SEVERAL CASES OF FATAL ILLNESS , NOVEL ARENAVIRUS STRAIN? - SOUTH AFRICA ex ZAMBIA

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

<TABLE xmlns:fo="http://www.w3.org/1999/XSL/Format"><TBODY><TR><TD class=ArticleHead colSpan=2>Mystery virus pinned down <!--head0--></TD></TR><TR><TD class=Byline><!--byline1-->Sashni Pather<!--byline0--></TD><TD class=Published align=right>Published:<!--date1-->Oct 13, 2008<!--date0--></TD></TR><TR><TD class=ArticleHead colSpan=2><HR class=ArticleLine width="100%" SIZE=1></TD></TR><TR><TD colSpan=2><TABLE cellSpacing=0 cellPadding=5 width=200 align=right border=0><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>
IDENTIFIED: Dr Lucille Blumberg tells journalists the virus is a type of the Lassa fever virus of West Africa Picture: TEBOGO LETSIE </TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>
</TD></TR></TBODY></TABLE></TD></TR><TR><TD>
</TD></TR></TBODY></TABLE><!--par1--><!--par0-->
<!--par1-->Isolated nurse in ?suspect? condition being treated<!--par0--> <!--par1--><!--par0-->
<!--blurb1-->THE virus that has claimed three lives has been identified as a rodent-borne arenavirus, a type of the Lassa fever virus endemic to West Africa.<!--blurb0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->This was announced yesterday after the eagerly awaited results of tests conducted at the US Centres for Disease Control in Atlanta, and at the National Institute for Communicable Diseases (NICD) in Johannesburg.<!--par0-->
<!--par1-->Cecilia van Deventer, 36, a Zambian resident, contracted the virus and infected paramedic Hannes Els, who accompanied her when she was airlifted to the Morningside Medi-Clinic in Sandton.<!--par0-->
<!--par1-->Els and a nurse at the hospital, Gladys Mthembu, also died.<!--par0-->
<!--par1-->Although health authorities believe they have contained the spread of the deadly virus, another nurse, in isolation at the Morningside Medi-Clinic, is being treated with an antiviral drug as a pre- emptive measure after showing symptoms of the disease. <!--par0-->
<!--par1-->The NICD?s Dr Lucille Blumberg said viruses similar to the Lassa fever virus have been found in rodents elsewhere in Africa, but have not previously been found to cause diseases in humans other than in West Africa.<!--par0-->
<!--par1-->?There is no indication yet that arenaviruses that cause disease in humans are present in South African rodents,? said Blumberg.<!--par0-->
<!--par1-->Arenaviruses cause chronic infections in multimammatic mice ? a species of wild mouse. The mice excrete the virus in their urine, which can then contaminate food or house dust, spreading the dangerous disease to humans.<!--par0-->
<!--par1-->Doctor Robert Swanepoel, of the special pathogens unit at the NICD, said these types of rodents thrive in ?unhygienic conditions. These are not rats that you would find in urban settings.?<!--par0-->
<!--par1-->Swanepoel discounted the possibility that Van Deventer had caught the virus from other animals.<!--par0-->
<!--par1-->?She had three horses and cats and dogs. She visited a polo ground ? but I don?t think horses have anything to do with this. She lived on a smallholding and there might have been rats there,? he said.<!--par0-->
<!--par1-->Gauteng health MEC Brian Hlongwa said the isolated nursing sister and a male paramedic in the isolation ward at the Morningside Medi-Clinic were flagged as possibly infected during temperature monitoring. Their increased temperatures showed they were possibly infected. <!--par0-->
<!--par1-->Both had been in contact with victims of the illness.<!--par0-->
<!--par1-->The paramedic had been since diagnosed with kidney stones and Blumberg said it was ?less likely? he had the virus.<!--par0-->
<!--par1-->But the nurse?s condition, Blumberg said, was ?highly suspect?. <!--par0-->
<!--par1-->?Fortunately there is a drug that has shown promising results in treating patients if their illness is recognised early,? said Blumberg.<!--par0-->
<!--par1--><!--par0-->

http://www.thetimes.co.za/News/Article.aspx?id=861831</TD></TR></TBODY></TABLE>

[Giuseppe]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (07): ARENAVIRUS [ProMedMail.org]

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (07): ARENAVIRUS
***********************************************

A ProMED-mail post
<http: org=""> ProMED-mail is a program of the International Society for Infectious Diseases <http: org="">
Date: 12 Oct 2008
Source: The Mercury [edited] <http: za="" fsectionid="3535&fArticleId=nw20081012152218513C97 5048">

</http:></http:></http:><http: style="color: rgb(255, 0, 0);" org=""><http: org=""><http: za="" fsectionid="3535&fArticleId=nw20081012152218513C97 5048">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]. </http:></http:></http:>
<http: org=""><http: org=""><http: za="" fsectionid="3535&fArticleId=nw20081012152218513C97 5048"></http:></http:></http:>
<http: org=""><http: org=""><http: za="" fsectionid="3535&fArticleId=nw20081012152218513C97 5048">
"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.
--
Communicated by: HealthMap Alert via ProMED-mail


[According to the above newswire, there has been a "preliminary" identification of an arenavirus in specimens from the initial 3 fatalities felt to be associated in this cluster. Apparently, the virus was identified in infected tissue of the 2nd and 3rd case (the paramedic accompanying the 1st case during the medical transfer from Zambia to South Africa and a nursing sister who cared for the 1st case while hospitalized in South Africa) and further identified through testing of blood from the original case (the 37-year-old woman from Zambia. We await further information on this from official sources.

Former viral disease moderator Prof. Charles H. Calisher had the following to add:
"There are at least 23 recognized arenaviruses (family _Arenaviridae_, genus _Arenavirus_). The conventional phylogeny of these viruses distinguishes "Old World" from "New World" arenaviruses, i.e., based on geographic distribution. 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. this moderator would like to thank Prof. C.J. Peters, an leading authority on arenaviruses, for kindly providing the references listed below on treatment modalities used for arenavirus infection.

