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

Treyfish · Oct 7, 2008

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

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

Two more in hospital after mystery disease 

07 October 2008
Zinhle Mapumulo
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Two members of the family of a Morningside hospital nurse who died after coming into contact with the victim of a mystery disease last week were taken to hospital last night.




The hospital said the two were taken there for observation and tests after having been in contact with the nurse.
But, authorities said the infectious flu-like disease that has claimed the lives of four people in Johannesburg is not airborne.
The national Health Department has also said that the public should not panic. 
The department?s spokesman Fidel Hadebe said: ?There is no need to panic at this stage because the only way one can be infected with this unknown deadly disease is through body fluids.?
The fourth person to fall victim to the mystery disease died at Leratong Hospital on the West Rand yesterday. 
She was a cleaner at Morningside Medi-Clinic where the unknown disease broke out.
A person with the disease suffers from internal and external bleeding, vomiting and feels hot.
On September 12, a critically ill Zambian woman was transferred from Central Lusaka Hospital to Morningside Clinic. 
The 36-year-old tourism manager was to be treated for what they believed was tick bite fever. However, she died two days after experiencing flu-like symptoms. 
A paramedic who had accompanied the woman from Zambia returned to the hospital on September 27 with similar symptoms. He died four days later. 
On Sunday, a nurse who came into contact with the Zambian woman also died while being treated at Sir Albert Robinson Hospital in the West Rand. 
Dr Chika Asomugha of the Gauteng health department said they have no idea what they are dealing with at present. 
The department is hoping to get a clearer picture from America.
?Blood samples taken from the deceased were not conclusive of any particular disease,? said Asomugha. 
?We have sent samples to Atlanta in the US for further investigation. We expect the results after 10 days.?:tiphat:http://www.sowetan.co.za/News/Article.aspx?id=857594

Treyfish · Oct 7, 2008

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

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

Panic as staff is checked 

07 October 2008
Sipho Masombuka and Pertunia Ratsatsi

Panicky staff at the Kalafong Hospital in Atteridgeville, Pretoria, who had been in contact with an elderly female patient who died on Saturday morning, are being closely monitored for possible signs of a highly infectious disease that has already claimed four lives in Johannesburg.




The patient was admitted on Friday afternoon as a transfer from the Mamelodi Hospital and died just after midnight.
The panic increased when casualty ward staff allegedly told a porter that preliminary tests pointed to a deadly and highly infectious disease.
A porter who spoke to Sowetan on condition of anonymity said she was even more alarmed when she heard a report on the radio yesterday about three people who had succumbed to the disease.
?Our temperatures and blood pressures were checked on Saturday morning but we were not told what was going on,? the porter said. 

?I started getting worried when I heard about a possible outbreak of the infectious disease because I am the one who wheeled the patient from the ambulance to the casualty ward.? 

Kalafong Hospital chief executive officer Trevor Fisher said everybody who had been in contact with the patient was being closely monitored as a precautionary measure.:tiphat:http://www.sowetan.co.za/News/Article.aspx?id=857600

Treyfish · Oct 7, 2008

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

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

Battle to beat killer disease

7 October 2008, 06:44By Louise Flanagan, Solly Maphumulo and Shaun Smillie

Four people have died from a mysterious disease, and while experts try to pinpoint the cause, details of the struggle to contain it have emerged.

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

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

On Monday, health authorities spent hours in discussions on the outbreak, then urged the public not to panic.

Experts believe a viral haemorrhagic fever is the culprit, probably Congo fever.

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

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

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

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

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

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

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

Samples might be sent to the US for further tests.

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

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

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

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

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

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

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

Morningside spokesperson Melinda Pelser said the clinic realised there was a possible outbreak when Els arrived, and they informed health authorities on September 30.

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

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

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

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

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

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

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

They could not get hold of Mokubung. "We tried to contact her since Thursday ? She was the only one we couldn't get hold of," said Pelser.

