UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]
UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION
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A ProMED-mail post <http: org="">
ProMED-mail is a program of the International Society for Infectious Diseases <http: org="">
Date: 5 Oct 2008
Source: News24, South Africa <http: com="" news24="" south_africa="" news="" html="">
Health scare in Gauteng
-----------------------
3 people have died following cases of an infectious disease in Johannesburg, the Health Department said on Sunday [5 Oct 2008].
"We are on high alert following the confirmation of 3 cases of an unknown highly infectious disease which has since led to 3 deaths," said the department in a statement.
According to the department the 1st patient was a female from Zambia who was critically ill when she arrived on [12 Sep 2008] in South Africa.
She was treated for tick-bite fever and other potential infections at Morningside Medi-Clinic.
"2 days later she died. Blood samples were taken and the results were not conclusive of any particular disease including the viral haemorrhagic fevers."
Flu-like symptoms
-----------------
The 2nd patient was a Zambian male paramedic who had accompanied the 1st patient. He was admitted on [27 Sep 2008] at the same facility with flu-like symptoms and treated for a variety of infections.
"His condition initially improved, but later deteriorated on Wednesday, [1 Oct 2008] and he died the following day [2 Oct 2008]."
Investigations for viral haemorrhagic fever and other formidable infectious diseases were conducted and the results came out negative. A nurse at Morningside Medi-Clinic who came into contact with the 1st patient became ill with flu-like symptoms and was subsequently admitted to Sir Albert Robinson hospital in the West-Rand on Wednesday [1 Oct 2008].
"Her condition deteriorated on Saturday [4 Oct 2008] and she passed away today (on Sunday [5 Oct 2008]). Viral haemorrhagic fever and other formidable infectious diseases were negative."
Healthcare workers monitored
----------------------------
According to the department, systems were in place to follow up on everyone with whom the deceased had had contact. Healthcare workers and family members were being monitored for raised temperatures and flu-like symptoms for a period of 21 days.
"Steve Biko Academic and Charlotte Maxeke Academic hospitals are on high alert and ready to handle any cases related to this situation."
Members of the community with travel history to Zambia during the last month and who suffer from raised temperatures or flu-like symptoms are requested to report to the nearest health facility for a medical examination or contact Dr Chika Asomugha on 082 330 1490.
--
Communicated by: ProMED-mail
[From the above description of the illness, it is difficult to develop a narrow differential diagnosis -- a disease that is a febrile disease with flu-like symptoms that is apparently highly fatal, occurring in Africa has one immediately thinking about the possibility of a viral hemorrhagic fever (even though hemorrhagic symptoms were not specifically mentioned in the newswire).
As one of the world's top reference laboratories for viral hemorrhagic fevers is located in South Africa, the information that testing for the known hemorrhagic fevers gave negative results means one can comfortably remove the known hemorrhagic fevers from the differential diagnosis list.
From the above description of the dates of onset, it appears the disease has an incubation period of between 2 and 4 weeks.
The mode of transmission is not clear (respiratory vs contact with bodily fluids).
One might suspect that it is contact with bodily fluids, [because if respiratory] one might have expected to see more cases by now (with 3 generations of cases most likely described in the above newswire).
However, on reviewing ProMED-mail archives, in November 2007 there was an outbreak of presumed pneumonic plague in Southern Zambia.
Borrowing from ProMED-mail Mod.LL's comment at that time, "Patients with primary pneumonic plague generate large quantities of infectious aerosols that pose a significant risk to close contacts. CDC (US Centers for Disease Control and Prevention) guidelines identify contacts within 2 meters (6.5 feet) as being at greatest risk and do not consider the organism likely to be carried through air ducts or vents."
(see ProMED-mail posting Undiagnosed deaths - Zambia (02): pneumonic plague susp. 20071130.3862).
Of note is that the incubation period for plague is 1 to 14 days, possibly shorter than noted in the above given dates of onset of the 3 cases. A review of all ProMED-mail prior postings on events in Zambia revealed the overwhelming number of reports were related to veterinary outbreaks (such as foot & mouth disease, contagious bovine pleurpneumonia and swine fever), the next most common reports were of zoonotic diseases affecting both human and animal health (anthrax, rabies, plague), and next, person to person or food and waterborne transmitted diseases (measles, cholera, diarrhea).