References.
1. Barry, M., M. Russi, L. Armstrong, D. Geller, R. Tesh, L. Dembry, J. P. Gonzalez, A. S. Khan, and C. J. Peters. 1995. Brief report: treatment of a laboratory-acquired Sabia virus infection.[see comment]. New England Journal of Medicine 333:294-296.
2. Enria, D. A., A. M. Briggiler, S. Levis, D. Vallejos, J. I. Maiztegui, and P. G. Canonico. 1987. Tolerance and antiviral effect of ribavirin in patients with Argentine hemorrhagic fever. Antiviral Research 7:353-359.
3. Jahrling, P. B., R. A. Hesse, G. A. Eddy, K. M. Johnson, R. T. Callis, and E. L. Stephen. 1980. Lassa virus infection of rhesus monkeys: pathogenesis and treatment with ribavirin. Journal of Infectious Diseases 141:580-589.
4. Kilgore, P. E., T. G. Ksiazek, P. E. Rollin, J. N. Mills, M. R. Villagra, M. J. Montenegro, M. A. Costales, L. C. Paredes, and C. J. Peters. 1997. Treatment of Bolivian hemorrhagic fever with intravenous ribavirin. Clinical Infectious Diseases 24:718-722.
5. McCormick, J. B., I. J. King, P. A. Webb, C. L. Scribner, R. B. Craven, K. M. Johnson, L. H. Elliott, and R. Belmont-Williams. 1986. Lassa fever. Effective therapy with ribavirin. New England Journal of Medicine 314:20-26.
6. Peters CJ. 2002. Arenaviruses, p. 949-969. In Richman DD, Whitely RJ, and Hayden FG (eds.), Clinical Virology. ASM Press, Washington, DC.
7. Peters CJ, Zaki SR, and Rollin PE. 1997. Viral hemorrhagic fevers, p. 10.l-10.26. In Mandell GL and Fekety R (eds.), Atlas of Infectious Diseases, Vol. 8. Current Medicine, Philadelphia. - Mod.MPP]

[see also:
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Human lymphocytic choriomeningitis virus - USA (03) 20080726.2276
Human lymphocytic choriomeningitis virus - USA (02) 20080516.1635
Human lymphocytic choriomeningitis virus - USA: organ donation 20080412.1339
Lassa fever - Nigeria (02) 20080611.1847
Lassa fever - Nigeria: (Ebonyi) 20080323.1100
Arenavirus hemorrhagic fever - Bolivia: (Chapare), new arenavirus 20080418.1387

2007
----
Arenavirus, organ transplants - Australia (VIC)(02) 20070430.1402
Arenavirus, organ transplants - Australia (VIC) 20070423.1325
Bolivian hemorrhagic fever - Bolivia (Beni)(02) 20070315.0914

2003
----
Arenaviruses and rodent taxonomy (02) 20030412.0891
Arenaviruses and rodent taxonomy 20030411.0879
Lassa fever - Sierra Leone 20030409.0863
Lassa fever, imported - UK ex Sierra Leone 20030210.0360

2002
----
Venezuelan hemorrhagic fever - Venezuela (02) 20020204.3479
Venezuelan hemorrhagic fever - Venezuela 20020203.3467

2001
----
Argentinean hem. fever - Argentina (Buenos Aires Prov.) 20010404.0675

2000
----
Arenavirus infection, human USA (CA): Confirmed (02) 20000813.1344
Arenavirus infections, human - USA (CA): Confirmed 20000804.1301
Arenavirus infection, human - USA (Calif.): comment (02) 20000708.1137
Arenavirus infection, human - USA (Calif.): comment 20000704.1110
Arenavirus infection, human - USA (California) 20000703.1104
Lassa virus, seroprevalence 20000119.0080

1996
----
List of recognized arenaviruses 19961218.2106]
...............................................mpp/msp/mpp/dk
--
</promed@promedmail.org></http:></http:></http:>

<cite cite="http://apex.oracle.com/pls/otn/f?p=2400:1001:1653225330763944::NO::F2400_P1001_BA CK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74346">http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,74346</cite>

[Giuseppe]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

No vaccine for killer virus [SABCnews.com]

No vaccine for killer virus

October 13, 2008, 05:45

The National Institute for Communicable Diseases (NICD) says there are no vaccines available for viral haemorragic fever in this country.


Doctor Janusz Paweska was speaking in Johannesburg following the release of preliminary results of tests on the mysterious viral haemorragic fever which killed three people.

Authorities revealed that the victims died of a ''rodent-borne arena virus'' which is a type of viral haemorragic fever.

The rodents, found in West Africa, can contaminate food or dust particles.

Two people suspected to have viral haemorragic fever are still in isolation at the Morningside Medi-Clinic in Johannesburg.

Paweska says there is a drug which has shown promising results - but only if diagnosed as soon as possible.

Meanwhile health experts have assured South Africans that they have no reason to worry about contracting the deadly rodent-borne arena virus from local rats.

Yesterday the NICD and the Centre for Disease Control identified the arena virus related to the Lassa fever virus in West Africa as the reasons behind the death of the three people.

The arena virus causes chronic infection in certain types of wild rodents.

The virus is carried in the urine of wild mice which can contaminate human food.

Robert Swanepoel of the NICD says there is no indication that arena viruses which could cause disease in humans were present in South African rodents.
--

<cite cite="http://www.sabcnews.com/south_africa/health/0,2172,178159,00.html">SABCnews.com - south_africa/health</cite>

[Shiloh]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

Source: http://www.who.int/csr/don/2008_10_13/en/

New virus from Arenaviridae family in South Africa and Zambia - Update

13 October 2008 -- The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the Arenaviridae family.

Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN).

Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up.

WHO and its GOARN partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts.

