Hemorrhagic fever outbreak kills 23 in south Sudan - unfounded

alert · Oct 10, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

The text of the above article has now been changed to (appears to be only a slight rewording for clarity):

Southern Health Ministry describes Ebola outbreakas ' unconfirmed'
Saturday, 10 October 2009
Southern Sudan's Undersecretary for Health, Dr Majok Yak, says the recent outbreak in Western Bahr El Ghazel has not been confirmed to be Hemorrhagic Fever or Ebola. He said he was surprised when it the media reported it to be an outbreak of the deadly Ebola virus when it had not been confirmed by the health ministry. Dr. Yak said medical experts were on the ground, trying to ascertain what the outbreak was.
The Director General for Preventive Medicine in the Ministry of Health, Dr Atem Nathan, said the cases were reported last month.

Meanwhile the World Health Organization (WHO) said there are enough supplies to deal with the situation if the disease was proven to be Hemorrhagic Fever.

Treyfish · Oct 10, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

<table class="contentpaneopen"><tbody><tr><td class="contentheading" width="100%">Authorities set measures to prevent spread of unknown disease in Raja County </td><td class="buttonheading" align="right" width="100%">

</td><td class="buttonheading" align="right" width="100%">

</td></tr></tbody></table><table class="contentpaneopen"><tbody><tr><td class="createdate" colspan="2" valign="top">Saturday, 10 October 2009 </td></tr><tr><td colspan="2" valign="top"><link href="file:///C:%5CDOCUME%7E1%5Craahmed%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml" rel="File-List"><style></style>

Treyfish · Oct 10, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

OPINIONS Independence? What independence? Why it is not yet Uhuru in my country

News reports emanating from a small corner of Southern Sudan during the last few days indicate that there has been outbreak of something resembling Ebola, the hemorrhagic fever that causes victims to bleed from all orifices in their bodies, death occurring within about 48 hours.
Ebola has neither a cure nor a vaccine. All you have to do to contract it is to come into contact with the body fluids of an infected person. All that is now well known. Equally well known is the fact that there is brisk commercial activity between the people of Southern Sudan and its immediate neighbours to the south and east, engendering a high rate of human traffic.
Without wishing to appear to be a prophet of doom countries like Ethiopia, Kenya and Uganda could soon have pockets of the dreaded fever within their own borders – assuming that the rumours of the outbreak turn out to be true.
We have brilliant medical doctors in this country; capable of monitoring almost to the minute of the outbreak of Ebola and its cousin Marburg from the neighbourhood and attempting to put in place prophylactic measures to contain the disease should it cross the border.
At least two high calibre physicians and dozens of other auxiliary medical personnel have had to pay the ultimate price. They did not have adequately safe protective gear, but worse than even that the country does not even possess a state of the art laboratory capable of screening samples to establish the presence of the Ebola virus. Quite possibly, there now exists one. In that case I apologise unreservedly.
Independence? Which independence? How many privileged ..{snip} the rest is a rant on lack of hospitals

:tiphat:http://www.monitor.co.ug/artman/pub...it_is_not_yet_Uhuru_in_my_country_92706.shtml

alert · Oct 10, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

The previous source is Ugandan. The dead doctors he is referring to are likely not in this outbreak - they are probably a reference to the 2007 Ebola outbreak in Bundibugyo, Uganda.

Treyfish · Oct 10, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

:tiphat: Correct, from a previous outbreak extensively covered on FT. Health commissioners are now admitting roadblocks and the taking of travellers for checkups. Also mentions 3 infected villages. The previous opinion piece tell of extensive traffic and trade in that area and mentions there will probably be infections soon in nearby countries. Let's hope that doesn't happen.l

Vibrant62 · Oct 11, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

If it is ebola, there is a potentially long incubation period. At least people are only infectious as symptoms show however, so it is containable.

alert · Oct 11, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

The incubation period of Ebola ranges from 2 to 21 days, but is usually 7 to 10 days.

alert · Oct 11, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Posting #2 from ProMed EAFR.

http://eafr.promedmail.org/

Published Date
2009-10-10 23:44:22
Subject
PRO/EAFR> Viral hemorrhagic fever - Sudan (02): (West Bahr
Archive Number
20091011.203026
Full Text
VIRAL HEMORRHAGIC FEVER - SUDAN (02): (WEST BAHR AL-GHAZAL), REQUEST
FOR INFORMATION
************************************************************************************
Date: 10 Oct 2009
Source: Voice of America [edited]
http://www.voanews.com/english/2009-10-10-voa4.cfm

Scientists to Investigate Reports of Ebola Outbreak in Sudan
------------------------------------------------------------
The government of southern Sudan and international scientists say
they are trying to reach a remote village to investigate reports of a
possible Ebola outbreak. The World Health Organization's Global Alert
and Response Department in Geneva says it began receiving reports of
an outbreak of viral hemmorhagic fever late last month [September
2009] in the village of Kitkit in the under-developed Western Bahr
al-Ghazal region of South Sudan.