There was one scare of a possible hemorrhagic fever outbreak but it was ruled out as attributable to 3 different diseases -- schistosomiasis, gum disease and pneumonia. (see prior ProMED-mail posting Re: Ebola - Zambia? 19950626.0458).
ProMED-mail would greatly appreciate receiving more information on these cases from knowledgeable sources in the region. For a map of Zambia, see <http: edu="" maps="" africa="" jpg="">.
For a map of South Africa, see <http: edu="" maps="" africa="" jpg="">.
For the interactive HealthMap/ProMED map of Zambia with links to recent ProMED-mail postings on events in Zambia and surrounding areas, see <http: org="" v="-14,27.8,5">.
Of note, recent ProMED-mail reports on events in Zambia have been about outbreaks of anthrax, cholera and diarrhea.]
[see also:
Anthrax, wildlife - Zambia (Eastern) 20081002.3115
2007
----
Undiagnosed deaths - Zambia (03): apology 20071130.3866
Undiagnosed deaths - Zambia (02): pneumonic plague susp. 20071130.3862
Undiagnosed deaths - Zambia: RFI 20071129.3853
Anthrax, human, bovine - Zambia (WP) 20071115.3714
2001
----
Plague, bubonic - Zambia (04) 20010418.0769
Plague, bubonic - Zambia (03) 20010328.0631
Plague, bubonic - Zambia (02) 20010327.0621
Plague, bubonic - Zambia 20010315.0525
1998
----
Mortality, human, undiagnosed - Zambia: RFI 19980406.0636
1997
----
Plague, bubonic - Zambia (04) 19970211.0325
Plague, bubonic - Zambia (03) 19970205.0271
Plague, bubonic? - Zambia (02) 19970203.0247
Plague, bubonic - Zambia 19970131.0201]
1995
----
Re: Ebola - Zambia? 19950626.0458
Ebola - Zambia? 19950623.0448
..............................mpp/jw
--
</http:></http:></http:></promed@promedmail.org></http:></http:></http:>
<cite cite="http://apex.oracle.com/pls/otn/f?p=2400:1001:1177507606404303::NO::F2400_P1001_BA CK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74242">http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,74242</cite>
************************************************** **********************
A ProMED-mail post <http: org="">
ProMED-mail is a program of the International Society for Infectious Diseases <http: org="">
Date: 5 Oct 2008
Source: News24, South Africa <http: com="" news24="" south_africa="" news="" html="">
Health scare in Gauteng
-----------------------
3 people have died following cases of an infectious disease in Johannesburg, the Health Department said on Sunday [5 Oct 2008].
"We are on high alert following the confirmation of 3 cases of an unknown highly infectious disease which has since led to 3 deaths," said the department in a statement.
According to the department the 1st patient was a female from Zambia who was critically ill when she arrived on [12 Sep 2008] in South Africa.
She was treated for tick-bite fever and other potential infections at Morningside Medi-Clinic.
"2 days later she died. Blood samples were taken and the results were not conclusive of any particular disease including the viral haemorrhagic fevers."
Flu-like symptoms
-----------------
The 2nd patient was a Zambian male paramedic who had accompanied the 1st patient. He was admitted on [27 Sep 2008] at the same facility with flu-like symptoms and treated for a variety of infections.
"His condition initially improved, but later deteriorated on Wednesday, [1 Oct 2008] and he died the following day [2 Oct 2008]."
Investigations for viral haemorrhagic fever and other formidable infectious diseases were conducted and the results came out negative. A nurse at Morningside Medi-Clinic who came into contact with the 1st patient became ill with flu-like symptoms and was subsequently admitted to Sir Albert Robinson hospital in the West-Rand on Wednesday [1 Oct 2008].
"Her condition deteriorated on Saturday [4 Oct 2008] and she passed away today (on Sunday [5 Oct 2008]). Viral haemorrhagic fever and other formidable infectious diseases were negative."
Healthcare workers monitored
----------------------------
According to the department, systems were in place to follow up on everyone with whom the deceased had had contact. Healthcare workers and family members were being monitored for raised temperatures and flu-like symptoms for a period of 21 days.
"Steve Biko Academic and Charlotte Maxeke Academic hospitals are on high alert and ready to handle any cases related to this situation."