[Shiloh]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

Source: http://www.sabcnews.com/south_africa...178187,00.html

More people observed for deadly arena virus
October 13, 2008, 17:30

The number of people who are being monitored for symptoms of the rodent-borne arena virus at Morningside Medi-Clinic in Johannesburg has increased from 55 people to 91. This follows the admission of a nurse and a paramedic at the weekend.

Over 100 people have been placed on a list to be monitored every six hours for 21 days as a safety precaution. They are believed to have been in direct contact with the patients who died of viral hemorragic fever at Morningside Medi-Clinic and Sir Albert Robinson hospital on the Gauteng's West Rand.


?? With a nursing sister being admitted, her close family had to be put on the list as well ?,? says Medi-Clinic spokesperson Melinda Pelser.

Nurses's union, Denosa, has again called on the Health Department to intensify efforts to prevent the spread of arena virus, which has killed three people and left two others in hospital in Johannesburg. Union spokesperson, Asanda Fongqo, says the admission of the nurse and paramedic is proof that the department has failed to contain the virus. Fongqo says the arena virus poses a great danger to their members and to the public at large. He has criticised the department's call to South Africans not to panic.

?We further condemn the stance taken by the [department] ? that the masses should not panic because there is no way that people cannot panic when people are losing their lives ?? says Fongqo.

Family faces discrimination
Meanwhile, the Westonaria Local Municipality on Gauteng's West Rand says it has initiated campaigns to raise awareness about viral hemorragic fever in the area. This follows the death of a nurse, Gladys Mthembu, who lived in Bekkersdal in the Westonaria Local Municipality. Mthembu was a nurse at Morningside Medi-Clinic.

Her family has raised concerns that it has been discriminated against by community members in their area due to the mystery surrounding the fever which killed Mthembu. Spokesperson for the Westonaria Local Municipality, Bomikazi Nkolongwane, says they have put up posters in public places to educate locals about the fever.

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

<TABLE class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Nurse under observation after symptoms of viral fever 13/10/2008 06:44:32
</TD></TR><TR><TD class=fptextBlack bgColor=#ffffff>


Authorities have confirmed a nurse is currently under strict observation at the Morningside Medi-Clinic and has shown symptoms of the viral haemorrhagic fever that has hit Johannesburg.

The mystery disease has killed three people in recent weeks and has been provisionally identified as an arena virus which is found in rodents and is believed to be related to the Lassa fever virus from West Africa.

Dr Lucille Blumberg from the National Institute of Communicable Disease says the nurse?s case is serious while the paramedic who is also under observation has been diagnosed with kidney stones and authorities say it's less likely he has the virus.

Gauteng Health MEC Brian Hlongwa has sent condolences to the families of the health professionals who died.

Officials were also quick to add there's no need for alarm because there's no proof that rats in South Africa carry the virus.

Professor Robert Swanepoel from the NICD says there's no need for alarm adding that there's no proof that rats in South Africa carry arena viruses.http://www.702.co.za/news/news.asp#95456<TABLE class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Viral haemorrhagic fever can be treated if diagnosed early 13/10/2008 07:20:27
</TD></TR><TR><TD class=fptextBlack bgColor=#ffffff>


Authorities say a drug that can treat patients infected with viral haemorrhagic fevers is available but can only be used if a patient's illness is diagnosed early.

Research done by the National Institute of Communicable Diseases and the Centre for Disease Control in the USA has indicated the virus that's killed three people in Johannesburg recently is probably the arena fever carried by wild rodents.

A paramedic and a nurse who may have contracted the virus are still under strict observation at the Morningside Medi-Clinic in Sandton.

Professor Robert Swanepoel says there's no indication as yet that the arena virus is present in South African mice and rats.http://www.702.co.za/news/news.asp#95480
</TD></TR></TBODY></TABLE>
<TABLE class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Nurse treated for arena virus 13/10/2008 18:01:49
</TD></TR><TR><TD class=fptextBlack bgColor=#ffffff>


Morningside Medi Clinic officials say a nurse who is under quarantine at the facility, after being diagnosed with the provisionally identified arena virus is in a stable condition.

The Morningside employee is receiving treatment after she was admitted to the clinic last week presenting symptoms of the illness.

Spokesperson for the clinic Melinda Pelser says, ?We have heard from medical experts that you can use the drug to treat the virus but it is not a guarantee?.

A paramedic is also being closely monitored although officials say it is unlikely he has the disease.

Experts are saying that the virus may be rodent borne.

However, tests are still being conducted to identify the exact strain of the virus which is believed to have been brought into the country by a woman from Zambia several weeks ago.

The patient, a paramedic who accompanied her and another nurse has all since died from the virus.http://www.702.co.za/news/news.asp#95516
</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

Haemorrhagic virus carried by common African mouse

• <!-- google_ad_section_start(weight=ignore) -->18:00 13 October 2008 Three people have died and another is seriously ill with a previously unknown strain of a virus carried by a common African rodent. The virus requires close contact to spread, but experts warn that more like it could be circulating.

A 36-year-old woman on a small farm outside the Zambian capital Lusaka developed flu-like symptoms in early September. When they worsened she was taken by air ambulance to South Africa, where she died.
Alarms were raised after the ambulance paramedic and the nurse who attended her also died after developing similar symptoms two weeks later. The nurse who tended the paramedic is also in a serious condition.
On Sunday South Africa's National Institute for Communicable Diseases announced that the victims were infected by an arenavirus, one of a family of viruses carried by rodents.
"They are very widespread," says Bob Swanepoel, former head of the NICD and one of the world's leading experts on haemorrhagic viruses. In Africa, arenaviruses are carried, with no symptoms, by the multimammate mouse, a common farm pest sold in Europe as a "pocket pet".
It is not known whether animals caught in Africa are being sold as pets.
Some of these viruses commonly infect humans. Several related viruses in the Americas cause haemorrhagic fevers, but in Africa only one was known to cause disease: Lassa fever, which kills around 5000 people a year in West Africa.
The rest seemed benign. "We have been testing haemorrhagic fever patients in southern Africa for three decades and we never found an arenavirus," says Swanepoel. "Now suddenly there's this."
The Zambian virus is being sequenced at the US Centers for Disease Control in Atlanta, to see how it is related to other arenaviruses.
This strain may be a new mutant, meaning the Zambian case may herald the start of a new disease. "Or it may always have been out there and we're only recognising it now," says Swanepoel. "It's shocking how little we know about the viruses that are circulating in Africa."http://www.newscientist.com/article/...an-mouse-.html