Villagers in the area say 4 people have died from the mysterious
illness. The Global Alert and Response Department's leading Ebola
scientist, Dr. Pierre Formenty, tells VOA that even though the
symptoms may appear to be those of Ebola, scientists will not be able
to determine which hemmorhagic virus is causing the disease until
they can investigate suspected cases in Kitkit. Hemorrhagic viruses
cause high fever and bleeding from openings in the body. Some viruses
cause relatively mild illnesses, while others such as Ebola and
Marburg have high death rates.

Dr. Formenty says because of rain in the area of Kitkit, it is
difficult for scientists to reach the village. He said they need a
helicopter to travel to the region and investigate the reports. The
last Ebola outbreak in southern Sudan occurred in 2004. The disease
killed 7 people and infected 17 others before it was contained more
than a month later. Ebola is transmitted by direct contact with the
blood, secretions, organs or bodily fluids of infected people.

--
Communicated by:
ProMED-EAFR

[Scientists are yet to access the access the village of Kitkit in
Western Bahr Al-Ghazal to investigate the probable outbreak of Viral
Hemorrhagic Fever (VHF) - Ebola. In a country that has had VHF
outbreaks (Ebola) in the past (1976 and 2004) chances are high that
another outbreak could be experienced in the country. Any additional
information from the investigation of this evolving outbreak will be
appreciated.

For a map of the Sudan see
http://www.lib.utexas.edu/maps/africa/txu-oclc-219400066-sudan_pol_2007.jpg.
For the HealthMap/ProMED interactive map of West Bahr al-Ghazal State, see
http://healthmap.org/r/00UR. - Mod.JFW]

[see also:
Viral hemorrhagic fever - Sudan: (West Bahr Al-Ghazal), RFI 20091007.202932
Ebola hemorrhagic fever - Uganda (02): (Mbale) NOT 20090825.201424
Ebola hemorrhagic fever - Uganda: (Mbale) RFI 20090825.201420
Marburgvirus, Egyptian fruit bat - Uganda 20090802.201034]

alert · Oct 11, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

http://www.sudantribune.com/spip.php?article32737

Investigations began to identify mysterious disease in Southern Sudan
Sunday 11 October 2009 04:10. Printer-Friendly version Comments...

October 10, 2009 (GENEVA) ? The World Health Organization and the southern Sudan government have began to investigate reports about a mysterious disease, suspected to be Ebola outbreak, that killed 23 people among them 20 soldiers of the SPLA.

The World Health Organization?s Global Alert and Response Department said it began receiving reports of an outbreak of viral hemmorhagic fever late last month in the village of Kitkit in the Western Bahr al-Ghazal state where the unexplained disease was very widespread.

WHO leading Ebola scientist Dr. Pierre Formenty said that even though the symptoms may appear to be that of Ebola, scientists will not be able to determine which hemmorhagic virus is causing the disease before to investigate suspected cases in Kitkit.

The Ebola hemorrhagic fever is a viral hemorrhagic fever. There are four recognized species within the ebolavirus genus, which in turn have number specific strains. The Zaire virus is the type species, which is also the first discovered and the most lethal.

Sudan Ebola virus is the second species of Ebola that emerged simultaneous with the Zaire virus. It was believed to have originated amongst cotton factory workers in Nzara, Sudan, with the first case reported as a worker exposed to a potential natural reservoir.

Dr. Formenty told VOA it is it is difficult for scientists to reach the village of Kitkit where four people have died from the mysterious illness, due to the rains. He said they need a helicopter to travel to the region and investigate the reports.

The most recent outbreak occurred in May 2004. 20 confirmed cases were reported in Yambio County, Sudan, with five deaths resulting. The average fatality rates for were 54% in 1976, 68% in 1979, and 53% in 2000 and 2001.

(ST)

--------------------------------------------------------------------------------

Treyfish · Oct 13, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

SUDAN: Rains, poor roads hamper mystery disease response

<TABLE style="BORDER-BOTTOM: #bbbbbb 1px solid; BORDER-LEFT: #cccccc 1px solid; PADDING-BOTTOM: 5px; BACKGROUND-COLOR: #eeeeee; MARGIN: 2px 5px 8px 0px; PADDING-LEFT: 5px; WIDTH: 120px; PADDING-RIGHT: 5px; BORDER-TOP: #cccccc 1px solid; BORDER-RIGHT: #bbbbbb 1px solid; PADDING-TOP: 5px" border=0 cellSpacing=0 cellPadding=0 align=left><TBODY><TR><TD style="PADDING-TOP: 3px" align=right>

Photo: Peter Martell/IRIN

</TD></TR><TR><TD style="FONT-FAMILY: Tahoma; FONT-SIZE: 7pt" class=ImgCreditCaption>A southern Sudanese woman in a hospital: Poor infrastructure prevents access to timely healthcare in the region </TD></TR></TBODY></TABLE>JUBA, 12 October 2009 (IRIN) - Efforts to identify a haemorrhagic disease that has killed four people in a remote corner of Southern Sudan have been thwarted by bad roads made impassable by heavy rainfall, according to officials.

