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

Treyfish · Oct 11, 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]

Virus: Two admitted

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<SCRIPT language=javascript> document.getElementById("articleAuthor").style.display = "none"; </SCRIPT>Sat, 11 Oct 2008 13:08
Two people were admitted for closer monitoring in connection with viral haemorrhagic fever at the Morningside medi-clinic, the hospital said on Saturday.

One woman was admitted on Thursday evening and the second person, a nursing sister, was admitted on Friday morning, said Morningside medi-clinic spokesperson Melinda Pelser.

"We were monitoring their temperatures. There was a discrepancy in their temperatures and that is why we admitted them said Pelser.

She said she could not give more information about their condition because of patient confidentiality.

On 12 September, 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 Friday morning the eight year-old son of the nursing sister who died and his 23 year-old nanny were discharged from hospital.

On Wednesday, a cleaning supervisor at Morningside Medi Clinic who had been admitted to the Chris Hani Baragwanath Hospital on Monday with symptoms of viral haemorrhagic fever was discharged.

All three would continue to be monitored, said Pelser.

Pelser said anyone who showed a change in temperature was brought into the hospital for increased temperature monitoring over a 72-hour period.

"If there are discrepancies in the temperature monitoring done at home they are brought to the hospital for closer monitoring to see whether the temperature changes were abnormal."

Currently Morningside clinic is monitoring 67 people. These people were outside of the hospital and every six hours their temperatures were taken for signs of change.

Gauteng health spokesperson Zanele Mngadi said on Saturday she was receiving continual updates from the outbreak response team.

On Friday, the World Health Organisation, said up to 144 people who had contact with the three people killed by the illness were being traced.

"121 known contacts of the fatal cases are being traced in South Africa and 23 in Zambia."

Epidemologists are still searching for the cause of the haemorrhagic fever. :tiphat:http://news.iafrica.com/sa/1042679.htm

Shiloh · Oct 11, 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]

Source: http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=nw20081011124935948C143631

Hospital admits two for fever monitoring
October 11 2008 at 01:10PM

Two people were admitted for closer monitoring in connection with viral haemorrhagic fever at the Morningside medi-clinic, the hospital said on Saturday.

One woman was admitted on Thursday evening and the second person, a nursing sister, was admitted on Friday morning, said Morningside medi-clinic spokeswoman Melinda Pelser.

"We were monitoring their temperatures. There was a discrepancy in their temperatures and that is why we admitted them said Pelser.

She said she could not give more information about their condition because of patient confidentiality.

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 Friday morning the eight year-old son of the nursing sister who died and his 23 year-old nanny were discharged from hospital.

On Wednesday, a cleaning supervisor at Morningside Medi Clinic who had been admitted to the Chris Hani Baragwanath Hospital on Monday with symptoms of viral haemorrhagic fever was discharged.

All three would continue to be monitored, said Pelser.

Pelser said anyone who showed a change in temperature was brought into the hospital for increased temperature monitoring over a 72-hour period.

"If there are discrepancies in the temperature monitoring done at home they are brought to the hospital for closer monitoring to see whether the temperature changes were abnormal."

Currently Morningside clinic is monitoring 67 people. These people were outside of the hospital and every six hours their temperatures were taken for signs of change.

Gauteng health spokeswoman Zanele Mngadi said on Saturday she was receiving continual updates from the outbreak response team.

On Friday, the World Health Organisation, said up to 144 people who had contact with the three people killed by the illness were being traced.

"121 known contacts of the fatal cases are being traced in South Africa and 23 in Zambia."

Epidemologists are still searching for the cause of the haemorrhagic fever. - Sapa

Treyfish · Oct 11, 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 virus spreads in two countries

11 October 2008, 10:10
The number of people being observed for traces of the deadly mystery viral haemorrhagic fever (VHF) has climbed to 144 and has spread across two countries.

On Friday, Zambian authorities admitted they were trying to trace any people who had contact with South African tour operator Cecelia van Deventer and paramedic Hannes Els before they came back to South Africa to die.

The World Health Organisation (WHO), which has been drawn into the deadly medical mystery, announced that 23 people were being monitored in Zambia while another 121 were under observation in South Africa.

WHO spokesperson Gregory Hartl said they were still doing more contact tracing.

In KwaZulu-Natal, health authorities have urged people not to panic about the outbreak. Health department spokesman Chris Maxon said it was geared up for a possible outbreak of the disease and that although no cases had been detected, the department was on high alert.

"There have been no cases of infected people in the province that have been brought to our attention, but we are keeping a watchful eye over the matter," he said

Maxon said a national outbreak response team was working tirelessly to support the provincial teams with guidelines, active field surveillance and tracing contacts.