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

<TABLE xmlns:fo="http://www.w3.org/1999/XSL/Format"><TBODY><TR><TD class=ArticleHead colSpan=2>Medi-Clinic nurse has virus<!--head0--></TD></TR><TR><TD class=Byline><!--byline1--><!--byline0--></TD><TD class=Published align=right>Published:<!--date1-->Oct 13, 2008<!--date0--></TD></TR><TR><TD class=ArticleHead colSpan=2><HR class=ArticleLine width="100%" SIZE=1></TD></TR><TR><TD colSpan=2><TABLE cellSpacing=0 cellPadding=5 width=200 align=right border=0><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>

</TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE width=200><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold">Article Tools</TD></TR><TR><TD><SCRIPT language=javascript> var PrintThis = '/PrintArticle.aspx?ID=' + ArticleID var printURL = "('"+PrintThis+"','','dependent=yes,resizable=no,s crollbars=yes,height=700,width=635,innerHeight=630 ,innerWidth=600')"; document.write(' Print'); </SCRIPT> Print<SCRIPT language=javascript> var EmailThis = '/EmailtoFriend.aspx?ID=' + ArticleID var emailURL = "('"+EmailThis+"','','dependent=yes,resizable=no,s crollbars=no,height=400,width=520')"; document.write(' E-Mail'); </SCRIPT> E-Mail</TD></TR></TBODY></TABLE><TABLE><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold">Save and Share</TD></TR><TR><TD><SCRIPT src="http://s7.addthis.com/js/152/addthis_widget.js" type=text/javascript></SCRIPT><SCRIPT type=text/javascript> addthis_pub = 'lindazinhle'; addthis_logo = 'http://www.addthis.com/images/yourlogo.png'; addthis_logo_background = 'EFEFFF'; addthis_logo_color = '666699'; addthis_brand = 'Your Site'; addthis_options = 'stumbleupon, favorites, digg, delicious, newsvine, facebook, google, live,'; </SCRIPT></TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE><!--par1--><!--par0-->
<!--par1-->A Morningside Medi-Clinic nurse is confirmed to have contracted the recently identified arenavirus which led to the deaths of three people. <!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->


<!--par1--><!--par0-->
<!--par1-->In a statement, clinic spokeswoman Melinda Pelser said the nursing sister was receiving treatment and her condition was stable this afternoon.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Yesterday, health authorities announced a breakthrough in identifying the mystery virus, isolating it as a virus associated with multimammate mice - a kind of wild mouse - who excrete the virus in their urine which can contaminate human food or house dust.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->The strain of the virus is still being determined.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->The list of people being monitored as a precautionary measure by the private hospital has increased to 91. <!--par0-->
<!--par1--><!--par0-->
<!--par1-->The hospital said a paramedic being monitored closely was not believed to have the virus.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->The monitoring of the large group is carried out at their homes, and results are telephoned in to Morningside Medi-Clinic.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->A tour operator from Zambia, the paramedic who accompanied her to South Africa for treatment, and a health worker who came into contact with her, have died since September 14.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Pelser said Morningside Medi-Clinic was in regular contact with the National Institute for Communicable Disease, and a team of local and international experts. <!--par0-->
<!--par1--><!--par0-->
<!--par1-->These, after an inspection, endorsed the infection control procedures in place at the hospital and said it was safe for patients, visitors and medical procedures.http://www.thetimes.co.za/News/Article.aspx?id=862237
</TD></TR></TBODY></TABLE>

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

Embassy of the United States of America
Warden Message U.S. Embassy Lusaka, Zambia October 7, 2008
This Warden Message is a follow-up to the notice released on Friday, 03 October 2008, relating to recent reports of an illness that took the life of a Lusaka resident and two caregivers. The Embassy continues to believe that this illness does not pose a significant threat to the American community in Lusaka or across Zambia at this time. Attached to this message is a copy of the formal statement released by the Zambian Ministry of Health.
The Embassy will continue to monitor events and will share information through the warden network as necessary. Should an American citizen experience a health emergency, the Embassy recommends that they seek immediate medical attention. If necessary, the Embassy can be reached at 260-211-250-955 on a twenty-four hour basis.
Copies of all warden messages can be found on the Embassy?s web-site: http://zambia.usembassy.gov.
Americans traveling abroad should regularly monitor the U.S. Embassy?s website the U.S. Department of State's, Bureau of Consular Affairs? website www.travel.state.gov , where the current Worldwide Caution, Travel Warnings, Travel Alerts, and Country Specific Information can be found. In addition to information on the Internet, travelers may obtain up-to-date information on security conditions by calling 1-888-407-4747 toll-free in the U.S. and Canada, or outside the U.S. and Canada on a regular toll line at 1-202-501-4444. To obtain Centers For Disease Control and Prevention (CDC) travel notices, you may dial the CDC at 1-800-CDC-INFO (1-800-232-4636) from within the U.S., and at 1-404-639-3534 from overseas, or visit their website at http://www.cdc.gov/travel
The U.S. Embassy is located at the corner of Independence and United Nations Avenue, tel. 260-211-250-955.
FROM THE ZAMBIAN MINISTRY OF HEALTH
Briefing on the Reported Deaths of Patients from an Unknown Illness
The nation is being informed that the Government of the Republic of Zambia through the Ministry of Health has received information of an unknown illness which so far has claimed three lives.
The first person to suffer from it was a female South African that was resident in Zambia who fell sick about 4 September 2008. She was evacuated to Morningside Clinic where she later died on 13 September 2008.
The second victim was a paramedic that had escorted the patient to South Africa. The third victim was a nurse based at Morningside that attended to the first patient. Unconfirmed reports indicate that the driver of the ambulance that ferried the patient from Lanseria Airport to Morningside in South Africa is presently in a critical condition.
All these patients developed a fever, cough and bled from various parts of their bodies.
Laboratory investigations so far done do NOT point to any particular known disease. However, the Ministry of Health in collaboration with the World Health Organization (WHO) and the Centers for Disease Control (CDC) is still carrying all the necessary investigations. In the meantime, all the contacts are being traced, and so far, of all those identified, none of them is in danger.
Note that none of our health facilities here in Zambia has reported such an illness.
The Government of the Republic of Zambia through the Ministry of Health would like to assure the nation that the situation is under control and is being given the special attention that it deserves and would like to appeal to all members of the public to remain calm.
It is from the foregoing that international and local travel, both air and road, trade and commercial services in and out of the country should continue as usual.
Members of the public are also cautioned that any suspicious case presenting with fever, cough and bleeding from any part of the body should be reported to the nearest health facility.
For more information please contact: Dr. S.K. Miti, Permanent Secretary on 253344, Dr. V.C. Mtonga, Director of Technical Support Services on 0955-753300 or Dr. Canisius Banda, Spokesperson on 0977-157519.
The Honorable Brig. Gen. Dr. Brian Chituwo, GSDS, MP, Minister of Health. http://zambia.usembassy.gov/uploads/...en10072008.pdf

