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

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

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

Virus outbreak: 11 quarantined

7 October 2008, 15:14
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.{released{

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.:tiphat:
http://www.thestar.co.za/?fSectionId=&fArticleId=vn20081007145051874C315614
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Patient at Bara is Medi Clinic worker
Published: 10/7/2008 13:26:32


JOHANNESBURG - A 51-year-old woman has been admitted to the Chris Hani Baragwanath Hospital with symptoms of the unknown illness that has claimed three lives in South Africa, the Gauteng health department said on Tuesday.
Spokeswoman Zanele Mngadi said the department had confirmed that Maria Stuurman, who was admitted to the hospital, was a cleaning supervisor at Morningside Medi Clinic.
Stuurman 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.
?This outbreak has put lives of many South Africans at risk and the authorities have a duty to investigate if negligence is to blame for this serious health hazard,? said spokesman Sizwe Pamla.
He said Nehawu was saddened by the death of the health workers at the Morningside Medi Clinic.
?The union salutes these selfless and dedicated workers who lost their lives in the line of duty and we hope their passing away will not be in vain and appropriate measures would be taken to prevent more lives being lost,? he said.
Three people have so far died of the unknown disease.
The first casualty 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.:tiphat:http://www.citizen.co.za/index/article.aspx?pDesc=79536,1,22
 
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



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<LINK media=all href="http://media3.washingtonpost.com/wp-srv/css/bookmarking_v2.css" rel=stylesheet>







</TD></TR></TBODY></TABLE>By Michael Georgy
Reuters
Tuesday, October 7, 2008; 11:02 AM


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 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.

<SCRIPT>if ( show_doubleclick_ad && ( adTemplate & INLINE_ARTICLE_AD ) == INLINE_ARTICLE_AD && inlineAdGraf ){placeAd('ARTICLE',commercialNode,20,'inline=y;',true) ;}</SCRIPT><SCRIPT language=javascript><!--if ( show_doubleclick_ad && ( adTemplate & INLINE_ARTICLE_AD ) == INLINE_ARTICLE_AD && inlineAdGraf ){document.write('
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"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 hospitalized 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 Organization, 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. :tiphat:http://www.washingtonpost.com/wp-dyn/content/article/2008/10/07/AR2008100700994.html

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

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

Zambia minister confirms mysterious killer disease

A mysterious illness with flu- like symptoms has broken out in Zambia, leaving three people dead so far. According to Health Minister Brian Chituwo a South African resident in Zambia, the first person to suffer from the strange disease on 4 September, was evacuated to South Africa?s Morningside Clinic in Johannesburg, where she died on 13 September. The second victim was a paramedic who escorted the patient to South Africa, while the third was a nurse based at Morningside Clinic, who attended to the first patient. Unconfirmed reports indicate that the driver of the ambulance that ferried the patient from Lanseria Airport to Morningside in South Africa was critically ill. "All these patients developed a fever, cough and bled from various parts of their bodies," Chituwo said, explaining that laboratory investigations carried out so far did not point to any known disease. Chituwo said the situation was under control and that all travels, either local or international, by air or road should continue as usual.:rolleyes: The Ministry of Health, in collaboration with the World Health Organisation and the U.S. Centre for Disease Control, is carrying out necessary investigations. (Tuesday 7 October - 13:59)
:tiphat:http://en.afrik.com/news12295.html
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Virus outbreak: 11 quarantined

7 October 2008, 15:14
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.

8 admitted to Sir Albert Robinson Hosp.
1 Female (20's), Morningside MediClinic
1 Boy (11), Morningside
Maria Stuurman (51), getting discharged today, blood test clean.
[the entry of the female and boy in Morningside in my summary must be a mistake. They are at Sir Albert Robinson Hosp.]

Also,
66 people being monitored for temp every 6 hours @ Sir Albert Rob. Hosp. and
55 people being monitored in same fashiion at Morningside MediClinic.
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

ANGOLA-BOTSWANA: Congo Fever scare

<TABLE style="BORDER-RIGHT: #bbbbbb 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: #cccccc 1px solid; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; MARGIN: 2px 5px 8px 0px; BORDER-LEFT: #cccccc 1px solid; WIDTH: 120px; PADDING-TOP: 5px; BORDER-BOTTOM: #bbbbbb 1px solid; BACKGROUND-COLOR: #eeeeee" cellSpacing=0 cellPadding=0 align=left border=0><TBODY><TR><TD style="PADDING-TOP: 3px" align=right>
200702151.JPG

Photo: Siegfried/IRIN
</TD></TR><TR><TD class=ImgCreditCaption style="FONT-SIZE: 7pt; FONT-FAMILY: Tahoma">South Africa sees five to 10 cases of the hemorrhagic fever known as Congo fever annually</TD></TR></TBODY></TABLE>JOHANNESBURG, 7 October 2008 (IRIN) - At least three people have been confirmed dead in Johannesburg, South Africa, in an outbreak of what officials believe to be contagious hemorrhagic fever.

Almost one month ago, Zambian tourism operator Cecilia van Deventer was airlifted to a private hospital in Johannesburg, where she died of what health officials say is likely to be Crimean-Congo fever.

Since then, the unconfirmed illness has claimed at least two more lives, that of a paramedic who accompanied van Deventer from Zambia, and a nurse who attended to her during her stay at the hospital. Health officials are on high alert.

Crimean-Congo hemorrhagic fever was first reported in South Africa in 1981, and since then the country has usually experienced up to 10 cases annually, not all of which resulted in death, according to Dr Lucille Blumberg of South Africa's National Institute for Communicable Diseases (NICD).