"Each and every health department has an emergency preparedness and response plan," he explained.

Maxon said the department was monitoring the situation very closely and was confident that it had the situation under control.

This week the Zambian health ministry said the country had not seen any more VHF cases.

Panic gripped Gauteng residents this week with a number of false alarms and rumours.

The most notable occurred at George Mukhari Hospital in Garankuwa, north of Pretoria, after a woman died shortly after being admitted on Thursday.

The unnamed patient's sudden death had sparked fears that she might have died from the viral haemorrhagic fever.

Yesterday Dr Patrick Maduna, chief operations officer of the Department of Health, dismissed reports that the woman had VHF.:tiphat:
http://www.thestar.co.za/index.php?fSectionId=&fArticleId=vn20081011084401593C301314

Treyfish · Oct 11, 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>Up to 144 people being traced over virus</TD></TR><TR><TD class=Byline>AFP </TD><TD class=Published align=right>Published:Oct 11, 2008</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><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>Up to 144 people who had contact with three people killed by a mysterious illness in southern Africa are being traced, the World Health Organisation said yesterday.






A statement said that "121 known contacts of the fatal cases are being traced in South Africa and 23 in Zambia."

The organisation?s spokeswoman Fadela Chaib also told journalists in Geneva that 121 of those are already under observation, and that "all are doing well."

WHO epidemologists have been been hunting for the cause of the mysterious illness which killed "an expatriate tour guide living in Lusaka" as well as a paramedic and a nurse, she added.

The disease is believed to be a haemorrhagic fever, but "three haemorrhagic fevers have been ruled out - Ebola, Rift Valley and Lhasa. They are not the cause of the disease," said Chaib.

The first victim arrived in 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 has also died since.:tiphat:http://www.thetimes.co.za/News/Article.aspx?id=861046
</TD></TR></TBODY></TABLE>

Treyfish · Oct 11, 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]

Travel Advisory - Zambia

Source : Minist?re des Affaires Etrang?res ( www.diplomatie.gouv.fr ) - Actualit? publi?e le 09 Octobre 2008 ? 21:35

Source: Ministry of Foreign Affairs (www.diplomatie.gouv.fr) - News published on 09 October 2008 21:35

Trois personnes (dont deux originaires de Zambie) sont d?c?d?es r?cemment d?une maladie infectieuse hautement pathog?ne ? Johannesburg (Afrique du Sud).

Three people (including two from Zambia) died recently of a highly pathogenic disease in Johannesburg (South Africa).

L?agent responsable de ces d?c?s n?est pour l?heure pas identifi?, mais il pourrait s?agir d?une fi?vre h?morragique virale.

The officer responsible for these deaths is for the time not identified, but it could be a viral haemorrhagic fever.

Dans l?attente des r?sultats d?finitifs, il est utile de rappeler quelques r?gles d?usage:

Pending the final results, it is useful to recall some rules of usage:

- r?gles d?hygi?ne alimentaire (cuisson suffisante des aliments et du lait, lavage fr?quent des mains)

- Food hygiene rules (cooking food and milk, frequent handwashing)

- lutte efficace contre les piq?res d?insectes (port de v?tements couvrants, utilisation de r?pulsifs, s?assurer de ne pas ?tre porteur de tiques apr?s un d?placement en brousse)

- Fight against insect bites (covering clothing, use of repellents, making sure not to be carrying ticks after a shift in the bush)

Enfin, il est recommand? de consulter un m?decin en cas de fi?vre.

Finally, it is advisable to consult a doctor in case of fever.

<TABLE width="100%"><TBODY><TR><TD>

Source : Minist?re des Affaires Etrang?res ( www.diplomatie.gouv.fr )

Source: Ministry of Foreign Affairs (www.diplomatie.gouv.fr) :tiphat:http://74.125.93.104/translate_c?hl...&tl=fr&usg=ALkJrhijDLEvQJQrR6RSNpLrBZeerPTDwA</TD></TR></TBODY></TABLE>

Treyfish · Oct 11, 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 class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Two people admitted for closer monitoring 11/10/2008 15:26:03
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Two people have been admitted for closer monitoring to the Morningside Medi-Clinic in connection with a viral hemorrhagic fever which has hit Johannesburg.

A nursing sister at the clinic was admitted on Friday, a second woman was brought in for monitoring the day before.

Hospital officials say the pair is among a group of 67 people who are being closely watched after coming into contact with those who died of the disease in recent weeks.

A woman who was brought in from Zambia, the paramedic who accompanied her and a nurse at the facility have all died of the illness.

