symptoms we will put them in isolation to evaluate," said treating doctor Nivesh Sewlall.

On September 12, a 36-year-old woman, Cecilia van Deventer, was airlifted from Zambia to the Morningside Medi Clinic in Sandton. She was treated for tick bite fever and other potential infections, but died two days later.

A Zambian paramedic who accompanied her into the country died last week, and a nurse at the clinic died on Sunday.

On Tuesday, Sewlall said of those being observed, six people had been taken to hospital but four had already been discharged.

A 51-year-old cleaning supervisor who was admitted to Chris Hani Baragwanath hospital with symptoms of the illness was also ready to be discharged on Tuesday.

Blumberg said her blood tests had come back clear and she was fine.

The 11-year-old son of a nurse that passed away, and his 23-year-old nanny, were still being kept in hospital although neither displayed any symptoms.

"He is fine, but it is a traumatic time and it's more for trauma counselling," said Sewlall.

His nanny had initially displayed a marginally high fever, but was now fine, with her blood test normal.

Doctors said while the recent death of a cleaning staff member at the Morningside Medic-Clinic was probably not related to the other deaths at the hospital, they could not disregard anything at this stage.

"Scientifically we can not exclude anything until we get to 21 days," said Sewlall.

Sewlall and other medical officials held a news conference at the Morningside Medi-Clinic on Tuesday, because they said they wanted to dispel misconceptions and panic around the illness.

Intensive care specialist professor Guy Richards said: "The public at large are not at risk, only those with direct exposure to the three cases".

Morningside Medi-Clinic Gauteng marketing manager Melinda Pelser said: "This hospital is at no risk, this is where there is a huge misunderstanding.

"You cannot contract the illness through air, [you cannot contract it] unless you have had direct contact with a patient mostly though blood, stool and urine. We don't want panic out there."

Blumberg said there was also no outbreak of the illness in Zambia itself and there was no risk of contracting the disease through travel to Zambia.

Sewlall said the idea that it was a disease that doctors had never heard of and knew nothing about was incorrect.

Blumberg said: "We don't have a diagnosis as yet.

"It is a viral haemorrhagic fever but we don't know what caused it."

Not knowing the cause made no difference to how patients were managed, said Richards.

"Treatment is not harmed by the fact it has not been identified."

Blumberg said various tests were being done but these could take some time.

Her institute was also collaborating with the US Centres for Disease Control.

On Tuesday the World Health Organisation (WHO) said it had flown in a laboratory expert and a disease surveillance expert to help the South African health authorities determine the illness.

Blumberg said the first victim, a tourism operator, probably contracted the illness in Lusaka.

She lived on the outskirts of the city in a place where there were horses and exposure to ticks.

Sewlall said she was ill for about 10 days before coming to SA and did have a tick bite but had not identified a specific incident of when she got ill.

Sewlall said all precautions had been in place such as masks and gowns for the nurse who contracted the illness. - Sapa

http://www.thestar.co.za/?fSectionId...46216C145 841

[Solitaire]

'Five days later she was dead'
07/10/2008 21:15 - (SA)
Verashni Pillay


Johannesburg - Former Springbok captain Corné Krige said on Tuesday that the death of his cousin is a tragedy, after she was killed by a mystery disease contracted in Zambia.

Cecilia van Deventer, 35, was airlifted from Zambia to the Morningside Medi-Clinic in Sandton on September 12 and treated for tick-bite fever and other potential infections, but died two days later.

The as yet unidentified virus has killed at least two other people and South African health authorities are on high alert.

Krige, 33, told News24 he grew up with Van Deventer in Lusaka, where the rugby hero was born and lived till the age of seven.

Zambian origins

His parents still live in Zambia, as does Van Deventer's family.

She lived on a farm close to her sister and father, who Krige said were shocked at her sudden death.

He recalled Van Deventer's great love of the outdoors. "She hated wearing shoes!" he said. "She was a person who loved being out in the fields and in the bush.

"It was such a tragedy that she was taken so early."

In his 2005 autobiography, The Right Place at the Wrong Time, Krige recounted joint holidays in the bush with "Uncle Ouboet and Aunt Bennie, and their daughters Magda and Cecilia who were the same age as my two older brothers".

He was related to them via his mother, Cecilia Krige.

"We'd have great fires that lasted all night, and when you lay down to sleep, you could hear hippos, hyenas and other animals," he wrote of the trips.

Passion for the outdoors

It was this upbringing that inspired Van Deventer's passion for the outdoors.

Van Deventer, also known as Silky, was a reservations manager for Wilderness Safaris in Lusaka.

But it was probably during her adventures in the bush that she was bitten by a tick. She became extremely ill but Zambian hospitals could not diagnose her disease and she was airlifted to the Morningside Medi-Clinic in Sandton on September 12.

She was treated for tick-bite fever and other potential infections, but died two days later.

A Zambian paramedic, Hannes Els, who accompanied her to South Africa, died last week, and a nurse at the Morningside Medi-Clinic, Gladys Mthembu, died on Sunday.

A cleaner from the hospital died on Sunday, but her death has not been conclusively linked to the disease.

Outbreak

Authorities have isolated certain family members of the deceased and were monitoring other close contacts as they race to identify the highly contagious virus.

The Department of Health's chief director of communicable diseases, Dr Frew Benson, told News24 on Tuesday it was suspected to be Crimean-Congo haemorrhagic fever (CCHF).

Krige attended Van Deventer's funeral last week in Lusaka.

"Her father and her sister are still very saddened because it all happened so quickly," he said.

"She was a healthy young woman and five days later she was dead."

- News24

http://www.news24.com/News24/South_A...405818,00.html

[Kassy]

Update on ProMed:
http://www.promedmail.org/pls/otn/f?..._ID:1000,74355


The results of tests conducted at the Centers for Disease Control in
Atlanta (CDC), USA, and at the National Institute for Communicable
Diseases of the National Health Laboratory Service in Johannesburg,
provide preliminary evidence that the causative agent of the disease
that has resulted in the recent deaths of 3 people in hospitals in
Johannesburg, is a rodent-borne arenavirus related to the Lassa fever
virus of West Africa. Further tests, to confirm the diagnosis by
growing the virus in culture and to characterize it further, are in
progress. It needs to be determined whether it is a previously
unrecognized member of the arenaviruses, and what its distribution
and reservoir host are.

Arenaviruses cause chronic infection in wild rodents (multimammate
mice) with excretion of virus in urine, which can contaminate human
food or house dust. Arenaviruses have been found in southern African
rodents in the past, but there has been no previous association with
human disease. The virus associated with the present outbreak may
prove to be a new member of the group.

In the current outbreak there have been 3 deaths, the index case
ex-Zambia and 2 persons who acquired disease after close contact in
the nosocomial setting. A 4th patient, a nurse, who had close contact
with the 2nd patient, has developed a febrile illness and
thrombocytopenia, and has tested positive by PCR [polymerase chain
reaction] for arenavirus. She is currently being treated with
ribavirin. The efficacy of ribavirin has been documented in Lassa
fever, but is unknown for the current virus.

The incubation period for cases in the present cluster ranges from
7-13 days. There is a prodromal illness of about 7 days with myalgia,
headache, diarrhoea, and a severe pharyngitis. This is followed by a
more severe illness with moderate thrombocytopenia but no bleeding.
Hepatic dysfunction with raised transaminases has typically occurred
late in the course of disease.

[Source: Centers for Disease Control and Prevention, Atlanta, USA