Members of the community with travel history to Zambia during the last month and who suffer from raised temperatures or flu-like symptoms are requested to report to the nearest health facility for a medical examination or contact Dr Chika Asomugha on 082 330 1490.
--
Communicated by: ProMED-mail
[From the above description of the illness, it is difficult to develop a narrow differential diagnosis -- a disease that is a febrile disease with flu-like symptoms that is apparently highly fatal, occurring in Africa has one immediately thinking about the possibility of a viral hemorrhagic fever (even though hemorrhagic symptoms were not specifically mentioned in the newswire).
As one of the world's top reference laboratories for viral hemorrhagic fevers is located in South Africa, the information that testing for the known hemorrhagic fevers gave negative results means one can comfortably remove the known hemorrhagic fevers from the differential diagnosis list.
From the above description of the dates of onset, it appears the disease has an incubation period of between 2 and 4 weeks.
The mode of transmission is not clear (respiratory vs contact with bodily fluids).
One might suspect that it is contact with bodily fluids, [because if respiratory] one might have expected to see more cases by now (with 3 generations of cases most likely described in the above newswire).
However, on reviewing ProMED-mail archives, in November 2007 there was an outbreak of presumed pneumonic plague in Southern Zambia.
Borrowing from ProMED-mail Mod.LL's comment at that time, "Patients with primary pneumonic plague generate large quantities of infectious aerosols that pose a significant risk to close contacts. CDC (US Centers for Disease Control and Prevention) guidelines identify contacts within 2 meters (6.5 feet) as being at greatest risk and do not consider the organism likely to be carried through air ducts or vents."
(see ProMED-mail posting Undiagnosed deaths - Zambia (02): pneumonic plague susp. 20071130.3862).
Of note is that the incubation period for plague is 1 to 14 days, possibly shorter than noted in the above given dates of onset of the 3 cases. A review of all ProMED-mail prior postings on events in Zambia revealed the overwhelming number of reports were related to veterinary outbreaks (such as foot & mouth disease, contagious bovine pleurpneumonia and swine fever), the next most common reports were of zoonotic diseases affecting both human and animal health (anthrax, rabies, plague), and next, person to person or food and waterborne transmitted diseases (measles, cholera, diarrhea).
There was one scare of a possible hemorrhagic fever outbreak but it was ruled out as attributable to 3 different diseases -- schistosomiasis, gum disease and pneumonia. (see prior ProMED-mail posting Re: Ebola - Zambia? 19950626.0458).
ProMED-mail would greatly appreciate receiving more information on these cases from knowledgeable sources in the region. For a map of Zambia, see <http: edu="" maps="" africa="" jpg="">.
For a map of South Africa, see <http: edu="" maps="" africa="" jpg="">.
For the interactive HealthMap/ProMED map of Zambia with links to recent ProMED-mail postings on events in Zambia and surrounding areas, see <http: org="" v="-14,27.8,5">.
Of note, recent ProMED-mail reports on events in Zambia have been about outbreaks of anthrax, cholera and diarrhea.]
[see also:
Anthrax, wildlife - Zambia (Eastern) 20081002.3115
2007
----
Undiagnosed deaths - Zambia (03): apology 20071130.3866
Undiagnosed deaths - Zambia (02): pneumonic plague susp. 20071130.3862
Undiagnosed deaths - Zambia: RFI 20071129.3853
Anthrax, human, bovine - Zambia (WP) 20071115.3714
2001
----
Plague, bubonic - Zambia (04) 20010418.0769
Plague, bubonic - Zambia (03) 20010328.0631
Plague, bubonic - Zambia (02) 20010327.0621
Plague, bubonic - Zambia 20010315.0525
1998
----
Mortality, human, undiagnosed - Zambia: RFI 19980406.0636
1997
----
Plague, bubonic - Zambia (04) 19970211.0325
Plague, bubonic - Zambia (03) 19970205.0271
Plague, bubonic? - Zambia (02) 19970203.0247
Plague, bubonic - Zambia 19970131.0201]
1995
----
Re: Ebola - Zambia? 19950626.0458
Ebola - Zambia? 19950623.0448
..............................mpp/jw
--
</http:></http:></http:></promed@promedmail.org></http:></http:></http:>
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