[Giuseppe]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

UNDIAGNOSED FATALITIES - SOUTH AFRICA EX ZAMBIA (08): ARENAVIRUS IDENTIFIED [ProMedMail.org]

UNDIAGNOSED FATALITIES - SOUTH AFRICA EX ZAMBIA (08): ARENAVIRUS IDENTIFIED
************************************************** *************************

A ProMED-mail post <http: org="">
ProMED-mail is a program of the International Society for Infectious Diseases <http: org="">

In this update:
[1] South Africa - National Institute for Communicable Diseases (NCID)
[2] WHO
[3] South Africa Government Communication and Information System
[4} Newswire
****

[1] South Africa - National Institute for Communicable Diseases (NCID)
Date: Mon 13 Oct 2008
From: Liz Millington <lizm@nicd.ac.za>

Outbreak of an acute disease, ex Zambia
---------------------------------------
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 National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa Department of Pathology, University of the Witwatersrand, Johannesburg, South Africa]
--
Communicated by: Liz Millington on behalf of Dr Lucille Blumberg National Institute for Communicable Diseases 1 Modderfontein Road Sandringham 2131 South Africa
<lucilleb@nicd.ac.za> ******

[2] WHO
Date: Mon 13 Oct 2008
Source: World Health Organisation (WHO), EPR, Disease Outbreak News [edited] <http: int="" csr="" don="" 2008_10_13="" en="" html="">

New virus from family _Arenaviridae_ in South Africa and Zambia - Update
-------------------------------------------------
The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the family _Arenaviridae_.

Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN).

Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up.

WHO and its GOARN partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts.
--
Communicated by: ProMED-mail Rapporteur Marianne Hopp
******

[3] South Africa Government Communication and Information System
Date: Mon 13 Oct 2008
Source: BuaNews online, compiled by the Government Communication and Information System [edited] <http: za="" news="" 08="" 08101311151006="">

Unknown illness identified as Arenavirus
----------------------------------------
The virus, which has caused the death of 3 people, has been provisionally identified as the rodent-borne arenavirus. The arenavirus, related to Lassa fever virus of West Africa, causes chronic infections in multimammate mice. Infected mice's excretion contains the virus, which can contaminate human food or house dust.

A joint statement by the National Institute for Communicable Disease (NICD) and the Department of Health explained that the arenavirus [infection] is a disease spread from human to human through the contact of body fluids.

The finding follows blood samples being sent to Atlanta, in the United States to determine the cause of the deaths of 3 people who had been suspected of contracting [a] viral haemorrhagic fever.

The virus is similar to Lassa fever [virus], the department said. It has previously been found in rodents elsewhere in Africa, but has not been found to cause disease in humans other than in West Africa.

Further tests are needed to confirm the diagnosis by growing the virus in culture.

"It needs to be determined whether it is a previously unrecognised member of the arenaviruses [the family _Arenaviridae_], and what its distribution is. There is no indication as yet that arenaviruses which cause disease in humans are present in South African rodents," the NICD said.

The 1st victim, who had to be flown in from Zambia in a critical condition, was admitted to the Morningside Medi-Clinic in mid September [2008]. She died 2 days later. About 2 weeks later, the paramedic who had flown in with the 1st victim, was admitted at the same clinic presenting the same symptoms. A nurse, died shortly afterwards. According to certain reports the nurse's family has been given a go-ahead to continue with the funeral arrangements as her bedroom had been cordoned off by health officials. A cleaner at the Morningside Medi-Clinic, who also died last weekend, has since been ruled out as a possible victim of the virus. Meanwhile the Gauteng Health Department has confirmed that the 3 other patients, including nurse's female supervisor, who had been under observation for showing symptoms of the virus have been discharged. However, departmental spokesperson Phumelele Kaunda said there were 2 contacts that were still under active surveillance after being admitted for observation. The one patient is a paramedic who had contact with the 1st patient and developed fever and flu-like symptoms. He was admitted initially in Flora Clinic and then transferred to Morningside Medi-Clinic with a diagnosis of kidney stones. The other patient is a nurse who attended to the 2nd patient and developed signs and symptoms similar to the 1st 3 patients. She is being treated in isolation and received the anti-viral medication, ribavirin. The patient is presently stable.

Gauteng Health MEC [member of the executive council] Brian Hlongwa meanwhile has sent condolences to the families of those that were killed by the viral infection, particularly families of health professionals who died in the line of duty.