Medi-Clinic's Melinda Pelser says the patient?s temperatures are being closely watched and any changes taken seriously.:tiphat:http://www.702.co.za/news/news.asp#95408
</TD></TR></TBODY></TABLE>

Treyfish · Oct 11, 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]

Casualty ward closed on fresh virus fears <TABLE style="WIDTH: 405px; HEIGHT: 44px; BACKGROUND-COLOR: #ffffff" cellSpacing=0 cellPadding=0><TBODY><TR><TD class=caption style="WIDTH: 360px">
October 11 2008 at 02:29PM </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></TD></TR></TBODY></TABLE><TABLE class=mainarticle cellSpacing=0 cellPadding=0 border=0><TBODY><TR><TD class=svarticletext>[SIZE=+1][/SIZE]By Candice Bailey and Sapa-AFP

A woman who died shortly after admission to George Mukhari Hospital this week forced the closure of the casualty section and observation of everyone who had attended to her.

The woman's sudden and unexplained death sparked fears that she might have died from the viral haemorrhagic fever (VHF) that has claimed three lives in Gauteng.

Hospital management closed off the casualty department and put everyone from doctors to nurses, porters and clerks under observation while they investigated the death.

On Friday, Dr Patrick Maduna, chief operations officer of the Department of Health, dismissed reports that the woman had VHF. "The patient did not have all the symptoms of VHF. We are investigating her death. Her illness did not comply with the conditions of VHF. We are comfortable that we are not dealing with anything of the nature. There is no link at all to VHF," he said.

Maduna said his department had instructed all hospitals to be on the look-out for patients suffering from headaches, fever, diarrhoea, vomiting and bleeding and to check their travel history for links to a VHF-infected person.

"The woman was dead on arrival and staff could not establish her travel history or if she had any contact with someone with VHF. We decided not to take any risks but to take the necessary precautions," he said.

He said closing the casualty wing was a normal precaution in an infectious disease situation.

The hospital is now monitoring all nurses, paramedics, security and clerks that dealt with the woman.

Doctors first diagnosed VHF in mid-September when Zambian tour guide Cecelia van Deventer (36) was airlifted to the Morningside Medi-Clinic in Sandton.

She was treated for tick bite fever and other potential infections, but died two days later.

Hannes Els, who accompanied Van Deventer into the country died last week, and Gladys Mthembu, a nurse at the clinic, died on Sunday. Maria Mokubung, a cleaner at the medi-clinic, who died this week, may also have died from the virus, but tests still need to prove this.

Mthembu's 11-year-old son, his nanny and at least 120 other people who made contact with Van Deventer, were isolated and put under observation.

Morningside Medi-Clinic on Friday said Mthembu's son and his nanny had been discharged.

However, 123 people who made contact with the infected people are still being monitored.

They will be watched for 21 days by a clinic sister for signs of a change in body temperature.

Meanwhile, nearly one week since the emergence of the mystery virus, health officials have thrown a veil of silence on the progress of investigations and in certain instances reports have been conflicting.

Health spokesperson Zanele Mngadi said there were no new developments and only 55 people were being monitored at Morningside Medi-Clinic while Medi-clinic spokesperson Melinda Pelser said 67 people were being monitored.

Meanwhile, Professor Lynne Webber, head of medical virology at the University of Pretoria, said it was possible that all the contacts were not found, but warned against mass hysteria against any fever-like symptoms.

Earlier in the week Webber said the numbers of contacts and scope of the virus were worrying and that it would be a nightmare finding all the contacts.

"When Ebola broke out in 1996 we needed to trace all the contacts and it was a major issue as some had gone on leave or went away."

While they were speculating that it was an Ebola-like virus or Crimean-Congo fever, caused by a tick bite, some virologists suspect it to be a new virus.

"New viruses are expected - it is a reality. But it takes a long time to test new viruses. The trouble (with VHF) is that all these people died really quickly."

Webber said hospital beds were another issue. "We don't have enough isolation areas in Gauteng." It is estimated that Charlotte Maxeke only has 10 beds.

Several stretchers outside the quarantined casualty unit at the George Mukhari Hospital in Ga-Rankuwa. The unit was closed shortly after a woman died on arrival. :tiphat:http://www.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20081011082835360C367146

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Giuseppe · Oct 11, 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]

Another person admitted for observation in Jo'burg [SABCnews.com]

Another person admitted for observation in Jo'burg

Doctors said the disease was a kind of viral haemorrhagic fever - Government says there is no cause for alarm following the outbreak of suspected haemorrhagic fever

October 11, 2008, 15:30

The number of people now admitted to the Morningside Medi-Clinic in Johannesburg after showing symptoms of viral haemorragic fever (VHF)has risen to two.

A man and a female nurse have been placed in isolation.

Medi-Clinic spokesperson, Melinda Pelser, says the patients had been on the Clinic's list of people to be monitored for three weeks.