Finally, on Sunday, her family was reached, only to report that Mokubung had since been in Chris Hani-Baragwanath and then Leratong Hospital.

A Health Department team went to Leratong to fetch Mokubung and took her to Charlotte Maxeke Johannesburg Academic Hospital on Sunday night, where she died hours later.

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

Pelser said "there could be a possibility, but a very low possibility", that her case was linked to the others.:tiphat:http://www.thestar.co.za/?fSectionId=&fArticleId=vn20081007060254757C735421

Treyfish · Oct 7, 2008

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

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

?Cleaner did not have strange illness? 

07 October 2008
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The death of a 39-year-old cleaner at Morningside Medi-Clinic yesterday was not related to the deaths of three others who contracted a mysterious infectious disease, said the clinic last night.




?She was not in contact with the patient. She died of a neurological disease,? said clinic spokesman Melinda Pelser.

Pelser said two relatives of the nurse who had attended to the first victim were brought into the clinic for observation. 
?The adult female, who is in her 20s has a slight fever and the 11-year-old boy does not have any symptoms of the disease,? said Pelser.
Pelser said the two were brought into the hospital as a precautionary measure. ? Namhla Tshisela:tiphat:http://www.sowetan.co.za/News/Article.aspx?id=857589

Treyfish · Oct 7, 2008

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

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: woman put into isolation </TD></TR><TR><TD class=Byline></TD><TD class=Published align=right>Published:Oct 07, 2008</TD></TR></TBODY></TABLE>A woman with symptoms similar to those of at least three people who have died of a mystery disease has been put into isolation at Chris Hani Baragwanath Hospital, reports Talk Radio 702.:tiphat:http://www.thetimes.co.za/News/Article.aspx?id=857869

Treyfish · Oct 7, 2008

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

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></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>

ISOLATED CASE: Morningside Clinic in Johannesburg, where three people have died in a suspected outbreak of a form of haemorrhagic fever </TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg><TABLE cellSpacing=0 cellPadding=0 width=200 align=right border=0><TBODY><TR><TD class=storybody width=200>

Mass hysteria is not necessary in this case

</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>:tiphat:</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>http://www.thetimes.co.za/News/Article.aspx?id=857563

Giuseppe · Oct 7, 2008

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

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

UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA (02)
***********************************************
[Original texts at: http://apex.oracle.com/pls/otn/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74261 ]

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: Mon 6 Oct 2008
Source: South African Broadcasting Corporation News online [edited]
<http://www.sabcnews.com/south_africa/health/0,2172,177844,00.htm>

A 4th person with viral haemorragic fever (VHF) symptoms has died.
The virus has already claimed the lives of a Zambian national and 2
other people at the Morningside Clinic in Johannesburg. The woman was
a cleaner at the clinic.

The National Health Department has issued an alert in Gauteng
following these deaths. Unconfirmed tests indicate they may have died
of [a] fatal viral haemorragic fever. An Outbreak Response and
Tracking Team has been set up to contain any further spread. The
department's Zanele Mngadi says investigations are still underway
into the cause of the deaths.

Mngadi confirmed the death of the 4th person, who was admitted at the
Leratong hospital last night [5 Oct 2008]. The patient, who showed
symptoms of VHF, was transferred to the Charlotte Maxeke Johannesburg
Academic Hospital, where she died. The health department says there
is no need for South Africans to panic. The department's Frew Denson
says the fever is highly contagious but is only transmitted through
body fluids.

It is reported that the virus can kill a person within 72 hours. VHF
is an extremely infectious and life-threatening disease caused by
[several different] viruses, including Ebola virus. The death rate
[in the case of Ebola virus] can be as high as 90 percent. Symptoms
vary but include fever, vomiting, diarrhea and bleeding.