<TABLE style="BORDER-RIGHT: #cccccc 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: #cccccc 1px solid; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; MARGIN: 2px 8px 8px; BORDER-LEFT: #cccccc 1px solid; WIDTH: 205px; PADDING-TOP: 5px; BORDER-BOTTOM: #cccccc 1px solid; HEIGHT: 345px; BACKGROUND-COLOR: #eeeeee" cellSpacing=0 cellPadding=0 align=right><TBODY><TR><TD style="FONT-WEIGHT: bold; FONT-SIZE: 12px; COLOR: #006699; FONT-FAMILY: Tahoma; TEXT-ALIGN: center" colSpan=2>More on Congo Fever </TD></TR><TR><TD vAlign=top>
sqr.gif
</TD><TD style="COLOR: #006699; size: 10px" align=left width="100%">Crimean-Congo hemorrhagic fever, or Congo fever, was first discovered in 1944 in Crimea, a peninsula in the Black Sea on the southern coast of Ukraine, and recognised in 1969 as the same virus causing an outbreak of illness in the Democratic Republic of Congo. </TD></TR><TR><TD vAlign=top>
sqr.gif
</TD><TD style="COLOR: #006699; size: 10px" align=left width="100%">Transmission to humans occurs through tick bites or contact with infected animal blood, putting those in slaughter houses or the agricultural industry at greater risk.

</TD></TR><TR><TD vAlign=top>
sqr.gif
</TD><TD style="COLOR: #006699; size: 10px" align=left width="100%">Health workers in areas where the disease is endemic can also be at risk, as human-to-human transmission has been known to occur in health care settings due to improper sterilisation of medical equipment.

</TD></TR><TR><TD vAlign=top>
sqr.gif
</TD><TD style="COLOR: #006699; size: 10px" align=left width="100%">Fatality rates in hospitalised patients have ranged from 9 percent to as high as 50 percent.</TD></TR><TR><TD vAlign=top>
sqr.gif
</TD><TD style="COLOR: #006699; size: 10px" align=left width="100%">Symptoms include:
headache
uncontrolled bleeding
high fever
joint pain
stomach pain

</TD></TR><TR><TD style="FONT-SIZE: 10px; COLOR: #006699; FONT-FAMILY: tahoma" colSpan=2>Source: Centres for Disease Control and Prevention (CDC)</TD></TR></TBODY></TABLE>Confirmation as to whether Congo fever is the cause of the recent deaths is expected late next week when the NICD delivers the findings of laboratory tests, according to Gauteng provincial health department spokesperson, Zanele Mngadi.

"It may be something else, although there are not a lot of diseases that present like this - transmission in a health care setting, high mortality and a clinical picture that would contain some bleeding," Blumberg said.

Uncontrolled bleeding from the mouth, nose or genitals are among the symptoms of Congo fever. It has a mortality rate of 30 percent, with death usually occurring in the second week of illness, according to the World Health Organisation.

Hospital spokesperson Melinda Pelser said the recent death of a cleaner was unrelated to the virus, but the provincial health department has not ruled out the possibility of hemorrhagic fever.

Infection control key

Meanwhile, health professionals working in provincial hospitals, mortuaries and ambulances have been put on high alert for patients presenting with symptoms of the fever, which initially include chills and severe muscle pains.

The NICD's Blumberg said people usually contracted the virus from tick bites or contact with the bodily fluids of infected livestock, but it could spread quickly once those infected were admitted into health care settings, especially where infection control was poor.

Pelser said doctors at the private hospital in Johannesburg had quickly identified possible cases of hemorrhagic fever and had implemented proper infection control procedures, including placing the patients in isolation wards.

She said the clinic's staff and their families were being monitored for symptoms, and two family members of the nurse who had died - although asymptomatic - had been admitted for observation.

Congo-Crimea, like Ebola, is a viral hemorrhagic fever that resides in an animal host, but is less virulent than its headline-grabbing relation. Treatment is primarily supportive, and recovery is slow.:tiphat:http://www.irinnews.org/report.aspx?ReportID=80793
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Outbreak: 121 under observation

7 October 2008,


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

Sewlall said all precautions had been in place such as masks and gowns for the nurse who contracted the illness. - Sapa
http://www.thestar.co.za/?fSectionId=493&fArticleId=nw20081007174346216C145841
 
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 (03)
****************************************************
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: Tue 7 Oct 2008
Source: IOL, Health [edited]
<http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20081007104101304C470799>


Cleaner's supervisor isolated
-----------------------------
At least 9 people have been isolated or put under observation after
the deaths of 4 people from a mystery disease. On Monday [6 Oct
2008], health authorities finally traced the families of [patient A],
37, from Slovoville, who died on Sunday night at Charlotte Maxeke
Johannesburg Academic Hospital, and nursing sister [patient B], 34,
of Westonaria, who died on Saturday. [Patient A] was a cleaner and
[patient B] a nurse, and both had contact with the 1st victim. In a
dramatic development on Monday afternoon [patient A]'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 [patient A]'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, [Crimean-]Congo fever and
other likely possibilities had all returned [out] 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 1st
person to be infected came from Zambia meant that of all the
haemorrhagic fevers, [Crimean-]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 1st victim was tourism operator [patient C], 36, who was flown to
the Morningside clinic on 12 Sep 2008 from Zambia in a critical
condition after being ill for 3 weeks. She died 2 days later. On 27
Sep 2008, the paramedic who had flown with her from Zambia, [patient
D], 33, of Speciality Emergency Services in Lusaka, returned to South
Africa and was admitted to the Morningside clinic with similar
symptoms, said Morningside manager Jaco Erasmus. [Patient D] died on
2 Oct 2008. Dr. Nivesh Sewlal, who was treating [patient D] at the
Morningside clinic, said he had diarrhoea, high fever and a rash.
Blood samples were taken from [patient D] and [patient C], 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, 2 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. [Patient B]
fell ill on October 1 and was admitted to a general ward with 4 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 [patient B] was put in isolation. She died on Saturday.
Sir Albert Robinson spokesperson Marion van der Walt said 8 people,
including staff who had contact with [patient B], 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 [patient C] or [patient D]. The clinic and Health
Department emphasised [patient A] had been ill for months before she
had ever been in contact with [patient C]. Pelser said there was "a
very low possibility", that her case was linked to the others.