They were believed to be at risk of contracting the fever after being in contact with Gladys Mthembu, a nurse who died of viral haemorragic fever.

Three people have died of VHF in Johannesburg since it first appeared last month and over 100 people who had been in contact with Mthembu are still being monitored every six hours at two hospitals in Gauteng.

Viral haemorrhagic fevers are a group of diseases that very often present with very similar manifestations --most often related to an attack by the virus on the lining of the blood vessels.
--

<cite cite="http://www.sabcnews.com/south_africa/health/0,2172,178110,00.html">SABCnews.com - south_africa/health</cite>

Treyfish · Oct 12, 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 class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Viral hemorrhagic fever still a mystery 11/10/2008 08:07:09
</TD></TR><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#ffffff>Health officials say they're hoping to find out which viral hemorrhagic fever has hit Gauteng very soon.

Three people have been killed after contracting the virus which is believed to have been brought into the country from Zambia.

The World Health Organisation is also investigating to determine exactly which virus killed a woman who arrived in the country from Zambia, a nurse and a paramedic in Johannesburg in recent weeks.

Over a hundred people who'd come into contact with those who died are being monitored. But despite assurances there's still a sense of panic that the disease is spreading.

The National Health Laboratory Service's Dr. Lucille Blumberg has reiterated the public is not at risk.:tiphat:http://www.702.co.za/news/news.asp#95385</TD></TR></TBODY></TABLE>

Giuseppe · Oct 12, 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]

It is perhaps the moment for a bit of reflection about this incident.

It was stated that a viral haemorrhagic fever occurred but according the WHO latest updated:

''Clinical features common to the three patients initially include fever, headache, diarrhoea and myalgia developing into rash and hepatic dysfunction, followed by rapid deterioration and death.''

Thus no hemorrhages as main clinical feature.

Further, on the basis of the confused story so far circulated among news releases, updates and other, do we really think the Viral Haemorrhagic Fever ''X Virus'' is the actual culprit of three unexplained fatal illness affected patients?

I suggest that a possible preliminary diagnosis was reached by local health authorities but - since IHR(2005) obligations about novel or emergent infectious diseases reporting and subsequent probable travel restrictions fears - there is the well known at FT hoarding of informations or at least, the temptation of slowing the final diagnosis disclosure.

Confusion is the main culprit for the spread of panic, in public health incidents as well as in other settings, such as shares' markets, political turmoil and more and more other.

It is possible indeed that a novel pathogen emerged in south african region and further characterization is needed with the participation of foreign laboratories for validation of tests.

Commonground · Oct 12, 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 show signs of fever

12 October 2008, 10:39
By Eleanor Momberg, Myrtle Ryan, Liz Clarke and Niyantha Singh

Two more people have been admitted to the Morningside Medi-Clinic for observation after they showed signs of viral haemorrhagic fever.

The hospital confirmed on Saturday that a man was admitted on Thursday night and a woman on Friday. The woman is the second nurse to show signs of the disease.

At the same time, two relatives of Gladys Mthembu, the nurse who died after being admitted to the Sir Albert Robinson Hospital in Randfontein, were discharged after being given a clean bill of health. They were Mthembu's 11-year-old son and his 23-year-old nanny.

A cleaning supervisor at Morningside, who was admitted to Chris Hani Baragwanath Hospital in Soweto on Monday with symptoms of viral haemorrhagic fever, has since been discharged.

A total of 154 people remain under out-of-hospital observation for the signs of the mystery disease.

The outbreak has claimed three lives in South Africa since September 14, when Cecilia "Silky" van Deventer, a safari operator, died two days after being flown to Morningside from Zambia, apparently with tick-bite fever.

Hannes Els, the paramedic who treated Van Deventer, was admitted to the hospital on September 27, but died on October 2.

Mthembu, who also treated Van Deventer, subsequently went on leave and became ill at home. She went to her personal doctor, who referred her to the Sir Albert Robinson hospital, where she was admitted on October 1. Morningside was notified of her death on October 5.

Melinda Pelser, a Morningside spokesperson, said Maria Mokubung, a cleaner at the hospital who died at Charlotte Maxeke Hospital in Johannesburg, had a chronic illness for which she had been receiving treatment at Chris Hani Baragwanath hospital.

All the people who have been placed under observation have had direct contact with the people who died at Morningside.

Pelser said that, as a safety precaution, people who may have had direct contact with the patients who died at the hospital were being monitored and would continue to be monitored for 21 days from the time of their last contact.

"This number was initially 55 and has now been extended to 67 people. The monitoring consists of regular temperature checks and a daily check in with the Morningside Medi-Clinic. These people are not in isolation or quarantine and can continue with their daily activities," she said.