"This illustrates the dedication of our health professionals and the need of society to respect and honour the work that they do," said MEC Hlongwa.

He also thanked the NICD, the National Health Laboratory Service, Centre for Disease Control in Atlanta, and the World Health Organisation for ensuring that the results were made available soon.
[Byline: Luyanda Makapela]
--
Communicated by: ProMED-mail Rapporteur Brent Barrett
******

[4] Newswire
Date: Sun 12 Oct 2008
Source: News24, South Africa, South African Press Association (SAPA) report [edited] <http: com="" news24="" south_africa="" news="" html="">

Virus identified - nurse ill
----------------------------
The mystery viral haemorrhagic 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-borne arenavirus related to the Lassa fever virus of West Africa," NICD's Dr Lucille Blumberg told reporters at the Charlotte Maxeke Johannesburg Academic Hospital. She said tests done by the NICD and the Centres for Disease Control in Atlanta, US, indicated that the disease seemed to be a kind of an arenavirus.

The World Health Organisation (WHO) has also been providing technical assistance in identifying the virus. Arenaviruses cause chronic infections in multimammate mice -- a kind of wild mouse -- that 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 that arenaviruses, which could cause disease in humans, were present in South African rodents.

"It needs to be determined whether it is a previously unrecognised 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. He said the kind of rodents who carried the virus was not generally found in urban areas. "They are out there, but attracted [to human dwellings] if there is inadequate waste disposal."

Crops 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 go on 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 where infected tissues, skin, liver, and muscles were tested were critically important in being able to make 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 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 and other animals, 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. On [27 Sep 2008] a Zambian paramedic who accompanied her into the country was admitted into the hospital with similar flu-like symptoms, fever, and a skin rash. In his case, viral haemorrhagic fever was queried. He developed diarrhoea, severe headaches, nausea, and vomiting and although he initially seemed to respond to treatment, died on [2 Oct 2008] at the clinic. A 3rd victim of the virus was a nurse from Morningside Medi-Clinic who attended to index case. She became ill with fever 18 days after the [index case] was admitted to the hospital and consulted a general practitioner, receiving intravenous therapy. She was then referred to Robinson Hospital in Randfontein and later transferred due to a bedding shortage to Sir Albert Clinic. Here she was treated for a suspected case of meningitis. Her condition deteriorated and she died last Sunday [5 Oct 2008]. A 4th person, a contract cleaner working at Morningside Medi-clinic Maria Mokubung, 37, died in Charlotte Maxeke. Earlier this week the Health Department said her death was not related to viral haemorrhagic 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 index case] 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 Blumberg said it was "less likely" he had the virus. The 2nd person in isolation is a nurse who had contact with the paramedic that died. 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.

Asked whether she could have contracted the virus, Blumberg said her condition was "highly suspect."

She said she could not say further how her condition was likely to progress.

This week [week of 6 Oct 2008] 3 other people who had been hospitalised after contact with the deceased were discharged. On Friday morning [10 Oct 2008] the 11 year-old son of the nursing sister who died and his 23-year-old nanny were discharged. 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 haemorrhagic fever was also released. 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 fluid. 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 was recognised early. Those who have been in contact with patients but are well do not spread infection.

On Sunday [12 Oct 2008], Hlongwa said the diagnosis of the virus was a step forward. However, it was still vital to conduct more tests to find out what kind of arenavirus it was, he said. Health department director-general Thami Mseleku cautioned South Africans not to now fear that every mouse that came their way contained the virus. Since the virus first broke out, medical officials have been at pains to emphasise 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.
--
Communicated by: ProMED-mail and a similar report ProMED-mail Rapporteur Mary Marshall


[These 3 accounts confirm that an unidentified arenavirus was responsible for the deaths of the 3 patients in South Africa. Contrary to a previous account a sample from the index case was available and has tested positive for the unidentified arenavirus.

Also a 4th critically ill surviving patient (who nursed the index case) in South Africa has tested positive for the same virus.

None of the other suspected cases have been confirmed so far.

As the virus has not yet been propagated in cell culture it must be presumed that the identification is based on PCR assay.

The family _Arenaviridae_ is split into Old and New world groups, which are only distantly related.

There are 5 species of Old World viruses -- Ippy virus, Lassa virus, lymphocytic choriomeningitis virus (LCMV), Mobala virus, and Mopeia virus.

The cosmopolitan LCMV is a mouse virus, whereas Lass virus and Mopeia virus share a common rodent host, species of the multimammate mouse (genus _Mastomys__). A photograph of a multimammate mouse can be seen at <http: jp="" jpg="">.

Lassa virus is present in west and central Africa and has been associated with disease in humans and other primates, whereas Mopeia virus is present further south and not known to be associated with disease in humans or primates so far. - Mod.CP]

[see also:
Undiagnosed fatalities - S. Africa ex Zambia (07): arenavirus 20081012.3234
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Human lymphocytic choriomeningitis virus - USA (03) 20080726.2276
Human lymphocytic choriomeningitis virus - USA (02) 20080516.1635
Human lymphocytic choriomeningitis virus - USA: organ donation 20080412.1339
Lassa fever - Nigeria (02) 20080611.1847
Lassa fever - Nigeria: (Ebonyi) 20080323.1100

2007
----
Arenavirus, organ transplants - Australia (VIC)(02) 20070430.1402
Arenavirus, organ transplants - Australia (VIC) 20070423.1325

2003
----
Arenaviruses and rodent taxonomy (02) 20030412.0891
Arenaviruses and rodent taxonomy 20030411.0879
Lassa fever - Sierra Leone 20030409.0863
Lassa fever, imported - UK ex Sierra Leone 20030210.0360

2000
----
Arenavirus infection, human USA (CA): Confirmed (02) 20000813.1344
Arenavirus infections, human - USA (CA): Confirmed 20000804.1301
Arenavirus infection, human - USA (Calif.): comment (02) 20000708.1137
Arenavirus infection, human - USA (Calif.): comment 20000704.1110
Arenavirus infection, human - USA (California) 20000703.1104
Lassa virus, seroprevalence 20000119.0080

1996
----
List of recognized arenaviruses 19961218.2106]
...................................mpp/cp/mj/mpp/cp/mpp
--
</http:></promed@promedmail.org></http:></http:></http:></lucilleb@nicd.ac.za></lizm@nicd.ac.za></http:></http:>

<cite cite="http://apex.oracle.com/pls/otn/f?p=2400:1001:3474769669796582::NO::F2400_P1001_BA CK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74355">http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,74355</cite>

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: NOVEL ARENAVIRUS STRAIN (?)