[Byline: Louise Flanagan, Solly Maphumulo, Shaun Smillie, Botho
Molosankwe, Gill Gifford]

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

******
[2]
Date: Tue 7 Oct 2008
From: Janusz Paweska, Lucille Blumberg, Jackie Weyer, Robert Swanepoel
National Institute for Communicable Diseases, South Africa
<lucilleb@nicd.ac.za>


Outbreak of an acute disease in South Africa, ex-Zambia
-------------------------------------------------------
An outbreak of an, as yet, unknown disease has been identified in
South Africa. To date there have been 4 probable cases, all of whom
have died. The index case was a Zambian national, resident in Lusaka
who had close contact with horses and a history of possible tick
exposure. The subsequent 2 patients had close contact with the index
case patient in a healthcare setting: a paramedic involved in her
medical evacuation to South Africa and an intensive care nurse in
Johannesburg. These 2 patients became ill approximately 7 days after
exposure to the index case. Clinical and laboratory features common
to all 3 patients include a prodromal illness of approximately 7 days
with (38oC), a morbilliform rash in 2 patients, thrombocytopaenia and
mild hepatic dysfunction in 2 patients. An initial improvement was
reported in the 2 latter patients, and all 3 patients had a sudden
and marked deterioration in mental state, rhabdomyolysis in one case,
and evidence of acute and severe hepatic necrosis. Bleeding was not a
marked clinical feature although oozing from venepuncture sites was
noted as well as a petechial rash in one patient. Blood cultures to
date have been negative. Tests for viral haemorrhagic fevers (VHFs)
including Ebola, Marburg, Crimean-Congo haemorraghic fever (CCHF),
Hantaviruses, Rift Valley fever virus and Lassa fever virus, are
negative to date. No further secondary cases have been identified and
there is no indication of similar cases occurring in Zambia. It seems
likely that this is an isolated case with secondary transmission in
the nosocomial setting. Given the high mortality, nosocomial
transmission and clinical presentation, a viral haemorrrhagic fever
remains possible.

Laboratory testing for VHFs has been conducted by the Special
Pathogens Unit at the National Institute for Communicable Diseases
(NICD). Multiple nucleic acid and antigen detection assays as well as
serological tests have been negative for CCHF, Ebola, Marburg, Lassa
fever, Hantaviruses and Rift Valley fever virus. The final results
for viral culture in animal and cell cultures are pending. Only
specimens from Cases 2, 3 and 4 were available for testing. The index
case has been given a diagnosis of "tick-bite fever" and no specimens
were available for testing (she died shortly after arrival in SA).
Negative results to date may be explained by several factors. These
could include; the timing of collection (taken late - day 10 of
illness), virus variants not detected by current molecular and
serological assays. All contacts of cases, including healthcare
workers and laboratory staff are under surveillance and are all currently well.

--
Janusz Paweska, Lucille Blumberg, Jackie Weyer, Robert Swanepoel
National Institute for Communicable Diseases
Private Bag X4
Sandringham 2131
South Africa

[The 1st report tends to the view that that one or more of the 4
fatalities may be a consequence of infection by Crimean-Congo
haemorrhagic fever virus, although this preliminary diagnosis has not
been supported by laboratory tests. There are now 9 people under
observation, but not all may be suffering from the same illness. Also
it is not yet clear that the 4 fatalities have been caused by the
same agent. No more cases have been reported in Zambia.

The 2nd authoritative report from the South African National
Institute for Communicable Diseases reviews in detail the current
status of laboratory diagnosis, which has yet to confirm the identity
of the agent involved. It is concluded that Crimean-Congo
haemorrhagic fever virus, or another uncharacterised haemorrhagic
fever virus may be responsible. It seems likely that this incident
can be interpreted as is an isolated case with secondary transmission
in a nosocomial setting. Unfortunately no clinical sample from the
index case is available, which complicates the task of identifying
the causative agent.

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 (02) 20081006.3157
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/ejp/dk

-
http://apex.oracle.com/pls/otn/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74284
------
</pre>
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Unfortunately no clinical sample from the
index case is available, which complicates the task of identifying
the causative agent.

The first report says that blood was drawn on the first victim:

Dr. Nivesh Sewlal, who was treating [patient D] at the
Morningside clinic, said he had diarrhoea, high fever and a rash.
Blood samples were taken from [patient D] and [patient C], 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.
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Man admitted for Congo Fever <TABLE style="WIDTH: 405px; HEIGHT: 44px; BACKGROUND-COLOR: #ffffff" cellSpacing=0 cellPadding=0><TBODY><TR><TD class=caption style="WIDTH: 360px">
October 07 2008 at 08:00PM </TD></TR><TR><TD style="HEIGHT: 1px; BACKGROUND-COLOR: #cccccc" colSpan=2></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=5 width="100%" border=0><TBODY><TR><TD align=right><TABLE cellSpacing=0 cellPadding=4 width=300 border=0><TBODY><TR><TD class=relatedheading align=right></TD></TR><TR><TD class=relatedlink align=right>
</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><TABLE class=mainarticle cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD class=svarticletext>[SIZE=+1][/SIZE]A Northern Cape abattoir worker has been admitted to the Kimberley Hospital after contracting Congo Fever, the SABC reported on Tuesday.

The man has been quarantined to avoid further infections.

Since January this year, seven people have been treated for Congo Fever.

It has claimed the lives of 14 people throughout the Northern Cape Province since 1995.

The Department of Health said that the disease is highly contagious and could be transmitted to humans through animals.