In addition, the department of health said that it was monitoring 66 people who may have had direct contact with Mthembu.

The World Health Organisation (WHO) said on Saturday that 23 people known to have had contact with the patients who died were being monitored in Zambia. None were symptomatic.

Clinical features common to the three patients include fever, headache, diarrhoea and muscle pain, which then developed into rash and hepatic (liver) dysfunction, followed by rapid deterioration and death, the WHO said.

"There is no indication at this point of the need for any restriction of travel to or from Zambia or South Africa and no special measures are required for passengers arriving from these countries," a WHO statement said.

What virologists were still trying to determine was which of the haemorrhagic viruses was responsible for the outbreak.

There was still concern about the family of Mthembu, who died last week in a Randfontein hospital. Mthembu had been urged to return to Morningside for treatment, but had chosen to be admitted to a local hospital, close to her family. Little is known about follow-up steps by the hospital to isolate those who came into contact with her.

Zambian authorities said they were still trying to trace people who had had contact with Van Deventer.

Blood samples from all three victims who died in South Africa have been sent by the National Institute for Communicable Diseases to the Centres for Disease Control in the United States. The results are expected before the end of the week.

South African specialists are also continuing their tests.

Professor Alan Smith, an eminent virologist, said the reason why virologists at the Special Pathogens Unit in Johannesburg - the only Level 4 laboratory in Africa - were taking so long to come up with an answer was that it was probably an emergent disease.

If it were Congo fever, it would have been identified in a few days, he said. "Ebola was one such emergent disease and in 1975 another was Marburg disease.

"There is no need to panic. Humans can only be infected through direct contact with the blood, urine or faeces of an infected person," he said.

http://www.thestar.co.za/?fSectionId=&fArticleId=vn20081012081150188C962767

Commonground · Oct 12, 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]

2 admitted to monitor fever
2008-10-12

-snip-

Morningside Medi-Clinic was currently monitoring 67 people who were contacts of those who died at the hospital. Their temperatures were taken for signs of change every six hours. However, this was being done from their homes. Charlotte Maxeke Academic hospital were monitoring their own list of contacts of the nurse who died in that hospital. Gauteng health spokeswoman Zanele Mngadi said on Saturday she was receiving continual hourly updates from the outbreak response team.

The World Health Organisation said up to 144 people who had contact with the three people killed by the illness were being traced. "121 known contacts of the fatal cases are being traced in South Africa and 23 in Zambia," the organisation said on Friday. Epidemologists are still searching for the cause of the haemorrhagic fever. Pelser emphasised that only people who were in direct contact with the bodily fluids of a person who had a confirmed case of the virus could be infected.

http://www.vocfm.co.za/public/articles.php?Articleid=41810

Commonground · Oct 12, 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]

Fliers shocked by lack of security

12 October 2008, 11:33

South Africans who recently visited Zambia were shocked upon their return that no control measures had been put in place at airports in this country to screen their health.

A group of engineers who had left for Livingstone, Zambia, on Monday amid the breaking news of the three deaths at the Morningside Clinic said they had been extremely apprehensive about venturing into Zambia on Monday.

"We were panicking about our health, but upon inquiry at the OR Tambo International Airport, we were told they had not been issued with any instructions to advise travellers any differently.

"My colleagues and I were not sure what to expect but boarded the flight nonetheless. There was little news coming through and all we knew at the time was that three people had died as a result of an infection contracted in Zambia.

"In fact, I was just waiting for one of my colleagues to say that they were not going and I would have joined him," said Raveen Maharaj, of Durban.

He said there was no information or public alarm about the infection in Zambia.

Maharaj said when they returned on Thursday, he was shocked that they were allowed to re-enter South Africa without anyone checking on them.

"We were expecting to be quarantined. On our flight there were people from all over the world...America, UK, and everyone was talking about the infection. On board the plane, the flight attendants just sprayed the air with a disinfectant as they normally do on international flights. That was it. There were no stops, no checks.

"Not one person even asked if we were feeling vaguely ill with flu-like symptoms. At passport control I told the attendants we were just in from Zambia and asked whether there were any health checks. All the attendant could do was say 'nice country'."

Maharaj said he was not overly concerned because they had not gone to Lusaka and he had been given all the prescribed preventative injections before he left.

http://www.pretorianews.co.za/?fSectionId=&fArticleId=vn20081012090114992C280451

Commonground · Oct 12, 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]

Hunting Virus X
Oct 12 2008 06:00

A virus new to humanity, or an old acquaintance dressed up in slightly new clothes, the disease that so far appears to have achieved a 100% kill rate in Johannesburg, is now up against the full might of humanity's scientific detectives.