--
Communicated by:
Rabelani Daswa <rabedaswa@gmail.com>

******
[2]
Date: Mon 6 Oct 2008
From: Amy Cantlay <inka@iwayafrica.com>

I have just read the posting (Undiagnosed fatalities - South Africa
ex Zambia: RFI 20081005.3139) on your site, and it appears to be
rather misleading. The chronological order of events (as I can
gather) is as follows (None of this information has yet been confirmed.):

4 Sep 2008 - Index Case - female South African, (living in Zambia for
many years) begins to suffer from flu-like symptoms.

9 Sep 2008 - She is slowly deteriorating. She sees multiple doctors in Lusaka.

11 Sep 2008 - She is admitted to hospital and deteriorates over night.

12 Sep 2008 - Paramedic is called in to evacuate her to South Africa.
He does the transfer, along with another Dr assisting.

13 Sep 2008 - Index Case dies.

14 Sep 2008 Paramedic starts to develop flu-like symptoms.

14-27 Sep 2008 - Paramedic slowly deteriorates.

27 Sep 2008 - Paramedic is diagnosed as very sick and medivaced to
South Africa. Nurse who treated Index case begins to get flu-like symptoms.

30 Sep 2008 - Paramedic dies.

1 Oct 2008 - Nurse who treated Index Case is admitted to hospital.

5 Oct 2008 - Nurse who treated Index Case dies.

The information that I can gather is the following:

1. Incubation period is as little as 2 days (paramedic), but as long
as 14 days (nurse).

2. Disease course is generally 4-7 days of flu-like illness with
patient only becoming critically ill in 2nd week of disease.

3. Further information is that Index Case reportedly had an eschar on
one of her feet, thought to be from a tick-bite. She had also been in
contact with horses from Congo in the weeks preceding her illness.
Transmission is hypothesized to be by 2 means: tick-borne 1st (which
may have brought the disease into the human population from the
animal population) followed by direct contact with bodily fluids
(resulting in human to human transmission).

4. It appears further hospital staff are now critically ill in
Zambia, though this has not been confirmed.

5. If the incubation period is as long as 2 weeks, then we should
still be closely watching all "contact-cases" for any signs of the
disease. Those in contact with the Index case should be in the clear
by now, while those in contact with the paramedic and the nurse (as
well as any hospital staff who are currently sick) are still at high
risk. One should probably work on a 21-day incubation
period/quarantine period to be safe.

6. Chances are this is a new virus (or new subtype of virus) in the
[family _Filoviridae_]. The only 2 known viruses in this group are
Ebola and Marburg. It looks as though [the infection] may have
entered Zambia from the Democratic Republic of the Congo (DRC)
through a tick (carried on a horse), but again this cannot be confirmed.

This comment assumes that labs in South Africa have already tested
all known VHFs. It is unlikely to be pneumonic plague, as this would
have been discovered in South Africa; however, it is still a
possibility that this [putative] viral disease has been in the
Southern Province of Zambia (and that the 4 reported cases seen there
were not diagnosed or wrongly called pneumonic plague).

7. The important steps in control are 1. effective quarantine of sick
patients, and 2. monitoring of all "in-contact" cases, with
quarantine as soon as any signs of flu or fever are noted. The
government should also ideally make a statement to calm the panic and
prevent people from fleeing the capital (potentially carrying the
disease countrywide). This disease only spreads to people who are in
very close contact with sick individuals. Those family members who
are potentially incubating the disease should be encouraged to stay
around Lusaka, so that signs can be picked up quickly and treatment
issued rapidly. Early treatment of most "viral hemorrhagic fevers"
with ribavirin has been proven to reduce the fatality rate
significantly. The country needs to import ribavirin if there is not
enough in stock.