The deaths took place in Kitkit, a military outpost in Western Bahr al-Ghazal state. On 23 September, the state's director-general of health, Martin Mayen Wol, had written to Southern Sudan's health ministry in Juba to report the deaths and that six soldiers were complaining of nose bleeds and vomiting blood.

"As there is no means to verify the situation and confirm the condition due to the bad roads attributed to the rainy season, we ask your esteemed office for direct intervention through the international and UN bodies," wrote Wol. "The situation is urgent, Sir."

A team from Southern Sudan's health ministry, the UN World Health Organization and the Sudan People?s Liberation Army (SPLA) could only get as far as Timsah, 70km away.

"... Not even a vehicle could move," Nathan Atem, the Director-General of Preventive Medicine, said. "They had to come back."

Without a landing strip, Kitkit is inaccessible even to aircraft.

A doctor sent to the region on a flight with the UN Mission in Sudan, following an appeal for help issued in late September, had to turn back.

Blood samples of those infected have been sent to the US Centers for Disease Control labs in Atlanta for analysis.

Ministry of Health Under-Secretary Majok Yak Majok played down fears that Ebola might be to blame for the deaths: "It could be any other disease that can cause bleeding," said Majok. "For a serious outbreak, it could have not remained [as] contained since 23 September."

He noted that if it was a viral infection it would have engulfed the entire region in the three weeks.

bdm/aw/mw
:tiphat:http://www.irinnews.org/report.aspx?ReportID=86552

alert · Oct 13, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

That last article is not clear. I'm not sure whose samples have been sent to Atlanta, but if no one has reached the village, it is not likely those of the dead villagers. Also of note is that only the villagers are mentioned as dead in that article, not soldiers or their wives.

The statement about:

"He noted that if it was a viral infection it would have engulfed the entire region in the three weeks."

is likely a reflection of the official's lack of understnading about VHF; if doctors can't get to the village, it is unlikely infected villagers could get out. Ebola is not airborne.

There are several other etiologies that might be responsible for this outbreak besides Ebola (including some non-infectious ones), especially if the 20 dead soldiers was a false rumor.

alert · Oct 13, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

ProMed EAFR posting #3. I think this is a new one from a relase not yet in this thread. If this report (from the Sudan MOH) is accurate, the 20 dead soldiers is a false rumor, as this reports 10 cases with four deaths. The fear of Ebola, combined with the remoteness of the village (and the difficulty accessing it) can be a powerful source of rumor.

http://eafr.promedmail.org/

Published Date
2009-10-13 05:50:21
Subject
PRO/EAFR> Viral hemorrhagic fever - Sudan (03): (West Bahr Al
Archive Number
20091013.203061
Full Text
VIRAL HEMORRHAGIC FEVER - SUDAN (03): (WEST BAHR AL-GHAZAL)
***********************************************
Date: 10 Oct 2009
From: Robert Napoleon
Ministry of Health, Government of Southern Sudan Report

On 23 Sep 2009, the State Ministry of Health, WBeG reported that 6
soldiers had experienced nasal bleeding and were vomiting blood and
that there had been 4 deaths in Kitkit village, which is 95 miles
from Raja town. The Ministry of Health of The Government of Southern
Sudan has been supporting and coordinating with State Ministry of
Health Western Bahr al Ghazal (WBeG) to investigate the above rumor
of patients presenting nasal bleeding and vomiting blood.

Accessibility to Kitkit and surrounding areas is very difficult due
to the rain, and there is no airstrip in the area. Nonetheless, with
the support of UNMIS, the 1st investigation team (consisting of SMoH,
WHO and SPLA) visited Timsah, which is 45 miles from Kitkit, and the
investigation team met with health personnel and community leaders in
Timsah, and they did not find any patient with bleeding tendencies or
meeting the case definition of suspected viral hemorrhagic fever.
Nonetheless, it has been reported that the most affected areas are
Kitkit and surrounding areas, which could not be reached until today
[10 Oct 2009] due to lack of coordinates to locate the landing site
for the UNMIS helicopter.

The MoH-GoSS, SMoH and WHO are still working to send another
investigation mission to Kitkit as soon as possible, and we are
coordinating with SPLA to get the actual coordinates in Kitkit. As we
are talking, the SMoH, WHO, UNMIS and RCSO are having a coordination
meeting to explore ways to speed up the investigation process and
obtain the coordinates so to facilitate the flight. MoH-GoSS and WHO
have already pre-positioned personnel protection equipment and other
necessary supplies for containing the situation, and we are
coordinating other partners if the situation deteriorates.

As of 8 Oct 2009, the available information remains the same, which
is 6 soldiers complaining of nose bleeding and vomiting blood, with 4
deaths in Kitkit village.