So far three people have died from the mysterious disease, which has retained its anonymity through an extensive first round of laboratory testing for viral haemorrhagic fevers.

Based on the pattern of disease and a suspected tick bite on the first patient, the pathogen -- let us call it Virus X -- is suspected of being Crimean-Congo Haemorrhagic Fever (CCHF) or Lassa fever, or one of their close relatives.

Such a diagnosis would be relatively good news if Virus X has infected other people, because these pathogens are estimated to kill about 30% of their victims. The nastier haemorrhagic fevers such as Ebola and Marburg have achieved kill rates of up to 90% in some outbreaks. There is also one antiviral, ribavirin, which can be used against CCHF and Lassa.

In the words of one World Health Organisation expert, haemorrhagic viruses kill by "melting the organs". They disrupt the body's internal structure and damage the clotting mechanism. The patient effectively bleeds to death either internally, or with dramatic bleeding from all orifices detailed in several books and films. Blood pressure falls and the patient dies from multi-organ failure.

Professor Guy Richards is an intensive care specialist at Charlotte Mxenge Johannesburg Hospital and one of the doctors who treated the outbreak of Ebola in Johannesburg in the late 1990s. In that case the original patient, a man flown in from Congo, survived. Sadly the nurse treating him died.

He says the haemorrhagic fevers typically attack the endothelial cells lining the blood vessels. The blood vessel system, with its myriad branching arteries, veins and capillaries, is the largest organ inside the body. The membranes of these cells are damaged and fluids leak in and out of the holed cells which are no longer able to maintain their cohesion with their neighbours. Blood vessels collapse, blood pressure falls and the patient dies.

Usually the best medical workers can do is try to keep the patient alive by giving fluids and keeping them cool, and hope that the individual's immune system will be able to fight off the pathogen. Another infectious disease doctor says that the problem is that measures to help the patient, such as inserting drips or tubes to help them breathe, can then trigger further bleeding.

Samples of Virus X are undergoing further tests at the National Institute of Communicable Diseases in Johannesburg, which is one of the few laboratories in any developing country with the infrastructure and skills to test for such dangerous and rare pathogens. The institute's Lucille Blumberg, who leads the laboratory investigations, says that it will probably take several days for Virus X to be identified -- and there is a chance it could be a new virus making its way on to the world stage.

http://www.mg.co.za/article/2008-10-12-hunting-virus-x

Treyfish · Oct 12, 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 class=border id=HEADLINES cellSpacing=0 cellPadding=0 width="100%" bgColor=#b3d2f3 border=0><TBODY><TR><TD class=fptextBlack style="PADDING-RIGHT: 5px; PADDING-LEFT: 5px; PADDING-BOTTOM: 5px; PADDING-TOP: 5px" bgColor=#e6e6e6>Morningside Medi-Clinic continues to monitor patients 12/10/2008 07:45:01
</TD></TR><TR><TD class=fptextBlack bgColor=#ffffff>

Officials at the Morningside Medi-Clinic say people who may have caught a viral hemorrhagic fever at the Johannesburg facility will continue to be monitored for another two weeks as a precautionary measure.

It comes as two people including a nursing sister were admitted to the clinic for closer monitoring on Thursday night.

Hospital officials say the pair are among a group of 67 people who are being monitored after they came into contact with patients who died of the disease in recent weeks.

A woman who was brought in from Zambia, the paramedic who accompanied her and a nurse at the facility have all died of the illness.

Medi-Clinic's Melinda Pelser says there other people have been admitted and discharged over the past week.

Meanwhile, health officials say they're hoping to find out exactly which virus has hit Gauteng.

Experts have repeatedly warned the public they're not at risk of infection.:tiphat:http://www.702.co.za/news/news.asp#95419
</TD></TR></TBODY></TABLE>

Treyfish · Oct 12, 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]

SA's mystery virus identified - rodents carriers
October 12, 2008, 17:15

The mystery viral haemorrhagic fever which killed three people in South Africa has been provisionally identified as an arenavirus, the National Institute for Communicable diseases and the Department of Health said today.

"The causative agent of the disease... may be a rodent-borne arenavirus related to the lassa fever virus of West Africa," said NICD's Dr Lucille Blumberg. She said tests done by the NICD and the Centers for Disease Control in Atlanta US indicated that the disease seemed to be a kind of an arenavirus.

Arenaviruses cause chronic infections in multimammatic mice - a kind of wild mouse - which excretes the virus in its urine which can then contaminate human food or house dust. Viruses similar to the lassa fever virus have been found in rodents in Africa, but other than in West Africa have not been found to cause diseases in humans.