--
Communicated by:
Dr Amy Cantlay BVSc.MRCVS <inka@iwayafrica.com>
Veterinarian
Mkushi, Zambia

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

A map of Zambia can be accessed at
<http://www.lib.utexas.edu/maps/africa/zambia_pol01.jpg>,
and a map of South Africa at
<http://www.lib.utexas.edu/maps/africa/south_africa_pol_2005.jpg>.
- Mod.CP]

[see also:
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Anthrax, wildlife - Zambia (Eastern) 20081002.3115
2007
----
Undiagnosed deaths - Zambia (03): apology 20071130.3866
Undiagnosed deaths - Zambia (02): pneumonic plague susp. 20071130.3862
Undiagnosed deaths - Zambia: RFI 20071129.3853
Anthrax, human, bovine - Zambia (WP) 20071115.3714
2001
----
Plague, bubonic - Zambia (04) 20010418.0769
Plague, bubonic - Zambia (03) 20010328.0631
Plague, bubonic - Zambia (02) 20010327.0621
Plague, bubonic - Zambia 20010315.0525
1998
----
Mortality, human, undiagnosed - Zambia: RFI 19980406.0636
1997
----
Plague, bubonic - Zambia (04) 19970211.0325
Plague, bubonic - Zambia (03) 19970205.0271
Plague, bubonic? - Zambia (02) 19970203.0247
Plague, bubonic - Zambia 19970131.0201
1995
----
Re: Ebola - Zambia? 19950626.0458
Ebola - Zambia? 19950623.0448]
...................................cp/msp/dk
-
-----

</pre>

Gert van der Hoek · Oct 7, 2008

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

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

Report posted in # 23 suggest "Congo Fever" could be the culprit; official name: Crimean-Congo Hemorrhagic Fever (CCHF). (No diagnose is confirmed yet!)

http://en.wikipedia.org/wiki/Crimean-Congo_hemorrhagic_fever

Some snips:

Crimean-Congo hemorrhagic fever (CCHF) is a widespread tick-borne viral disease, a zoonosis of domestic animals and wild animals, that may affect humans.

The pathogenic virus, especially common in East and West Africa, is a member of the Bunyaviridae family of RNA viruses.

Clinical disease is rare in infected mammals, but commonly severe in infected humans, with a 30% mortality rate. Outbreaks of illness are usually attributable to handling infected animals or people.

Outbreaks have occurred in clinical facilities where health workers have been exposed to infected. blood and fomites.

Typically, after a 1–3 day incubation period following a tick bite (5–6 days after exposure to infected blood or tissues), flu-like symptoms appear, which may resolve after one week.

In up to 75% of cases, however, signs of hemorrhage appear within 3–5 days of the onset of illness in case of bad containment of the first symptoms: first mood instability, agitation, mental confusion and throat petechiae, then soon nosebleeds, bloody urine and vomiting, and black stools.

The liver becomes swollen and painful. Disseminated intravascular coagulation may occur as well as acute kidney failure and shock, and sometimes acute respiratory distress syndrome.

Patients usually begin to recover after 9–10 days from symptom onset, but 30% die in the second week of illness.

A thread on CCHF in South Africa can be found here:

http://www.flutrackers.com/forum/showthread.php?t=74425

Gert van der Hoek · Oct 7, 2008

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

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

Cleaner's supervisor isolated

October 07 2008 at 11:07AM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Samples might be sent to the US for further tests.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20081007104101304C470799

Gert van der Hoek · Oct 7, 2008

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

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

Mystery S.Africa killer disease may be Congo fever

Tue 7 Oct 2008,

By Michael Georgy

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

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

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

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

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

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

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

TREATMENT POSSIBLE

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

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

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

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

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

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

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

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

Gert van der Hoek · Oct 7, 2008

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

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Zambia, WHO join hunt for S.Africa's deadly mystery illness

59 minutes ago

JOHANNESBURG (AFP) ? Zambia along with the World Health Organisation have joined the hunt for a mystery illness that has killed four people in South Africa, Zambia's ambassador said on Tuesday.

Three of the four victims are believed to have died of a viral haemorrhagic fever, but the exact disease has yet be to identified, Melinda Pelsa, spokeswoman for Johannesburg's Morningside Medi-Clinic, told AFP.