The MoH-GoSS will give you updates on the situation if any new
information becomes available.

--
Dr. Robert P. Napoleon

[ProMED-EAFR would like to thank Dr. Robert Napoleon for sharing this
information with ProMED-EAFR in response to an RFI (request for
information) posting on this outbreak (see prior ProMED-EAFR
postings: Viral hemorrhagic fever - Sudan (02): (West Bahr
20091011.203026, Viral hemorrhagic fever - Sudan: (West Bahr
Al-Ghazal), RFI 20091007.202932). Earlier newswire reports had
mentioned that at least 23 deaths had occurred in the affected
region, whereas the above report mentions only 4 deaths.

In this statement from the Government of Southern Sudan, the
investigation teams haven't reached the affected area, Kitkit, but
the government, with support from other international organizations,
is in advanced stages of getting teams to the affected area. The
information currently available indicates that there are 6 soldiers
with nose bleeding and vomiting in addition to 4 deaths in Kitkit
village. We appreciate the current information and will be grateful
for any further updates from the investigation of this evolving outbreak.

For a map of the Sudan, see
http://www.lib.utexas.edu/maps/africa/txu-oclc-219400066-sudan_pol_2007.jpg.
For the HealthMap/ProMED interactive map of West Bahr al-Ghazal
State, see http://healthmap.org/r/00UR. - Mods.JFW/MPP]

[see also:
Viral hemorrhagic fever - Sudan (02): (West Bahr 20091011.203026
Viral hemorrhagic fever - Sudan: (West Bahr Al-Ghazal), RFI 20091007.202932
Ebola hemorrhagic fever - Uganda (02): (Mbale) NOT 20090825.201424
Ebola hemorrhagic fever - Uganda: (Mbale) RFI 20090825.201420
Marburgvirus, Egyptian fruit bat - Uganda 20090802.201034

For additional background postings on viral hemorrhagic fever in the
Sudan, the following can be found at the general ProMED-mail website:
(http://www.promedmail.org).

2008
----
Ebola hemorrhagic fever - Congo DR (02): (KS) 20081229.4093
Rift Valley fever - Sudan: WHO 20080122.0272
2007
----
Ebola hemorrhagic fever - Uganda (09): (Bundibugyo) 20071209.3972
Rift Valley fever - Sudan (11): WHO 20071221.4108
Rift Valley fever - Sudan 20071103.3570
Ebola hemorrhagic fever - Uganda: (Bundibugyo), WHO 20071130.3869
Hemorrhagic fever - Uganda (04): (Bundibugyo), Ebola confirmed 20071130.3859
Hemorrhagic fever - Uganda (02): (Bundibugyo), Marburg NOT 20071116.3718
Rift Valley fever, bovine, ovine - Sudan: (West Nile), OIE 20071114.3694
Zaire ebolavirus, apes - Gabon/DR Congo: lineage variation 20071020.3423
Ebola hemorrhagic fever - Congo DR (08) 20070926.3191
Ebola hemorrhagic fever - Congo DR 20070910.2996
Marburg hemorrhagic fever - Uganda (05) 20070817.2697
Marburg hemorrhagic fever - Uganda 20070803.2514
Viral hemorrhagic fever - Uganda (Kamwenge): Marburg conf. 20070801.2490
Viral hemorrhagic fever - Uganda (Kamwenge): Marburg susp., RFI 20070801.2475
Rift Valley fever - Eastern Africa (18): Kenya, bovine 20070219.0624
2005
----
Yellow fever - Sudan (South Kordofan) (07) 20051223.3665
Yellow fever - Sudan (Kordofan) 20051121.3387
2004
----
Ebola hemorrhagic fever - Sudan (W. Equatoria) (09) 20040807.2180
Ebola hemorrhagic fever - Sudan (W Equatoria) 20040525.1404
Acute hemorrhagic fever - Sudan (W Equatoria) (03): Ebola conf. 20040524.1387
Acute hemorrhagic fever - Sudan (W Equatoria)(02) 20040521.1369
Acute hemorrhagic fever - Sudan (W Equatoria): susp 20040518.1328]
.......................................jfw/msp/mpp

_______________________________________________
ProMED-EAFR mailing list
ProMED-EAFR@promedmail.org
http://eafr.promedmail.org/

alert · Oct 14, 2009

Re: Suspected ebola outbreak kills 23 in south Sudan - army

Re: Suspected ebola outbreak kills 23 in south Sudan - army

This article has a new symptom, diarrhea, but still no flu-like symptoms, and more importantly, no fever. There are conflicting reports of who died, when, and where, but this is looking less like an Ebola outbreak.

http://www.mirayafm.org/index.php/sudan/570-no-more-cases-of-unknown-disease-official-says

No more cases of unknown disease, official says
Wednesday, 14 October 2009 11:17 .The Western Bahr el Ghazal State Minister of Health, Ishag Elias Ibrahim, has confirmed that no more cases of the unknown disease that killed about 20 people in Firga, Kitkit and Timsah, has been reported.An unknown disease with symptoms of vomiting, diarrhea and bleeding from the nose is reported to have claimed the lives of over twenty people last week.