Killer virus was caught from rodents

Air evacuation drill too lax - doctor
<!-- article pic if exists --><!--div class="article-pic">
Photo: INLSA </div--><!-- end article pic -->
October 13, 2008 Edition 2
Kanina Foss and Solly Maphumulo
Test results have shown that the disease which has killed at least three people in Johannesburg hospitals is one of the rodent-borne Arena viruses - a family of viruses that includes Lassa fever.
The Arena virus is carried by wild rodents (multimammate mice) and it is shed in their urine or droppings.
The tests were conducted at US Centers for Disease Control in Atlanta and the National In-stitute for Communicable Diseases (NICD) in Johannesburg and the results were made public yesterday.
NICD virologist Dr Lucille Blumberg said further tests were needed to confirm the diagnosis by growing the virus in culture and to determine whether it was a previously unrecognised member of the Arena virus family.
Professor Robert Swane-poel, from the NICD's special pathogens unit, said the first person to die, Cecilia van Deventer, must have come into contact with rodents in unhygienic places such as in rubbish, animal feed or crop disposal areas.
Naming the virus has brought some reassurance, but has also prompted a whole new set of questions and concerns.
Dr Fathima Docrat used to work for a medical air evacuation company and in 2006 she was the doctor on the flight that brought to South Africa the first documented Lassa fever patient to be treated here, a Nigerian doctor working in a rural area. The hospital in Abuja said he had had organ failure as a result of sepsis.
They said nothing about Lassa fever, which kills about 5 000 West Africans a year, and is responsible for 80% of hospitalisations in the area where the doctor was working.
Docrat was in close contact with the patient, who was bleeding excessively - a symptom of viral haemorrhagic fever. Docrat thought it was because he'd been on dialysis and had been given heparin to prevent his blood clotting. Doctors hadn't known how much heparin to administer, so they'd given him the whole bottle.
After the flight, she went home, stuffed her clothes in the washing machine and fell into bed. When she woke, she found a phone message telling her not to leave her house. She was given a prophylaxis, which made her ill, though at the time no one knew whether she was suffering from drug side-effects or from Lassa.
Docrat was housebound for about a week. Then, one night, an ambulance parked outside her door. "People came in these 'spacesuits' and fetched me in the middle of the night." She was taken to the Netcare Unitas Hospital in Pretoria, and placed in the same makeshift isolation ward as the Nigerian patient she had transported. He eventually died.
There were only two nurses willing to enter the unit, so they worked around the clock, wearing full protective suits. Docrat was not given protective gear.
Afterwards, she needed post-traumatic stress counselling. She said the most stressful part had been that no one knew what to do: "There was no protocol to follow.
"We don't have a hospital in the country that's geared up for this," she warned. "Think what's going to happen during the World Cup.
"Africans are going to be flooding in," she said.
Docrat is worried about poor medical air evacuation standards. "In an aircraft, 50% of the air is recirculated."
Specialty Emergency Services, the Zambian company that transported Van Deventer, said they treated all flights as though there were communicable diseases on board.
But, says Docrat, the only company that has a proper containment unit is International SOS. In the two years she worked with medical air evacuations, no one from Port Health checked the aircraft, although patients were from different countries. Also, on South Africa-Nigeria flights, planes would refuel in Luanda and no one checked them there either.
The lucrative nature of the business (being airlifted from Nigeria costs R1 million) was resulting in substandard companies.
A male paramedic and a female nurse are now in Sandton's Morningside Medi-Clinic. The paramedic has been diagnosed as having kidney stones.
The nurse attended to the second person who died, paramedic Hannes Els. She has been given a prophylaxis.http://www.capeargus.co.za/index.php...icleId=4658508
<!--img src="" alt="Group writers SA" /-->

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: NOVEL ARENAVIRUS STRAIN (?)

Morningside hospital is at the corner of Rivonia and Hill road. A densly populated area.<TABLE style="BORDER-RIGHT: #c8e7f9 1px solid; BORDER-TOP: #c8e7f9 1px solid; BORDER-LEFT: #c8e7f9 1px solid; BORDER-BOTTOM: #c8e7f9 1px solid; BACKGROUND-COLOR: white" cellSpacing=2 cellPadding=0 width=160 align=center border=0><FORM action=http://www.brabysmaps.co.za/brabys/map_search.asp target=new><TBODY><TR vAlign=top><TD></TD></TR><TR vAlign=top><TD align=middle></TD></TR></TBODY></FORM></TABLE>
http://www.morningsidemc.co.za/defau...o&page=map.asp HOMEPAGEhttp://www.morningsidemc.co.za/defau...page=main.aspx

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: NOVEL ARENAVIRUS STRAIN (?)