A fourth victim appears to have died of a neurological disease, but tests are still under way to determine if they are linked and to identify the disease, provincial health department spokesman Chika Asomugha said.

Health workers have been put on alert for symptoms of the strange illness, he added.

Two of the victims had earlier been identified as Zambians, but the country's ambassador said they were actually South Africans who had been living in the impoverished nation.

"We have investigated all our institutions, we have involved the WHO and the Centres for Disease Control, as well as Zambian medical teams and administrators in the investigations," Ambassador Leslie Mbula said on South African radio.

The first victim came to South Africa on September 12 and died two days later after being treated for what was believed to be tick-bite fever. The medic who accompanied her from Zambia died two days later with flu-like symptoms.

A nurse and a cleaner at the hospital have also died with strange symptoms.

http://afp.google.com/article/ALeqM5j4tuNoiKqiRouSd0p0FbgbeMi2gw

Gert van der Hoek · Oct 7, 2008

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

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

Sick woman a Medi-Clinic worker

A 51-year-old woman has been admitted to the Chris Hani Baragwanath hospital with symptoms of the unknown illness that has claimed four lives in South Africa, the Gauteng health department said on Tuesday.

Spokesperson Zanele Mngadi said the department had confirmed that *****, who was admitted to the hospital, was a cleaning supervisor at Morningside Medi Clinic.

*** was admitted on Monday with flu-like symptoms.

"She is in isolation and tests are being done to confirm her illness. Ms Stuurman is stable and there is a chance of her being discharged today or soon," Mngadi said.

Meanwhile private and public hospitals were urged by the National Education Health and Allied Workers Union (Nehawu) to take precautionary measures and isolate patients who were vomiting and suffering from diarrhoea.

- snip -

http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=nw20081007124607140C580221

Commonground · Oct 7, 2008

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

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

[any corrections/modifications are always welcomed]

Morningside MediClinic
Cecilla van Deventer (36) Adm: 9/12. Died: 9/14. From: Lusaka, Zambia. Sym onset: 9/4 [post #17]. Recon: Central Lusaka Hosp., Cop Med Clinic, CFB Medical Clinic. Tourism operator/manager.

Hannes Els (33) [paramedic] Adm: 9/27. Died: 10/2 From: Zambia Sym onset: 9/27.

Female (20's) Adm: 10/7. Brought in for observation.
Boy (11) Adm: 10/7. Brought in for observation
Relatives of nurse. No symptoms.

Charlotte Maxeke Johannesburg Academic Hospital
Maria Mokubung (37) [cleaning lady] Adm: ? From: Slovoville. Sym onset: 10/4 (?) Recon: Leratong Hosp. (West Rand)
Died: 10/5 at Charlotte Maxeke Hosp. [Died @ Leratong Hosp. post#8]

Sir Albert Robinson Hospital (West Rand/Randfontein)
Gladys Mthembu (34) [nurse] Adm: 10/2 From: Westonaria Sym onset: 10/1. Died: 10/5 (post#17)

10/7: 8 people. Adm: ? Put into isolation for observation. Staff/people who were in contact with nurse.

Chris Hani Baragwanath Hospital
Maria Stuurman (51) Adm: 10/7 Cleaning ladies supervisor. In isolation. Sym: flu-like including fever. "similar to at least 3 people who died".

Shiloh · Oct 7, 2008

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

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Source: http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20081007145051874C315614
Virus outbreak: 11 quarantined
Staff Reporters
October 07 2008 at 03:14PM

Eleven people are in isolation and are being closely monitored for flu-like symptoms as Gauteng health authorities work to stop the possible spread of a virus that has led to the deaths of at least three people.

One woman has been quarantined at Chris Hani Baragwanath Hospital since being admitted last night. She is the supervisor of the cleaner who possibly died of the mystery virus.