Farmers have also been warned to take precautionary measures. - Sapa :tiphat:http://www.iol.co.za/index.php?set_id=1&click_id=79&art_id=nw20081007195754328C835969
</TD></TR></TBODY></TABLE>
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

<!-- -->Mysterious disease from Zambia claiming lives in South Africa

A mysterious disease with symptoms of flu, bleeding and vomiting suspected to have originated from Zambia has claimed four lives in South Africa.<!-- LIEN VERS DOSSIER & VERSION FRANCAISE -->

<TABLE cellSpacing=0 cellPadding=0 width=510 border=0><TBODY><TR><TD vAlign=bottom width=16></TD><TD> </TD></TR></TBODY></TABLE><!-- DATE ET AUTEUR ET BOUTONS -->


<TABLE cellSpacing=0 cellPadding=0 width=510 border=0><TBODY><TR><TD class=dix width=262>Tuesday 7 October 2008,</TD></TR></TBODY></TABLE>The Zambian government has, however, assured the nation that there has not been any reported case of the killer disease anywhere in the country and called for calm.
<SCRIPT language=javascript src="http://pagead2.googlesyndication.com/pagead/show_ads.js" type=text/javascript></SCRIPT><SCRIPT> window.google_render_ad(); </SCRIPT>Media reports today say Health Minister Brian Chituwo said the ministry was in total control and all travel should continue normally.
The first person to suffer from the unknown disease was a female South African who was resident in Zambia and fell ill on September 4.
She was evacuated to Morningside Clinic in South Africa where she later died on September 13, this year.
?The second victim was a paramedic who escorted the patient to South Africa. The third victim was a nurse based at Morningside that attended to the first patient,? Dr Chituwo said.
The third victim was a nurse based at the clinic who had attended to the first patient.
Reports indicate that the driver of the ambulance that ferried the patient from Lanseria Airport to Morningside was also in a critical condition. He said all the patients developed fever, cough and bled from various parts of their bodies.
Dr Chituwo said laboratory investigations so far done did not point to any particular known disease.
Dr Chituwo said the mysterious disease had so far claimed three lives in South Africa.
Meanwhile, Zambian authorities and the World Health Organisation (WHO) said they had mounted investigations into the disease.
Zambia?s High Commissioner in Pretoria, Leslie Mbula, said reports from Zambia indicated that no other person in that country had contracted the "mysterious disease".:tiphat:http://en.afrik.com/article14638.html
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

from post #51. A new victim??

Reports indicate that the driver of the ambulance that ferried the patient from Lanseria Airport to Morningside was also in a critical condition.
 
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>Killer virus: 121 now on danger list<!--head0--></TD></TR><TR><TD class=Byline><!--byline1-->Sashni Pather and Borrie La Grange<!--byline0--></TD><TD class=Published align=right>Published:<!--date1-->Oct 08, 2008<!--date0--></TD></TR><TR><TD class=ArticleHead colSpan=2><HR class=ArticleLine width="100%" SIZE=1></TD></TR><TR><TD colSpan=2><TABLE cellSpacing=0 cellPadding=5 width=200 align=right border=0><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>
thumbnail.aspx


</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>
quoteline.gif

quotestart.gif
121 now on virus danger list
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</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold"></TD></TR><TR><TD class=RelatedLinks><LI type=square></TD></TR></TBODY></TABLE><TABLE><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold"></TD></TR><TR><TD><SCRIPT src="http://s7.addthis.com/js/152/addthis_widget.js" type=text/javascript></SCRIPT><SCRIPT type=text/javascript> addthis_pub = 'lindazinhle'; addthis_logo = 'http://www.addthis.com/images/yourlogo.png'; addthis_logo_background = 'EFEFFF'; addthis_logo_color = '666699'; addthis_brand = 'Your Site'; addthis_options = 'stumbleupon, favorites, digg, delicious, newsvine, facebook, google, live,'; </SCRIPT>http://www.addthis.com/bookmark.php</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE><!--par1-->Individuals quarantined as experts move to reassure the public <!--par0--><!--par1--><!--par0-->
<!--blurb1-->HEALTH officials are keeping a close eye on 121 people known to have come into contact with victims of the mystery virus that has killed three people in and around Johannesburg.
<!--par1--><!--par0--><!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->Paramedic Hannes Els, 33, and Morningside Medi-Clinic nurse Gladys Mthembu, 34, died after caring for the first victim of the virus, Zambian Cecilia van Deventer, 36.<!--par0-->
<!--par1-->Fifty-five of the quarantined individuals were linked to the Morningside Medi-Clinic, and 66 were from the Leratong Hospital. <!--par0-->
<!--par1-->Response teams are monitoring them closely.<!--par0-->
<!--par1-->
Mthembu?s 11-year-old son and his 28-year- old nanny are being kept in isolation at the Morningside hospital, although they have not shown symptoms of the disease.<!--par0-->
<!--par1-->
Maria Stuurman, 51, the supervisor of a cleaner initially believed to be the fourth victim of the virus, was yesterday admitted to the Chris Hani Baragwanath Hospital with symptoms similar to those presented by victims. <!--par0-->
<!--par1-->Dr Chika Asomugha, medical adviser at the Gauteng health department, said Stuurman had flu-like symptoms, but none associated with haemorrhagic fever. She was likely to be discharged soon. <!--par0-->
<!--par1--><!--par0-->
<!--par1-->A panel of experts yesterday assured the public there was no need to panic about the virus. Dr Lucille Blumberg, of the National Institute of Communicable Diseases, and two doctors who treated Van Deventer, Els and Mthembu, said the risk of the virus spreading in the general population was low.<!--par0-->
<!--par1-->Nurses, doctors and other healthcare workers were at risk because they were most likely to have direct contact with bodily fluids of patients infected with the virus. This would include people who handled the bodies of those who died as a result of the disease.<!--par0-->
<!--par1-->Asomugha said mortuary workers and families would be instructed that the bodies of Els and Mthembu must be kept in sealed bags and that they should be buried in special lead-lined coffins, if not cremated.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Dr Nivesh Sewlall, of Morningside Medi- Clinic, said it would be difficult to contract the virus as one would have to have direct, unprotected contact with the blood, faeces or urine of a victim.;)<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Doctors in South Africa and Lusaka, Zambia, are trying to piece together the last days of Van Deventer?s life. She contracted the mystery virus and infected three others who subsequently died.<!--par0-->
<!--par1-->The Times is in possession of letters sent to South African authorities to try to ascertain which virus killed Van Deventer, Els and Mthembu.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Dr Craig Oranmore-Brown has gathered information that Van Deventer went to safari camps on the Zambezi River on July 22. I n August, Van Deventer, who was an avid horse rider, played in a polo-cross tournament on a game farm near Lusaka.<!--par0-->
<!--par1-->?It?s possible a tick could have been brought in in this way. Cecilia was keen on horses and regularly got tick bites. She also sustained an injury to her foot,? Oranmore-Brown said.<!--par0-->
<!--par1-->On September 4, Van Deventer developed flu-like symptoms, but she travelled to South Africa for a wedding. She returned to Lusaka and her condition ?deteriorated?. Her sister, Magda, took her to doctors in Lusaka . On September 12, Magda called the emergency service. Els, the paramedic on duty, took Van Deventer to hospital. She was airlifted to the Morningside Medi-Clinic.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->She died on September 13. Els started to develop flu-like symptoms the next day. He was flown to the Morningside Medi-Clinic on September 27 and died on September 30.<!--par0-->
<!--par1--><!--par0-->
<!--par1-->Professor Robert Swanepoel, of the special pathogens unit at the National Institute for Communicable Diseases, has been trying to unravel the cause of the outbreak. He wrote to colleagues and noted that Van Deventer was brain dead on arrival at Morningside. He said she had a wound resembling a tick bite between her toes.<!--par0-->
<!--par1-->?It suggests she had rickettsiosis, which can be fatal. One also thinks of Crimean-Congo haemorrhagic fever . We?ve never had a patient with both CCHF and rickettsiosis, but maybe this can happen,? Swanepoel wrote.<!--par0-->
<!--par1-->
Dr Guy Richards, director of intensive care at the Charlotte Maxeke Johannesburg Academic Hospital [formerly Johannesburg Hospital ], treated the cleaner thought to be the fourth victim of the virus. He said Maria Mokubung?s symptoms were ?atypical? of haemorrhagic fever. She apparently passed away due to a neurological disease and had been ill for some time.:tiphat:http://www.thetimes.co.za/News/Article.aspx?id=858408<!--par0-->
</TD></TR></TBODY></TABLE>
 