The Minister added that most of the infections are due to the lack of standard medical facilities. He further appealed for deployment of trained medical health providers to the remote areas of Firga and Kitkit.

alert · Oct 15, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

There are some blatant contradictions within this article about the epidemiology of the outbreak, but there is suspicion that the outbreak may trace back into August.

I see moderators have removed the word "Ebola" from the title of this thread, as there are many possible causes. While the title of this thread calls this a hemorrhagic fever, fever itself has not yet been reported - the only symptoms we have been given are the hemorrhagic ones.

http://www.sudantribune.com/spip.php?article32796

W. Bahr el Ghazal State investigates Ebola outbreak
Friday 16 October 2009 02:30. Printer-Friendly version Comments...

By Ngor Arol Garang

October 15, 2009 (KHARTOUM) — The western Bahr el Ghazal State government in collaboration with international medical practitioners today says they are trying to reach a remote village of Kitkit to investigate reports of Ebola outbreak in the region. 23 people among them 20 soldiers of southern Sudan army died of an unexplained disease suspected to be Ebola earlier this month the Southern Sudan army said. However further investigation should be done identify it.

The Ebola hemorrhagic fever is a viral hemorrhagic fever. There are four recognized species within the ebolavirus genus, which in turn have number specific strains. The Zaire virus is the type species, which is also the first discovered and the most lethal. Sudan Ebola virus is the second species of Ebola that emerged simultaneous with the Zaire virus.

"We have organized ourselves into teams and planed to go to the area to fully investigate what caused the death of the four Sudan People’s Liberation Army (SPLA) soldiers besides four other civilians in the area in both August and September 2009," said the state minister of information and communications, Efesio Kon Uguak.

The minister, speaking from Wau town, reiterated that reports from the state ministry of health indicates that at least four people have died and several others are showing symptoms of some type of viral hemorrhagic fever.

The State Ministry of Health report also revealed death of the six soldiers allegedly believed to be members of the SPLA stationed around village of Kitkit in Western Bahr al-Ghazal state. They were found bleeding from the nose and vomiting blood, the report indicates.

Similarly, Major General Kuol Deim Kuol, the SPLA official spokesperson, acknowledged in an interview with members of press death of other 20 soldiers including three wives belonging to these soldiers in Bahr al-Ghazal of a disease suspected to be Ebola.

However, Kuol made no mention of the place where the incident occurred adding that he fear large number of the population may also be infected if immediate medical intervention is not taken.

Even though the symptoms may appear to be that of Ebola, medical practitioners will not be able to determine which hemorrhagic virus is causing the disease until they can investigate suspected cases in Kitkit, said a medical doctor belong to the world health organization in Juba earlier September 2009.

The medical practitioner identified as Dr. Formenty added that there are several types of viruses that cause similar symptoms - high fever and bleeding from openings in the body.

Some viruses cause relatively mild illnesses, while others such as Ebola and Marburg, often kill their host, immediately if no proper medical attention is given.

The practitioner said they did not exclude a long list of possible diseases that might be the cause of the death of four SPLA soldiers and four civilians in Kitkit.

However, the doctors’ plans to investigate the real cause met with a lot of rain in this area. Roads were bad and helicopter could not land as this village of Kit Kit is deep in the forest to reach and investigate all these rumors, he said.

Earlier minister Uguak said that reports from the state ministry of health indicates that the last Ebola outbreak in southern Sudan occurred in 2004.

The disease, one of the most feared in the world, killed seven people and infected 17 others before it was contained more than a month later.

(sT)

Roehl_JC · Oct 16, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Thanks Alert!
You're right, sounds to me too like there's lots of rehashing of the earlier stories, with intentional muddying like "the doctors’ plans to investigate the real cause met with a lot of rain in this area. Roads were bad and helicopter could not land as this village of Kit Kit is deep in the forest to reach and investigate all these rumors, he said."(ibid.)
.
Assuming some of the aforementioned stories are true, and there's some sort of hemorrhagic viral disease afoot....then why/how does it take 9 days since the initial stories to get qualified international health experts/doctors in there to obtain samples and begin treatment of sufferers? Any ideas on CDC's end as to why collecting samples is so hard? Especially if the initial casualties were military, would it be too adolescent to assume the military of the SPLA IS THERE ALREADY?Cellphones? leaping lizards? smoke signals? sorry just being silly, but anytime I hear stories like this one and the one in Papua New Guinea recently too, first it seems like they're really concerned, then there's silence, and lastly, a soothing rejoinder of mollifying platitudes saying pretty much 'no big news here', 'move along', it's all been resolved or simply silence...for months. Hopefully we'll hear more soon.