Two relatives who had contact with the nurse who died after contact with the original patient are being held at the Morningside Medi-Clinic and another eight clinical staff members are confined at the Sir Albert Robinson Hospital on the West Rand.

All of the patients are being held in isolation and, although none of them are presenting worrying symptoms of the unidentified disease, their conditions are being monitored.

Strict infection controls have been put in place - those treating the patients have to wear protective gear, gloves and masks.

South African tourism manager Cecilia van Deventer, 36, was flown to the Morningside Medi-Clinic from Zambia on September 12 and died two days later.

Hannes Els, 33, the paramedic who attended her, died of the same disease on October 2, while nursing sister Gladys Mthembu died on October 4.

Maria Mokubung, a cleaner at the Morningside Medi-Clinic, died yesterday after having been treated at three hospitals. But Medi-Clinic spokeswoman Melinda Pelser said today that Mokubung's death was no longer believed to be linked to the others.

"We know that she never even went into the cubicle where the patient who died was lying, and her cause of death has been confirmed as a neurological disease."

This morning the 11 isolated patients remained in quarantine as technicians here and at the US Centre for Disease Control in Atlanta battled to identify the viral strain.

Pelser said the three deaths were caused by a viral haemorrhagic fever as all the victims presented with the same symptoms: high fever, body aches, diarrhoea, vomiting and skin rash or bleeding. But tests for known strains such as Ebola, Congo and Marburg had all come back negative.

Dr Lucille Blumberg of the National Institute for Communicable Diseases confirmed that the virus under investigation "looks and behaves exactly like viral haemorrhagic fever".

She said her colleague, Professor Robert Swanepoel, a "world-famous virus hunter", was in Zambia tracing the steps of Van Deventer, the first known patient to die of the disease.

"From what he has determined from the hospitals there, there have been no other cases in Zambia so people don't need to panic and stop travelling. If they take the normal precautions for malaria, they will not be at risk," said Blumberg.

Pelser said two family members who had been in close contact with Mthembu, a woman in her 20s and an 11-year-old boy, had no access to other patients and that the isolation area even had its own separate entrance.

Gauteng Health Department spokesperson Zanele Mngadi said this morning Mokubung's supervisor was admitted to Chris Hani Baragwanath Hospital last night with flu-like symptoms.

Maria Stuurman of Orange Farm was being held in isolation at the hospital as a precautionary measure. Her condition was no longer considered serious.

Mngadi was unable to confirm or deny whether Mokubung's death was linked to the other three.

Marion van der Walt, spokesperson for the Sir Albert Robinson Hospital, said the eight Morningside Medi-Clinic staff members who had been in contact with Mthembu were being held in isolation for observation.

o This article was originally published on page 3 of Cape Argus on October 07, 2008

Shiloh · Oct 7, 2008

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Source: http://www.sabcnews.com/south_africa/health/0,2172,177912,00.html
Hundreds being monitored after virus kills 4
October 07, 2008, 16:45

South African health authorities are monitoring 111 people who came in contact with a nurse who has died as a result of an as yet unidentified infectious disease.

A total of 55 people are being monitored at the Morningside Medi-Clinic and 66 at the Randfontein hospital on the West Rand. Four people have died as a result of the unidentified infectious disease, which is believed might be a form of Congo fever, but this is not yey confirmed.

The latest victim, Gladys Mthembu, a nurse at the Medi-Clinic, was admitted at Randfontein where she later died.

Meanwhile, experts from the World Health Organisation are meeting with South African authorities to help tackle the mystery disease.

Treyfish · Oct 7, 2008

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

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

Hundreds being monitored after virus kills 4
October 07, 2008, 16:45

South African health authorities are monitoring 111 people who came in contact with a nurse who has died as a result of an as yet unidentified infectious disease.

A total of 55 people are being monitored at the Morningside Medi-Clinic and 66 at the Randfontein hospital on the West Rand. Four people have died as a result of the unidentified infectious disease, which is believed might be a form of Congo fever, but this is not yey confirmed.