Therefore further tests still need to be done to find out whether this current strain is an undiscovered member of the arenavirus and what its distribution is. Blumberg said a female nurse and a male paramedic were currently in isolation after they were in contact with those who previously died from the illness.

The paramedic has since been diagnosed with kidney stones and Blumberg said it was "less likely" he had the virus. The nurse is "highly suspect" and is receiving anti-viral medication. She was presently stable, but Blumberg could not say more on how her condition was likely to progress. - Sapa:tiphat:http://www.sabcnews.com/south_africa/health/0,2172,178151,00.html

Treyfish · Oct 12, 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 virus identified

12 October 2008, 15:20The mystery viral haemorrhagic fever which killed three people in South Africa has been provisionally identified as an arenavirus, the National Institute for Communicable Diseases and the Department of Health said on Sunday.

"The causative agent of the disease...may be a rodent-born arenavirus related to the Lassa fever virus of West Africa," NICD's Dr Lucille Blumberg said at the Charlotte Maxexe Johannesburg Academic Hospital.

She said tests done by the NICD and the Centers for Disease Control in Atlanta, US, indicated that the disease seemed to be a kind of an arenavirus. The World Health Organisation has also been providing technical assistance.

Arenaviruses cause chronic infections in multimammatic mice - a kind of wild mouse - who excrete the virus in their urine which can then contaminate human food or house dust.

Viruses similar to the Lassa fever virus has been found in rodents in Africa, but other than in West Africa have not been found to cause diseases in humans.

She said there was no indication that arenaviruses which could cause disease in humans were present in South African rodents.

Blumberg said further tests still needed to be done.

"It needs to be determined whether it is a previously unrecognised member of the arenaviruses and what its distribution is," she said.

The NICD's Robert Swanepoel there were viruses of this family in Southern Africa but that this could be an undiscovered kind.

"Not every country has been thoroughly searched," he said.

He said the kind of rodents who carried the virus were not generally found in urban areas.

"They are out there but attracted [to human dwellings] if there is inadequate waste disposal."

Crop disposal and animal feed also sometimes attracted them, he said.

He said the kinds of viruses could range from causing mild fevers to being lethal.

There were only three cases to go on for the kind of arenavirus now discovered but "it looks like it is very lethal," he said.

Head of the NICD's Special Pathogens Unit, Dr Janusz T Paweska, said the arenavirus diagnosis came about after a number of tests.

Biopsys conducted on the last two victims where infected tissues, skin, liver and muscles were tested were critically important in being able to make a diagnosis.

A blood sample obtained in Zambia from the first victim also confirmed test results.

He said doctors were now waiting for the virus to grow in cell culture to conduct further tests to identify what strain it was.

Gauteng health MEC said the first victim of the virus was 36-year-old Cecilia van Deventer, who was airlifted from Zambia to the Morningside Medi Clinic in Sandton on September 12 in a critical condition.

She is known to have lived in a smallholding on the outskirts of Lusaka where she kept three horses, although the exact point of contamination has never been discovered.

She fell ill on September 8 and was treated in three different hospitals in Lusaka. Once in South Africa she was treated for tick bite fever and other potential infections, but died two days later.

She was not tested for viral haemorrhagic fever.

On September 27 a Zambian paramedic who accompanied her into the country was admitted into the hospital with similar flu-like symptoms, fever and a skin rash and viral haemorrhagic fever was queried.

He developed diarrhoea, severe headaches, nausea and vomiting and although he initially seemed to respond to treatment, died on October 2 at the clinic.

A third victim of the virus was a nurse from Morningside Medi-Clinic who attended to Deventer.

She became ill with fever 18 days after Deventer was admitted to the hospital and consulted a general practitioner, receiving intravenous therapy.

She was then referred to Robinson Hospital in Randfontein and later transferred due to a bedding shortage to Sir Albert Clinic. Here she was treated for a suspected case of meningitis.

Her condition deteriorated and she died last Sunday.

A fourth person, a contract cleaner working at Morningside Medi-clinic Maria Mokubung, 37, died in Charlotte Maxeke Academic hospital.

Earlier this week the health department said her death was not related to viral haemorrhagic fever.

On Sunday, Blumberg said a female nurse and a male paramedic were currently in isolation after they were in contact with the deceased.

The paramedic had contact with Deventer and after developing flu-like symptoms and a fever was admitted to Flora clinic. He was subsequently transferred to Morningside medi-clinic and diagnosed with kidney stones.

On Sunday Blumberg said it was "less likely" he had the virus.

The second person in isolation is a nurse who had contact with a paramedic that died. She has developed symptoms similar to the three deceased and is receiving anti-viral medication called ribavirin.

The department of health said she was presently stable.