Perhaps it's 'E' but then again I keep wondering how H5N1 is evolving in N. Africa ever since Egypt first began announcing cases in communities there more than 2 years ago. Sudan to the South along the Nile would surely have been or still be seeing H5N1 and other avian-borne viruses too, so if it is Ebola, then wouldn't there by more civilian cases than military, and wouldn't the SPLA know right this moment the status of the area? if it's safe to assume that military organizations usually respond more quickly than civilians do. Leads me to think there is more here than meets the eye.

Roehl_JC · Oct 16, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

However, Kuol made no mention of the place where the incident occurred adding that he fear large number of the population may also be infected if immediate medical intervention is not taken.

comment:
Now is he intentionally dissembling? Surely he knows. Or is it not convenient to be clear for other less obvious reasons?

Vibrant62 · Oct 16, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Remember that Sudan is in the middle of ongoing conflict, and this involves soldiers - so what better time for one faction to attack the other than when one side is disabled through illness, and to increase the chances of the other side winning? As such, the precise nature, severity and location of this outbreak (as it involves soldiers) is likely to be a military and state secret.

I think that this has a lot to do with misinformation that may emanate from this area, and we just have to hope that any health threat is localised and not a potential global threat.

alert · Oct 16, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,79646

Archive Number 20091016.3562
Published Date 16-OCT-2009
Subject PRO/EDR> Ebola hemorrhagic fever - Sudan (02): (WB) susp

EBOLA HEMORRHAGIC FEVER - SUDAN (02): (WEST BAHR AL-GHAZAL) SUSPECTED
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 16 Oct 2009
Source: Sudan Tribune [edited]
<http://www.sudantribune.com/spip.php?article32796>

Western Bahr al-Ghazal State investigates [ebolavirus] outbreak
---------------------------------------------------------------
The West Bahr al-Ghazal State government in collaboration with
international medical practitioners today [15 Oct 2009] says they are
trying to reach the remote village of Kitkit to investigate reports of an
Ebola [hemorrhagic fever] outbreak in the region. 23 people, among them 20
soldiers of the southern Sudan army, died of an unexplained disease
suspected to be Ebola hemorrhagic fever earlier this month [October 2009]
the Southern Sudan Army said. However further investigation should be done
[to confirm this].

Ebola hemorrhagic fever is a viral hemorrhagic fever. There are 4 [now 5. -
Mod.CP] recognized species within the genus _Ebolavirus_, which in turn
include [a number of species]. The _Zaire virus_ is the type species, which
was also the first discovered and the most lethal. _Sudan ebolavirus_ is
the 2nd species of the _Ebolavirus_ genus that emerged almost simultaneous
with the _Zaire virus_.

"We have organized ourselves into teams and plan to go to the area to fully
investigate what caused the death of the 4 Sudan People's Liberation Army
(SPLA) soldiers besides 4 other civilians in the area in both August and
September 2009," said the state minister of information and communications,
Efesio Kon Uguak. The minister, speaking from the town of Wau, reiterated
that reports from the State Ministry of Health indicate that at least 4
people have died and several others are showing symptoms of some type of
viral hemorrhagic fever.

The State Ministry of Health report also revealed the deaths of 6 soldiers
allegedly believed to be members of the SPLA stationed around the village
of Kitkit in Western Bahr al-Ghazal state. They were found bleeding from
the nose and vomiting blood, the report indicates.

Similarly, major general Kuol Deim Kuol, the SPLA official spokesperson,
acknowledged in an interview with members of press the death of another 20
soldiers including 3 wives [of] these soldiers in Bahr al-Ghazal of a
disease suspected to be Ebola hemorrhagic fever. However, Kuol made no
mention of the place where the incident occurred, adding that he feared a
large number of the population may also be infected if immediate medical
intervention is not taken.

Even though the symptoms may appear to be that of Ebola hemorrhagic fever,
medical practitioners will not be able to determine which hemorrhagic fever
virus is causing the disease until they can investigate suspected cases in
Kitkit, said a medical doctor from the World Health Organization in Juba
earlier in September 2009. The medical practitioner identified as Dr
Formenty, added that there are several types of viruses that cause similar
symptoms -- high fever and bleeding from openings in the body. Some viruses
cause relatively mild illnesses, while others such as _Ebolavirus_ and
_Marburgvirus_, often kill their host, immediately if no proper medical
attention is given. The practitioner said they did not exclude a long list
of possible diseases that might be the cause of the death of 4 SPLA
soldiers and 4 civilians in Kitkit. However, the doctors' plans to
investigate the real cause [have been affected] by heavy of rain in this
area. Roads were badly affected and a helicopter could not land as the
village of Kitkit is deep in the forest.

Earlier minister Uguak said that [information] from the state Ministry of
Health indicates that the last ebolavirus outbreak in southern Sudan
occurred in 2004. The disease, one of the most feared in the world, killed
7 people and infected 17 others before it was contained more than a month
later.