The latest victim, Gladys Mthembu, a nurse at the Medi-Clinic, was admitted at Randfontein where she later died.

Meanwhile, experts from the World Health Organisation are meeting with South African authorities to help tackle the mystery disease. :tiphat:http://www.sabcnews.com/south_africa/health/0,2172,177912,00.html

HenryN · Oct 7, 2008

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

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

Mystery S.Africa killer disease may be Congo fever

Tue 7 Oct 2008, 13:28 GMT
<INPUT id=CurrentSize type=hidden value=13 name=CurrentSize>
[-] Text [+]

(Adds details of people being monitored in paragraphs 4-5)
By Michael Georgy
JOHANNESBURG, Oct 7 (Reuters) - A mystery disease that has killed three people in South Africa and put medical authorities on high alert may be Crimean-Congo hemorrhagic fever, a health official said on Tuesday.
"We suspect that it may be Congo hemorrhagic fever but we have not made a diagnosis yet," Frew Benson, the South African Health Department's deputy director of communicable diseases, told Reuters. South African health officials said they were closely monitoring the illness, which causes external and internal bleeding, but called on the public not to panic. There were no signs it was airborne.
Officials said on Tuesday they were observing a total of 111 people who had come into contact with the deceased patients.
"These are mostly people who may have had specific high risk contact with the patients. They are not admitted to hospital but are having their temperatures checked every six hours," Dr Nivesh Sewlall, who treated the first patient who died from the disease, told reporters at a press conference.
South African authorities were due to send blood samples to the U.S. Centers for Disease Control and Prevention in Atlanta on Tuesday, Benson said. The tests would take a number of days.
The first fatality from the mystery disease was a patient from Zambia flown to South Africa for treatment. A paramedic who accompanied her later died from the same symptoms, health authorities said. A third person also died from the illness.
A cleaner at Johannesburg's Morningside Clinic who was suspected of contracting the disease died of an unrelated condition, said the hospital's spokeswoman, Melinda Pelser.
CCHF, which causes death in around 30 percent of hospitalised patients, is carried by domestic animals and can be transmitted by ticks. It is found in Africa, Eastern Europe and Asia.
The first patient was originally treated for tick bite fever and had evidence of a tick bite on her, Sewlall said.

TREATMENT POSSIBLE
CCHF first appeared in Crimea in 1944 and was later identified in 1956 as the cause of an illness in what is now Democratic Republic of Congo.
Cases have been recorded in Kosovo, Albania, Iran, Pakistan and South Africa. Symptoms include headaches, back pains, vomiting, severe bruising and nose bleeds.
According to the World Health Organisation, CCHF can be treated but recovery is slow. If treatment is not provided in time, death can occur in the second week of illness.
There are several other strains of hemorrhagic fever, including Ebola and Marburg, which have killed hundreds of people in outbreaks in Africa. These diseases cause bleeding from multiple sites and can have very high death rates.
Ebola is rare, but there is no known cure and the virus usually kills between 50 and 90 percent of its victims.
It is spread through contact with bodily fluids of a patient. As with other hemorrhagic fevers, patients die from dehydration, bleeding, and shock.
The latest outbreak, which ended in February in Uganda, was unusually mild, killing 37 people out of 149 infected. (Additional reporting by Muchena Zigomo; Editing by Dominic Evans)

http://africa.reuters.com/wire/news/usnL7247963.html

Treyfish · Oct 7, 2008

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Family members of viral disease victim isolated
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Zambian authorities say none of the people who have died from the mysterious disease are Zambians

</TD></TR></TBODY></TABLE>October 07, 2008, 11:30

Two family members of the Morningside Medi-Clinic nurse who died of a viral disease have been put into isolation as a precautionary measure, the hospital said today.