Infected nurse?s burial gets go-ahead <!--head0-->

11 October 2008
Getrude Makhafola and Ntwaagae Seleka
<TABLE cellPadding=5 width=200 align=right border=0><!--box0--><TBODY><TR><TD><CENTER>
</CENTER>MISSED: Gladys Mthembu </TD></TR><!--box10--><TR><TD>
</TD></TR></TBODY></TABLE>
<!--blurb1-->The Mthembu family is relieved they can now continue with preparations for their daughter?s funeral.<!--blurb0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->Gladys Mthembu, 34, from Bekkersdal, Westonaria, was also a nursing sister at Morningside Clinic. <!--par0-->
<!--par1-->She died last week after she contracted the deadly viral haemorrhage fever (VHF) from Cecilia van Deventer, a patient who had been brought in from Zambia for treatment. <!--par0-->
<!--par1--><!--par0-->
<!--par1-->Mthembu?s family could not make funeral arrangements as her bedroom was closed and cordoned off by health officials.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->On Friday the bedroom was decontaminated by officials from the department of health.<!--par0-->
<!--par1-->When Sowetan visited the family, Mthembu?s 12-year- old son was playing with his friends in the street.<!--par0-->
<!--par1-->A few days ago, before he was taken to hospital for thorough checkups, his peers were afraid of coming close to him.<!--par0-->
<!--par1-->Neighbours, who feared coming into contact with the Mthembus, were given the go-ahead to enter the house.<!--par0-->
<!--par1-->Her aunt Evelyn Mokgosi, 46, said they were relieved that the house had been declared safe and would continue with funeral arrangements. She said Mthembu was the sole breadwinner who looked after the family.<!--par0-->
<!--par1-->?We relied on her and do not know where to look now that she is gone,? said Mokgosi. ?We have lost a pillar of strength.?<!--par0-->
<!--par1-->Mthembu lived with her two children and her father Joseph Mthembu. Her mother died years ago.<!--par0-->
<!--par1-->Mokgosi said Mthembu had promised to take her 17-year-old niece and another relative to their matric dance function before she died.http://www.sowetan.co.za/News/Article.aspx?id=861817<!--par0-->

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: NOVEL ARENAVIRUS STRAIN (?)


TD Jakes cancels trip to Zambia


By Times Reporter
RENOWNED American televangelist TD Jakes who was expected in Zambia and was scheduled to officiate at the Africa Global Summit has postponed his coming for fear of a mysterious disease that was reported last week to have killed some people.
Efforts by summit organisers to reassure Bishop Jakes and his team through the ministry of Health, Foreign Affairs and American embassy in Zambia that there was no such a disease in the country proved futile.
According to a statement released by the summit organisers in Lusaka yesterday, the decision by Bishop Jakes and his team to postpone their trip to Zambia was as a result of concerns regarding a disease they understood to have originated from Zambia.
?Please, take this as official notification by the African Global Summit planning team for the postponement of the 2008 Africa Global Summit with Bishop Jakes, which was scheduled to take place today at Mulungushi International Conference Centre.
?This decision was made by Bishop Jakes and his team because of their concerns regarding a disease they understood to have originated in Zambia,? the statement reads.
The organisers apologised for the inconvenience and for missing the opportunity the country could have received from the ministry of Bishop Jakes.
The statement appealed to people who bought tickets for the event to take the documents back to where they were purchased for refund.
While in the country, Bishop Jakes was expected to pray for the Zambian presidential aspirants ahead of the October by-election.
Experts recently said a woman from Zambia who died in South Africa from a mysterious disease was in fact afflicted by cerebral edema and multi-organ failure, putting to rest suspicions that she was hit by the deadly Ebola.
Five experts who carried out investigations on two of the four deceased people revealed that the woman could have died from suspected viral infection from a tick bite that she incurred in Lusaka.
Experts from Specialty Emergency Services, Corpmed Medical Centre and Wilderness Safari said that the first victim of the disease that had so far claimed four lives owned horses and attended polo matches in Lusaka. The woman is known to have walked barefoot most of the time and travelled within Africa frequently without seeking medical attention. http://www.times.co.zm/news/viewnews...&id=1223883974

[Treyfish]

Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: NOVEL ARENAVIRUS STRAIN (?)

<TABLE height="100%" cellSpacing=0 cellPadding=0 width=1005 align=center border=0 valign="top"><TBODY><TR><TD height=50><TABLE cellSpacing=0 cellPadding=0 width="100%" align=left border=0 valign="top"><TBODY><TR><TD align=middle></TD><TD></TD><TD align=right>Back to WWA</TD></TR><TR><TD colSpan=3> </TD></TR></TBODY></TABLE></TD></TR><TR><TD vAlign=top align=left>Situation Update No. 17
On 13.10.2008 at 11:18 GMT+2</B>

<CODE>Report by WHO: The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the Arenaviridae family. Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN). Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up. WHO and its GOARN partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts.</CODE>
<HR SIZE=1>Situation Update No. 16
On 13.10.2008 at 03:52 GMT+2</B>

<CODE>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.</CODE>
<HR SIZE=1>Situation Update No. 15
On 12.10.2008 at 17:17 GMT+2</B>

<CODE>A disease that has killed three people in South Africa and forced others into isolation wards may be rodent borne, a health official said on Sunday. All three have died from external and internal bleeding. The first was a patient from Zambia flown to South Africa for treatment. A paramedic who accompanied her, and a nurse from the Morningside clinic where she was taken, also died. "The causative agent of the disease ... may be a rodent borne arenavirus related to the lassa fever virus of West Africa," said Lucille Blumberg of the National Institute for Communicable Diseases as saying. Blumberg could not be reached directly and the health authorities declined to comment on the report. Arenaviruses can cause a type of haemorrhagic fever in rodents. Lassa fever is an acute viral haemorrhagic fever endemic to West Africa that may be spread from rodents to humans through contact with faeces and urine. Last week, the health authorities sent blood samples from the victims to the U.S. Centers for Disease Control and Prevention in Atlanta. A nurse and a paramedic were being monitored in an isolation ward after showing symptoms of the disease.

Arenaviruses

CDC: - http://www.cdc.gov/ncidod/dvrd/spb/m...ages/arena.htm
WikiPedia: - http://en.wikipedia.org/wiki/Arenaviridae</CODE>



</TD></TR></TBODY></TABLE>
http://hisz.rsoe.hu/alertmap/woalert_read.php?glide=EP-20081005-18746- ZAF&cat=dis&lang=eng http://hisz.rsoe.hu/alertmap/woalert...t=dis&lang=eng the google map of Johannesburg and the clinic area