[byline: Ngor Arol Garang)

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Mon 12 Oct 2009
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86552>

Rains and poor roads hamper mystery disease response
----------------------------------------------------
Efforts to identify a haemorrhagic disease that has killed 4 people in a
remote corner of Southern Sudan have been thwarted by bad roads made
impassable by heavy rainfall, according to officials.

The deaths took place in Kitkit, a military outpost in Western Bahr
al-Ghazal state. On 23 Sep 2009, the state's director-general of health,
Martin Mayen Wol, had written to Southern Sudan's health ministry in Juba
to report the deaths and that 6 soldiers were complaining of nose bleeds
and vomiting blood. "As there are no means to verify the situation and
confirm their condition due to the bad roads attributed to the rainy
season, we ask your esteemed office for direct intervention through the
international and UN bodies," wrote Wol. "The situation is urgent, Sir."

A team from Southern Sudan's health ministry, WHO, and the Sudan People's
Liberation Army (SPLA) could only get as far as Timsah, 70 km [about 45 mi]
away. "... not even a vehicle could move," Nathan Atem, the
director-general of Preventive Medicine, said. "They had to come back."

Without a landing strip, Kitkit is inaccessible even to aircraft. A doctor
sent to the region on a flight with the UN Mission in Sudan, following an
appeal for help issued in late September [2009], had to turn back. Blood
samples of those infected have been sent to the US Centers for Disease
Control labs in Atlanta for analysis.

Ministry of Health under-secretary Majok Yak Majok played down fears that
Ebola haemorrhagic fever might be to blame for the deaths: "It could be any
other disease that can cause bleeding," said Majok. "For a serious
outbreak, it could have not remained [as] contained since 23 Sep 2009." He
noted that if it was a viral infection it would have engulfed the entire
region in the 3 weeks.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[There is some confusion about the number of individuals affected and the
nature of the unidentified disease. It appears now that a few civilians in
the village of Kitkit have been affected in addition to the soldiers of the
Southern Sudan Army and some of their wives. The only positive news is that
blood samples have been sent to the US CDC in Atlanta for analysis,
although it is not clear how this has been achieved since attempts to reach
the affected area have been thwarted by heavy rain and its remoteness.

There is no firm evidence that the deaths and illnesses have been caused by
Ebola hemorrhagic fever virus infection. Fever and hemorrhage can be caused
by a number of agents, which can best be distinguished on the basis of
laboratory analysis.

A map showing the location of the state of West Bahr al-Ghazal can be
accessed at <http://en.wikipedia.org/wiki/Western_Bahr_el_Ghazal>. The
HealthMap/ProMED-mail interactive map of Sudan can be accessed at
<http://healthmap.org/r/00UR>. - Mod.CP]

[see also:
Ebola hemorrhagic fever - Sudan: (WB) susp. RFI 20091008.3482
2004
---
Ebola hemorrhagic fever - Sudan (W. Equatoria) (09) 20040807.2180
Ebola hemorrhagic fever - Sudan (W Equatoria) (08) 20040706.1810
Ebola hemorrhagic fever - Sudan (W. Equatoria) (07) 20040622.1668
Ebola hemorrhagic fever - Sudan (W. Equatoria) (06) 20040618.1626
Ebola hemorrhagic fever - Sudan (W. Equatoria) (05) 20040612.1581
Ebola hemorrhagic fever - Sudan (W. Equatoria) (04) 20040609.1547
Ebola hemorrhagic fever - Sudan (W Equatoria): (03) 20040602.1500
Ebola hemorrhagic fever - Sudan (W Equatoria): (02) 20040527.1435
Ebola hemorrhagic fever - Sudan (W Equatoria) 20040525.1404]

.................cp/mj/sh

alert · Oct 20, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

This story had gone dead for over a week, and now produced this article. No ongoing outbreak, and not 23 deaths; just four. We'll see if results are released, but I'm guessing this is not going to be an infectious disease at all. Note the blue symptoms that are typical of Ebola. The only one of them associated with this outbreak is the bleeding.

The article also contains a slight error: Ebola Reston in the Phillipines did not cause "very mild symptoms" - it caused asymptomatic infection.

http://thefastertimes.com/globalpandemics/2009/10/20/ebola-possible-outbreak-vaccine-trial/

Ebola: Outbreak Fears in Sudan, Vaccine Trials in Uganda October 20, 2009 Onome Akpogheneta
Zaire Ebola virus, Murphy, 1976
The World Health Organisation (WHO) has confirmed a possible Ebola outbreak in Kitkit village and Timsah village of Raja county, Western Bahr El Ghazal, in southern Sudan. ‘6 suspected cases… including 4 deaths’ have been reported; prior to death symptoms included nasal bleeding and blood vomiting. There is no ongoing haemorrhagic disease outbreak in this area, but samples are being tested to assess whether Ebola virus was the cause of death in the identified cases. The Ministry of Health of the Government of southern Sudan is expected to announce their findings in the coming days.