"We admitted them for observation under strict isolation regulations but none of them have shown any symptoms," said regional marketing manager Melinda Pelser. She said it had been confirmed that the three people who died of a "mysterious disease" at the clinic had suffered from a viral haemorrhagic fever but the cause of the disease was not yet known.

The Centre for Disease Control and Prevention in Atlanta was working with health officials in South Africa to investigate the cause, she added.

Pelser also said it had been confirmed that the cleaner who worked for a contract company at the hospital did not die from the viral fever. "She died of a neurological illness. It has been established that she was not near the patient."

Virus is not airborne
The first casualty who succumbed to the viral disease was a 36-year-old woman who was airlifted from Zambia to the Morningside Medi-Clinic in Sandton on September 12. She was treated for tick-bite fever and other potential infections but died two days later.

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

Pelser said the incubation period for the disease was between 72 hours and 21 days. "We know that it is not airborne and is contracted through the bodily fluids of the infected person."

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

Confusion over nationality
Meanwhile, there is confusion around the nationality of two of the four people who have died as a result of an unidentified infectious disease.

Zambian High Commissioner to South Africa Leslie Mbula has denied that Cecelia van Deventer and Herman Els are Zambians. Mbula says Deventer had travelled between the two countries at the time of contracting the mysterious disease. Els worked in Zambia. Mbula says there haven't been any cases of this disease reported in any Zambian health facilities.

- additional reporting by Sapa:tiphat:http://www.sabcnews.com/south_africa/health/0,2172,177899,00.html

Treyfish · Oct 7, 2008

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Bara says woman is not infected with killer virus
7 October 2008

A 51-year-old woman will be discharged from the Chris Hani Baragwanath Hospital in Soweto as her blood tests are clear and she is now fine, doctors say. The woman, a cleaning supervisor, was admitted after displaying symptoms of an unknown illness that has claimed three lives.

The National Institute for Communicable Diseases? Dr Lucille Blumberg said all blood tests for the woman had returned clear. She would probably be discharged later on Tuesday, the doctor said.

A total of 121 people who had direct contact with the three people who died are currently under observation.

They will also be having their temperatures monitored every 6 hours for the next 21 days ? the length of time, the doctors feel, that is the possible incubation period of the illness.

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

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

On Tuesday, Dr Nivesh Sewlall, the doctor treating the affected patients, said that since then 6 other people who might have had direct contact with the deceased had been admitted into hospital for observation, but 4 had already been discharged.

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

?He is fine, but it is a traumatic time and [keeping him in hospital] it?s more for trauma counselling,? said Sewlall.

His nanny had initially displayed a marginally high fever, but was now fine.

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

Intensive care specialist professor Guy Richards said: ?The public at large are not at risk?.

The doctors said only those who had direct contact with the deceased, and only through bodily fluids such as stools, urine and blood, had any possibility of contracting the illness.

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

Blumberg said there was also no outbreak of the illness in Zambia itself.

Although doctors did not yet have a diagnosis of the illness, they knew it was a viral haemorrhagic fever, but the cause was not known.

A number of tests which could still take some time were being done to identify the cause.:tiphat:http://www.sowetan.co.za/News/Article.aspx?id=858138

Treyfish · Oct 7, 2008

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WHO team flies in to help South Africa with killer virus 

7 October 2008
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The World Health Organisation (WHO) has flown in a laboratory expert and a disease surveillance expert to help the South African health authorities determine the unknown virus that killed three people.


?We are helping with the investigation to identify the cause of the disease and have flown in two experts,? spokesman Dr James Mwanzia said on Tuesday.

Mwanzia said the two experts would work with the communicable disease unit of the Department of Health, the Gauteng health department, and the National Institute for Communicable Diseases.

Mwanzia would not be drawn to discuss whether the virus under investigation was viral haemorrhagic fever or the congo virus fever.
He said the world body was also working with the Zambian authorities where the first case of the disease manifested. :tiphat:http://www.sowetan.co.za/News/Article.aspx?id=858127

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

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