Blumberg said she "highly suspect" to have contracted the virus and could not say further how her condition was likely to progress.

This week three other people who had been hospitalised after contact with the deceased were discharged.

On Friday morning the eleven year-old son of the nursing sister who died and his 23- year-old nanny were discharged.

A cleaning supervisor at Morningside Medi-Clinic who had been admitted to the Chris Hani Baragwanath Hospital on Monday with symptoms of viral haemorrhagic fever was also released.

On Sunday,Hlongwa said she was currently "well".

All three continued to be monitored as part of the disease surveillance system currently tracking 151 people who had contact with the deceased.

Blumberg said arenaviruses could cause a disease which spreads from human to human through contact fluid.

In hospital settings, special precautions were needed when nursing patients.

People in contact with those who have contracted the virus must be monitored for 21 days following their last contact with the patient.

Their body temperature is monitored and those who develop fever or illness are admitted to an isolation ward in the hospital.

Blumberg said there was a drug which showed promising results in treating patients if their illnes was recognised early.

Those who have been in contact with patients but are well, do not spread infection.

On Sunday, Gauteng health MEC Brian Hlongwa said the diagnosis of the virus was a step forward.

"We are now a step further because we know specifically what we are dealing with."

However, it was still vital to conduct more tests to find out kind of arenavirus it was, he said.

Director General Thami Mseleku cautioned South Africans not to now fear that every mouse that came their way contained the virus.

Since the virus first broke out, medical officials have been at pains to emphasise that the general public is not at risk as only people who were in direct contact with the bodily fluids of a person who had a confirmed case of the virus could be infected. - Sapa :tiphat:http://www.thestar.co.za/?fSectionId=&fArticleId=nw20081012152218513C975048

Treyfish · Oct 12, 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]

Virology laboratories put on high alert

12 October 2008, 11:55
In the wake of the deaths linked to the "mystery disease", the National Institute for Communicable Diseases has placed several virology laboratories around the country on alert.

What is baffling scientists is that two of the victims, Hannes Els and Gladys Mthembu, showed an initial improvement, but then had a sudden and marked deterioration in mental state, rhabdomyolysis (a rapid breakdown of skeletal muscles) in one case, and evidence of acute and severe hepatic necrosis (death of cells).

The clinical and laboratory features in all three victims included about seven days of fever, headache, diarrhoea and myalgia (painful muscles) in the early stages, followed by an acute illness with fever of 38C, a morbilliform (measle-like) rash in two patients, thrombocytopenia (abnormal decrease in the number of platelets in the blood) and mild hepatic (liver) dysfunction in two patients.

While bleeding was not a marked clinical feature, oozing from venepuncture sites (where needles have been inserted into the veins) had been noted, as well as a petechial rash (small spots indicating subcutaneous bleeding) in one patient.

The Institute said laboratory tests to date had proved negative for Crimean-Congo haemorrhagic fever, Ebola, Marburg, Lassa fever and Rift Valley fever viruses.

The Hantavirus (the source of Korean haemorraghic fever) had also proved negative.

The Institute explained that no specimens were available from Van Deventer, who died soon after arriving in South Africa, but she had been given a diagnosis of "tick bite fever".

Negative results to date, said the Institute, could be attributed to the late collection of specimens (day 10 of illness), and virus variants not detected by current molecular and serological assays.

Blood cultures to date had been negative and further laboratory testing was continuing.

It was believed, though, that a viral haemorrhagic fever was the culprit.

No further cases had been identified in either South Africa or Zambia and the authorities believe this was an isolated case with secondary transmission.

Finally, the Institute said the recent case of Crimean-Congo haemorrhagic fever (CCHF) from Calvinia in the Northern Cape was not linked to the above cluster.

That patient, an abattoir worker, is now clinically stable.
:tiphat:http://www.thestar.co.za/index.php?fSectionId=&fArticleId=vn20081012090148680C872674

Commonground · Oct 12, 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]

Post #97:

So the woman admitted on 10/9 is a paramedic, her contact was Deventer (index case). She had flu-like symptoms & a fever. Was reconciled from Flora clinic to Morningside. Diag: kidney stones.

The other person admitted was a nurse. Her contact was Hannes Els (paramedic). She has symptoms similar to the 3 that died. Receiving anti-viral: ribavirin. Stable.

Commonground · Oct 12, 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]

Post #98:

Negative results to date, said the Institute, could be attributed to the late collection of specimens (day 10 of illness), and virus variants not detected by current molecular and serological assays.

Could be my notes are incorrect. I have the Nurse, Gladys Mthembu as symptom onset of 10/1. Died on 10/5.

Hannes Els, paramedic, symptom onset of 9/27. Died on 10/2.

Anyone else have varying information?

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

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