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>Ground zero account<!--head0--></TD></TR><TR><TD class=Byline><!--byline1--><!--byline0--></TD><TD class=Published align=right>Published:<!--date1-->Oct 08, 2008<!--date0--></TD></TR><TR><TD class=ArticleHead colSpan=2><HR class=ArticleLine width="100%" SIZE=1></TD></TR><TR><TD colSpan=2><TABLE cellSpacing=0 cellPadding=5 width=200 align=right border=0><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>
thumbnail.aspx

NOT TAKING CHANCES: Virologist Pat Leman, of the Special Pathogens Unit of the National Institute for Communicable Diseases works in a bio-safety cabinet inside the bio-safety level-4 lab. She is pipetting a specimen for screening against six of the main viral haemorrhagic fever s. NICD is on the Rietfontein campus of the National Health Laboratory Services Picture: NICD </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>
quoteline.gif

quotestart.gif
This flu-like symptom is identical to the one common at this time
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</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold"></TD></TR><TR><TD><SCRIPT src="http://s7.addthis.com/js/152/addthis_widget.js" type=text/javascript></SCRIPT><SCRIPT type=text/javascript> addthis_pub = 'lindazinhle'; addthis_logo = 'http://www.addthis.com/images/yourlogo.png'; addthis_logo_background = 'EFEFFF'; addthis_logo_color = '666699'; addthis_brand = 'Your Site'; addthis_options = 'stumbleupon, favorites, digg, delicious, newsvine, facebook, google, live,'; </SCRIPT>http://www.addthis.com/bookmark.php</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE><!--par1-->VHF ( Viral Haemorrhagic Fever) Outbreak in Lusaka 10/2008 Report by Dr Craig Oranmore-Brown<!--par0--> <!--par1--><!--par0-->
<!--blurb1-->This report was compiled by the Zambian doctor who treated Cecilia van Deventer, first victim of the mystery infectious virus that has killed three people in hospitals around Johannesburg<!--blurb0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->HERE is the chronological report of events as I was best able to assimilate the information?<!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->22 JULY: Cecilia and Linda van Rensburg went to the Lower Zambezi game lodge for a walk.<!--par0-->
<!--par1-->Game lodge manager Linda Bennett has had a few staff members who have subsequently been assessed, but found to have flu with no worrying signs.
<!--par0-->
<!--par1-->AUGUST: A polo cross tournament brought horses over from DRC. Cecilia participated in that tournament. It is possible that a tick could have been brought in in this way. Cecilia is keen on horses and regularly gets tick bites. She also sustained an injury to her foot.<!--par0-->
<!--par1-->On September 4 Cecilia developed flu-like symptoms.<!--par0-->
<!--par1-->SEPTEMBER 6-8: Cecilia and some friends attended a wedding in South Africa, and many people at the wedding developed diarrhoea and vomiting. All the others recovered fully.<!--par0-->
<!--par1-->SEPTEMBER 9-11: Cecilia continued to deteriorate and her sister, Magda, took her to see numerous doctors at hospitals in Lusaka .
<!--par0-->
<!--par1-->On September 9 a doctor diagnosed sepsis and gave her a cephalosporin.
On September 10 the antibiotic was stopped because a doctor noticed a rash and decided it was a drug reaction . On September 11 another doctor made the diagnosis of sepsis, then meningitis. Antibiotics were recommenced. She was admitted to hospital where her SpO2 [amount of oxygen carried by red blood cells in the blood] was reported by the nurse to be below 70 percent during the night. She was not intubated at that time. <!--par0-->
<!--par1-->SEPTEMBER 12: Magda found out about the low SpO2 and decided to call Special Emergency Services. Hannes [Els] was the paramedic on duty and took her to the Trust Hospital.<!--par0-->
<!--par1-->Cecilia had a generalised convulsion shortly after arriving at the Trust Hospital. Hannes then called me as the SES ICU consultant to assist him with this critically ill patient. She was intubated by the Trust anaesthetist.<!--par0-->
<!--par1-->Shortly after the intubation I arrived and did her transfer to Johannesburg. She was sedated and ventilated for the transfer. <!--par0-->