There are 5 known species of Ebola virus: Zaire, Sudan, Cote d’Ivoire, Bundibugyo & Reston. Zaire viruses have the highest mortality rates, killing up to 90% of those infected within just days after exposure. However, not all 5 strains are similarly life-threatening. Sudan and Bundibugyo Ebola viruses have lower (53 and 25%) fatality rates compared to Zaire. Only one case of Cote d’Ivoire Ebola has been documented; the victim survived. Reston causes only mild or asymptomatic illness and there are no documented fatalities 1. Animals including chimpanzees, mountain gorillas and forest antelopes are also known to be fatally infected by Ebola viruses, and swine have recently been confirmed as a host for Reston Ebola virus. Natural Ebola reservoirs are thought to exist in the rainforests of West Africa and in the Western Pacific. While the natural hosts for the viruses have not been identified, current research suggests that bats may be the most likely candidates 2.

Ebola is one of two known filoviruses which cause fatal haemorrhagic disease, Marburg is the second. Both Ebola and Marburg viruses are transmitted by direct contact with blood, secretions or other bodily fluids of infected people. Uncontrolled viral multiplication is the reason for rapid disease onset after infection with Ebola virus. It appears that only bones and skeletal muscles are spared attack. Infection can result in internal and external bleeding as the virus appears to infect and multiply within all cell type, breaking cell membranes (exterior coverings) and causing irreparable damage. In humans Ebola is characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is often followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. The brutal symptoms and swift, high fatalities have inspired fear of Ebola. The virus has also been an inspiration to Hollywood with the movie hysterics and heroics of ‘Outbreak’. A nickname for Paris Hilton (aka Hollywood Ebola) is also inspired.

Ebola outbreak, Uganda, Thompson 2001
Those known to be infected with Ebola will be isolated and hydrated, but there is no specific drug treatment against the virus. There is also no available vaccine. Small scale human vaccine trials have begun with a vaccine developed by the National Institutes of Allergy and Infectious Diseases (NIAID). Early animal studies have also shown promise; vaccine-induced protection from new Ebola infection and disease has been described in non-human primates. Small scale human studies to test vaccine safety and ability to generate immune specific responses have been conducted in the US. The results of the US clinical trial are being evaluated; further similar small scale human studies are expected to begin in Uganda in the coming weeks. It’s hoped that this vaccine, which is composed of synthetic DNA portions of the virus, can be given in a single dose to protect before and after exposure to Ebola 3 4.

Since Ebola was identified in 1976 in Sudan and Zaire there have been 2273 confirmed infections and 1482 deaths (65% mortality) 1. Disease outbreaks have been documented in Democratic Republic of Congo (DRC), Sudan, Republic of Congo, Gabon, Ivory Coast and Uganda. Human cases of Reston Ebola virus (very mild symptoms!!) in the Philippines were confirmed to have been contracted from swine 5. A handful of Reston cases have been reported in Europe and USA as a result of importation of monkeys from the Philippines. The locations and communities primarily affected by the virus are limited and remote. Outbreaks largely remain localized to the geographical areas where the viruses appear to have originated.

Ebola is not a global pandemic, but remains a mysterious, fear-inspiring disease, and a high priority possible bioterrorism agent. The numbers infected by Ebola are small. But when it does infect, Ebola virus is frequently a swift, violent, bloody and deadly pathogen.

1. CDC. Ebola Haemorrhagic Fever: Known Cases and Outbreaks of Ebola Hemorrhagic Fever, in Chronological Order. 2009; http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/ebolatable.pdf

2. Pourrut X, Souris M, Towner JS, Rollin PE, Nichol ST, Gonzalez JP, Leroy E. Large serological survey showing cocirculation of Ebola and Marburg viruses in Gabonese bat populations, and a high seroprevalence of both viruses in Rousettus aegyptiacus. BMC Infect Dis 2009; 9 159 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761397/?tool=pubmed

3. NIAID. Experimental Vaccine for Prevention of Ebola Virus Infection. 2009; http://clinicaltrials.gov/ct2/show/study/NCT00374309

4. NIAID. Ebola/Marburg Vaccine Development. 2009; http://www3.niaid.nih.gov/topics/ebolaMarburg/default.htm

5. WHO. Outbreak news. Ebola Reston in pigs and humans, Philippines. Wkly Epidemiol Rec 2009; 84 (7) 49-50 http://www.who.int/wer/2009/wer8407.pdf

alert · Oct 21, 2009

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Re: Hemorrhagic fever outbreak kills 23 in south Sudan - army

Published today in a Ugandan source of questionable accuracy (likely using old/incorrect information).

http://www.independent.co.ug/index.php/category-table/32-quotes/1962-issue-82-quotes-and-numbers-

23

Number of people suspected to have died of Ebola in southern Sudan. According to South Sudan Army spokesman Kuol Diem, the majority of the deaths reported are SPLA soldiers.

Hemorrhagic fever outbreak kills 23 in south Sudan - unfounded

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