<!--par1-->Her clinical condition revealed septic shock with severe perfusion deficit, hypotension, ARDS [acute respiratory distress syndrome], clinically with SpO2 95 percent on 100 percent O2. The right lung was more consolidated than the left with diffuse crackles. She had an eschar [nechrotic tissue] and laceration on her left foot, a diffuse vasculitic rash which blanched on compression. There were no red or purple spots on the body caused by a minor haemorrhage, but she had a haemorrhagic pharyngitis. There was no significant swelling of glands. N euro exam was not possible due to the recent seizure and subsequent anaesthesia.<!--par0-->
<!--par1-->She was resuscitated with IV fluids and loaded with Flagyl, Gent, Ceftriaxone and Ampicillin en- route. Her flight was uneventful. <!--par0-->
<!--par1-->She continued to pass urine into the catheter throughout the flight. On arrival in Morningside ICU, Dr Sewlall found her to be completely unresponsive, and a CT scan revealed extensive cerebral oedema. She developed rapidly progressive multi-organ failure.<!--par0-->
<!--par1-->SEPTEMBER 13: Cecilia died.
<!--par0-->
<!--par1-->SEPTEMBER 14: Hannes started to develop flu -like symptoms .
<!--par0-->
<!--par1-->SEPTEMBER 16: Hannes flew a patient out of the Congo with pilot Angus Mathi. Angus has no symptoms, nor does his wife or child. We have no reports in Congo of any infection as a result of this flight.<!--par0-->
<!--par1-->Angus works for Star of Africa and flies twice a week to Congo. H e has been quarantined in Congo and needs a letter from CDC to confirm safety for him to fly.
<!--par0-->
<!--par1-->SEPTEMBER 17-25: Hannes continued to deteriorate at home. His wife remains symptom free. ;)Lee-Anne Robinson [his neighbour] was visiting to do physio on Hannes? son .:magnify: She had no physical contact with him at all. I know of no other contacts during his illness.
<!--par0-->
<!--par1-->SEPTEMBER 25 : Lee-Anne develops flu-like illness
<!--par0-->
<!--par1-->SEPTEMBER 26: Her colleague, Conrad, decided that she was sick enough to warrant evacuation.
<!--par0-->
<!--par1-->SEPTEMBER 26-28: Lee- Anne has a 40?C fever.
<!--par0-->
<!--par1-->SEPTEMBER 27: Hannes was flown out to Johannesburg?s Morningside hospital, also under the care of Dr Sewlall. I have no records of this flight.
<!--par0-->
<!--par1-->SEPTEMBER 27-28: Hannes has progressive multi-organ failure<!--par0-->
<!--par1-->SEPTEMBER 29: Respiratory failure. Intubated and ventilated. Lee-Anne reports that s he has drunk six litres of water, more than usual with poor urine output. She was quarantined at her home while we tried to plan where to send her.<!--par0-->
<!--par1-->OCTOBER 2: New set of bloods were taken from Lee-Anne as she was feeling a lot better.<!--par0-->
<!--par1-->OCTOBER 3: I receive news via Dr Mead that a young Lebanese boy was evacuated and is now presenting with similar deterioration at some hospital in Lebanon. <!--par0-->
<!--par1-->Lee-Anne says she feels well and wants to visit her family on Kushiya farm.<!--par0-->
<!--par1-->Linda Van Rensburg, her husband, Charles, and baby are all examined by Dr Mead and cleared.
<!--par0-->
<!--par1--><!--par0-->
<!--par1-->COMMENTS AND CONCERNS: I was sure that the incubation period was less than 10 days, but we have now been informed that the time of contact of the ICU nurse in South Africa was 14 days from contact to first symptoms, then 13 days to point of rapid deterioration. The disease appears to take about 14 days from onset to mortality. Patients are still able to function well until three 3 days before they die.
<!--par0-->
<!--par1-->This flu-like symptom is identical to the viral flu that is common in the community at this time. The only keys we have identified at this time are a vasculitic rash (at about 7 days) or petechiae (late) and a fever ? 39?C. <!--par0-->
<!--par1-->Clearly, if the Lebanese boy was not a contact of the others we have a very serious problem.<!--par0-->
<!--par1-->I have informed the polo cross events people to ensure that horses are dipped and special precautions against ticks are taken.:tiphat: http://www.thetimes.co.za/News/Article.aspx?id=858410
</TD></TR></TBODY></TABLE>
 
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>Healthcare workers at risk of contracting virus <!--head0--></TD></TR><TR><TD class=Byline><!--byline1-->Borrie La Grange<!--byline0--></TD><TD class=Published align=right>Published:<!--date1-->Oct 08, 2008<!--date0--></TD></TR><TR><TD class=ArticleHead colSpan=2><HR class=ArticleLine width="100%" SIZE=1></TD></TR><TR><TD colSpan=2><TABLE cellSpacing=0 cellPadding=5 width=200 align=right border=0><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 width=200 border=0><TBODY><TR><TD class=ArticleImg>
thumbnail.aspx

ON THE BEAT: Doctor Nivesh Sewlall and Professor Guy Richards address the media at Morningside Clinic yesterday. They were among experts and doctors who told the public yesterday that there was little risk that the virus would spread </TD></TR></TBODY></TABLE></TD></TR><TR><TD><TABLE width=200><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold"></TD></TR><TR><TD><SCRIPT language=javascript> var PrintThis = '/PrintArticle.aspx?ID=' + ArticleID var printURL = "('"+PrintThis+"','','dependent=yes,resizable=no,scrollbars=yes,height=700,width=635,innerHeight=630,innerWidth=600')"; document.write(' Print'); </SCRIPT>javascript: var printFriendlyWin=wi...00,width=635,innerHeight=630,innerWidth=600')</TD></TR></TBODY></TABLE><TABLE><TBODY><TR><TD class=RelatedLinksTitle style="FONT-WEIGHT: bold"></TD></TR><TR><TD><SCRIPT src="http://s7.addthis.com/js/152/addthis_widget.js" type=text/javascript></SCRIPT><SCRIPT type=text/javascript> addthis_pub = 'lindazinhle'; addthis_logo = 'http://www.addthis.com/images/yourlogo.png'; addthis_logo_background = 'EFEFFF'; addthis_logo_color = '666699'; addthis_brand = 'Your Site'; addthis_options = 'stumbleupon, favorites, digg, delicious, newsvine, facebook, google, live,'; </SCRIPT>http://www.addthis.com/bookmark.php</TD></TR></TBODY></TABLE>
</TD></TR></TBODY></TABLE><!--par1--><!--par0-->
<!--blurb1-->DOCTORS, nurses and other healthcare workers are at the greatest risk of contracting the killer haemorrhagic fever virus, because they are directly exposed to the bodily fluids of the infected.<!--blurb0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1--><!--par0-->
<!--par1-->A panel of experts and doctors who gathered at Johannesburg?s Morningside Medi-Clinic yesterday downplayed fears of the deadly fever spreading outside hospitals. <!--par0-->
<!--par1-->They said they believed the danger of the virus was under control as they monitor more than 100 people who were in contact with the three known fatalities.<!--par0-->
<!--par1-->The next 21 days are critical. This is thought to be the incubation period of the virus, which has claimed the lives of tourist Cecilia van Deventer, paramedic Hannes Els and Morningside Medi-Clinic nurse Gladys Mthembu.<!--par0-->
<!--par1-->The virus is not airborne and can be transmitted only through direct, unprotected contact with body fluids such as blood, faeces and urine.<!--par0-->
<!--par1-->Dr Nivesh Sewlall of the Morningside Medi-Clinic said doctors were unable to explain how Mthembu was infected even though precautions were taken from the moment Van Deventer arrived at the hospital.<!--par0-->
<!--par1-->Sewlall said it was assumed that she contracted the virus through leaked body fluids, possibly at the time of Van Deventer?s death, or preparation of the body when ?gloves or a mask were not worn properly?. <!--par0-->
<!--par1-->?There was some breakdown,? he said.<!--par0-->
<!--par1-->Several teams are monitoring 121 people known to have been in contact with the now deceased .<!--par0-->
<!--par1-->Dr Guy Richards, an intensive care specialist, said: ?We?ll keep monitoring the [121] people and can say that we are 100percent sure there are no other cases. Those who were in contact with the [three] patients [could] contract the disease , but we?ll only know in 21 days? time.?<!--par0-->
<!--par1-->Richards said despite their not knowing the origin of the virus or having a specific diagnosis of the type of haemorrhagic fever, new patients could still be treated effectively. But he pointed out that the virus could mutate and that would make it tricky to test for it.<!--par0-->
<!--par1-->Dr Lucille Blumberg of the National Institute of Communicable Diseases (NICD) said although no blood samples were taken from Van Deventer, samples were taken from Els, Mthembu and hospital cleaner Maria Mokubung. <!--par0-->
<!--par1-->Not having Van Deventer?s samples would not hamper clinical tests by the NICD and the US Centre for Disease Control, both of which are trying to determine the type of haemorrhagic fever.:tiphat:http://www.thetimes.co.za/News/Article.aspx?id=858411
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Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

from post #51. A new victim??
Reports indicate that the driver of the ambulance that ferried the patient from Lanseria Airport to Morningside was also in a critical condition.

tack on the Lebanese boy:

OCTOBER 3: I receive news via Dr Mead that a young Lebanese boy was evacuated and is now presenting with similar deterioration at some hospital in Lebanon. ...."Clearly, if the Lebanese boy was not a contact of the others we have a very serious problem."
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Killer-fever link found by luck

The link between the first two people who died from a viral haemorrhagic fever in Johannesburg recently was discovered by accident.

"It was blind luck," said Dr Nivesh Sewlall who realised the cases were linked.

Sewlall is an intensive-care specialist and lung specialist with an interest in infectious diseases at the Morningside Medi-Clinic Private Hospital in Johannesburg.

'It was blind luck'
"On Monday last week at 4.15pm I made the connection," Sewlall said.

About two weeks earlier, on September 12, critically-ill Cecilia van Deventer had arrived at Morningside from Zambia with an unidentified illness. She died two days later.


Sewlall treated her.

On September 27 paramedic Hannes Els arrived at Morningside. He took care of Van Deventer on the medical charter flight to SA and co-incidentally returned to Morningside when he also became ill, not realising his illness was connected to that of Van Deventer.

On Monday last week, two days after Els arrived, Sewlall overheard a discussion about the new patient that alerted him. He investigated, realised Els had the same symptoms as Van Deventer, and discovered the connection between the pair.

'Viruses are tricky'
Els died two days later.

The confirmation of the link made it likely that the disease was infectious and probably a viral haemorrhagic fever rather than the ordinary tick-bite fever which doctors had eventually decided Van Deventer probably had.

Sewlall immediately called Dr Lucille Blumberg at the National Institute for Communicable Diseases and notified the Department of Health, as haemorrhagic fevers are a notifiable disease.

Sewlall called it one of the fastest linkings of the first cases in an outbreak.

The last time Morningside treated a case of haemorrhagic fever was about 14 years ago, when there was an ebola outbreak in Johannesburg.

On Tuesday experts said more than 100 people were being monitored for signs of haemorrhagic fever but none had shown signs of it yet.

These are the people who were in contact with any of the four people who have died.

The first two deaths and that of a Morningside nurse are believed to be linked while the fourth, a Morningside cleaner, may be.

No further deaths have been reported and although a handful of people were taken to hospital for further observation, none has shown further symptoms.

At Morningside Medi-Clinic, 55 contacts were identified - including the two staff who died - and Sir Albert Robinson Hospital in the West Rand added 66.

Those being monitored will have their temperature taken every six hours every day for 21 days to watch for the onset of fever. Meanwhile they can go to work without danger of infecting anybody.

"You only pass the virus along once you become ill," he said, explaining that quarantining them was unnecessary unless they became ill.

The 11-year-old son of the Morningside nurse who died, Gladys Mthembu, and his caretaker were admitted to Morningside, but Sewlall said this was more for trauma counselling than fears of illness.

Experts said the public should not panic.

"The public at large is not at risk," said Professor Guy Richards, head of critical care at Charlotte Maxege Johannesburg Academic Hospital.

Richards emphasised that those at risk were only people who came into contact with bodily fluids of those who had died. The disease was not air-borne.

Experts dismissed cautions over travel to Zambia, saying malaria was a more likely problem there.

Van Deventer lived in Zambia and is believed to have caught the virus from a tick. No other related cases have been reported in Zambia and an NICD expert is in Zambia tracking all Van Deventer's contacts.

"It's clear that she most likely acquired it in Lusaka," said Blumberg.

While Blumberg, Richards and Sewlall agreed the illness was definitely a viral haemorrhagic fever, the specific fever has not yet been identified.

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

Blood samples were not taken from Van Deventer as doctors ultimately decided she probably had non-infectious tick-bite fever, but samples were taken from the other three who died and sent to NICD for analysis.

Blumberg said it would have been useful to have a sample from Van Deventer too.

She said identifying the virus was difficult because if samples were taken from seriously ill patients they would show the damage caused, but not the virus.

Richards said viruses were very difficult in clinical terms to distinguish from one another.

"Viruses are tricky in that they alter themselves slightly."

Samples were also sent to the Centres for Disease Control (CDC) in the US.

http://www.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20081008055631284C178069
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

Zimbabwe: Country on Alert as Mysterious Flu Claims Four in S. Africa
8 October 2008

ZIMBABWE has been placed on high alert following reports of a mysterious flu-like disease that has so far claimed four lives in neighbouring South Africa, the Minister of Health and Child Welfare, Dr David Pari-renyatwa, said last night.

Of the four people who died, two were Zambians.

In an interview, Dr Parirenyatwa said the country's SARS (acronym for severe acute respiratory syndrome) and haemorrhagic fever teams were on high alert while investigations into the illness were in progress.

He, however, assured the nation that there was no need to panic as the disease could only be transmitted through direct contact with an infected person.

"We will be holding a meeting with World Health Organisation officials and other stakeholders tomorrow (today), to talk about the disease," said Dr Parirenyatwa.

"There is no need for people to panic as the cases of infection were isolated, happened outside Zimbabwe and one needs to have direct contact with the bodily fluids of an infected person to catch the disease."

Dr Parirenyatwa said the severe flu afflicting many people in the country was not linked to the deadly viral disease.

Cross-border traders have expressed fear that the mysterious disease, which originated in Zambia, could infect them because they visit neighbouring countries regularly to do business.

Some of them have kept on calling their relatives to check on their welfare, especially those that they left suffering from normal colds and flu.

The flu bug that has hit Zimbabwe, causing many people to be hospitalised in some cases, has heightened their fears.

Health authorities in South Africa have, however, reassured travellers that there is no need to panic as the viral infection could only be transmitted through exchange of bodily fluids and is not airborne.

According to WHO's website, Zambia has since launched an investigation into the mysterious illness.

-snip-
Zambia's High Commissioner to South Africa Mr Leslie Mbula said from Pretoria on Monday that reports from Zambia indicated that no other person in the country had contracted the "mysterious disease".

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

"The disease is transferable through bodily fluids and is not airborne. We want to ensure that there's no panic in the broader public.

"There is no outbreak at the hospital. We currently don't have patients with the same symptoms," said Medi-Clinic regional marketing manger Malinda Pelser.

Meanwhile, all hospital staff who came into contact with the deceased patients have been put under close medical supervision.

Tests conducted on the patients were not conclusive of any particular disease, including viral haemorrhagic fevers.

http://allafrica.com/stories/200810080135.html
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

[That's odd. This is not the "vomiting and diarrhea" that they were looking for in early accounts]

-snip-
Infection control key

Meanwhile, health professionals working in provincial hospitals, mortuaries and ambulances have been put on high alert for patients presenting with symptoms of the fever, which initially include chills and severe muscle pains.

The NICD's Blumberg said people usually contracted the virus from tick bites or contact with the bodily fluids of infected livestock, but it could spread quickly once those infected were admitted into health care settings, especially where infection control was poor.

Pelser said doctors at the private hospital in Johannesburg had quickly identified possible cases of hemorrhagic fever and had implemented proper infection control procedures, including placing the patients in isolation wards.

She said the clinic's staff and their families were being monitored for symptoms, and two family members of the nurse who had died - although asymptomatic - had been admitted for observation.

Congo-Crimea, like Ebola, is a viral hemorrhagic fever that resides in an animal host, but is less virulent than its headline-grabbing relation. Treatment is primarily supportive, and recovery is slow.

Relevant Links
Southern Africa
Health and Medicine
South Africa
[ This report does not necessarily reflect the views of the United Nations ]

http://allafrica.com/stories/200810080001.html
 
Re: UNDIAGNOSED FATALITIES - SOUTH AFRICA ex ZAMBIA: REQUEST FOR INFORMATION [ProMedMail.org]

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

If anyone has a subscription to "the Star" I would be interested in this article....
"100 Tested For Signs of Virus"
[unless they define "tested" as taking the temperature every 6 hours. I don't know]

http://www.thestar.co.za/index.php?fSectionId=492&fArticleId=vn20081008055631284C178069

http://www.thestar.co.za/index.php?fSectionId=2518&fRequestedUrl=/?fArticleId=4650084
 
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