|
|
UNDIAGNOSED FATALITIES - SOUTH AFRICA EX ZAMBIA (08): ARENAVIRUS IDENTIFIED
***************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] South Africa - National Institute for Communicable Diseases (NCID)
[2] WHO
[3] South Africa Government Communication and Information System
[4} Newswire
****
[1] South Africa - National Institute for Communicable Diseases (NCID)
Date: Mon 13 Oct 2008
From: Liz Millington <lizm@nicd.ac.za>
Outbreak of an acute disease, ex Zambia
---------------------------------------
The results of tests conducted at the Centers for Disease Control in
Atlanta (CDC), USA, and at the National Institute for Communicable
Diseases of the National Health Laboratory Service in Johannesburg,
provide preliminary evidence that the causative agent of the disease
that has resulted in the recent deaths of 3 people in hospitals in
Johannesburg, is a rodent-borne arenavirus related to the Lassa fever
virus of West Africa. Further tests, to confirm the diagnosis by
growing the virus in culture and to characterize it further, are in
progress. It needs to be determined whether it is a previously
unrecognized member of the arenaviruses, and what its distribution
and reservoir host are.
Arenaviruses cause chronic infection in wild rodents (multimammate
mice) with excretion of virus in urine, which can contaminate human
food or house dust. Arenaviruses have been found in southern African
rodents in the past, but there has been no previous association with
human disease. The virus associated with the present outbreak may
prove to be a new member of the group.
In the current outbreak there have been 3 deaths, the index case
ex-Zambia and 2 persons who acquired disease after close contact in
the nosocomial setting. A 4th patient, a nurse, who had close contact
with the 2nd patient, has developed a febrile illness and
thrombocytopenia, and has tested positive by PCR [polymerase chain
reaction] for arenavirus. She is currently being treated with
ribavirin. The efficacy of ribavirin has been documented in Lassa
fever, but is unknown for the current virus.
The incubation period for cases in the present cluster ranges from
7-13 days. There is a prodromal illness of about 7 days with myalgia,
headache, diarrhoea, and a severe pharyngitis. This is followed by a
more severe illness with moderate thrombocytopenia but no bleeding.
Hepatic dysfunction with raised transaminases has typically occurred
late in the course of disease.
[Source: Centers for Disease Control and Prevention, Atlanta, USA
National Institute for Communicable Diseases of the National Health
Laboratory Service, Johannesburg, South Africa
Department of Pathology, University of the Witwatersrand,
Johannesburg, South Africa]
--
Communicated by:
Liz Millington on behalf of
Dr Lucille Blumberg
National Institute for Communicable Diseases
1 Modderfontein Road
Sandringham 2131
South Africa
<lucilleb@nicd.ac.za>
******
[2] WHO
Date: Mon 13 Oct 2008
Source: World Health Organisation (WHO), EPR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2008_10_13/en/index.html>
New virus from family _Arenaviridae_ in South Africa and Zambia - Update
----------------------------------------------------------------------------------------------
The results of tests conducted at the Special Pathogens Unit,
National Institute for Communicable Diseases (NICD) of the National
Health Laboratory Service in Johannesburg, and at the Special
Pathogens and Infectious Disease Pathology branches of the Centers
for Disease Control in Atlanta, USA, provide preliminary evidence
that the causative agent of the disease which has resulted in the
recent deaths of 3 people from Zambia and South Africa, is a virus
from the family _Arenaviridae_.
Analysis continues at the NICD and CDC in order to characterize this
virus more fully. CDC and NICD are technical partners in the Global
Outbreak Alert and Response Network (GOARN).
Meanwhile, a new case has been confirmed by PCR in South Africa. A
nurse who had close contact with an earlier case has become ill, and
has been admitted to hospital. Contacts have been identified and are
being followed-up.
WHO and its GOARN partners continue to support the Ministries of
Health of the two countries in various facets of the outbreak
investigation, including laboratory diagnosis, investigations, active
case finding and follow-up of contacts.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
******
[3] South Africa Government Communication and Information System
Date: Mon 13 Oct 2008
Source: BuaNews online, compiled by the Government Communication and
Information System [edited]
<http://www.buanews.gov.za/news/08/08101311151006>
Unknown illness identified as Arenavirus
----------------------------------------
The virus, which has caused the death of 3 people, has been
provisionally identified as the rodent-borne arenavirus. The
arenavirus, related to Lassa fever virus of West Africa, causes
chronic infections in multimammate mice. Infected mice's excretion
contains the virus, which can contaminate human food or house dust.
A joint statement by the National Institute for Communicable Disease
(NICD) and the Department of Health explained that the arenavirus
[infection] is a disease spread from human to human through the
contact of body fluids. The finding follows blood samples being sent
to Atlanta, in the United States to determine the cause of the deaths
of 3 people who had been suspected of contracting [a] viral
haemorrhagic fever. The virus is similar to Lassa fever [virus], the
department said. It has previously been found in rodents elsewhere in
Africa, but has not been found to cause disease in humans other than
in West Africa.
Further tests are needed to confirm the diagnosis by growing the
virus in culture. "It needs to be determined whether it is a
previously unrecognised member of the arenaviruses [the family
_Arenaviridae_], and what its distribution is. There is no indication
as yet that arenaviruses which cause disease in humans are present in
South African rodents," the NICD said.
The 1st victim, who had to be flown in from Zambia in a critical
condition, was admitted to the Morningside Medi-Clinic in mid
September [2008]. She died 2 days later. About 2 weeks later, the
paramedic who had flown in with the 1st victim, was admitted at the
same clinic presenting the same symptoms. A nurse, died shortly
afterwards. According to certain reports the nurse's family has been
given a go-ahead to continue with the funeral arrangements as her
bedroom had been cordoned off by health officials. A cleaner at the
Morningside Medi-Clinic, who also died last weekend, has since been
ruled out as a possible victim of the virus. Meanwhile the Gauteng
Health Department has confirmed that the 3 other patients, including
nurse's female supervisor, who had been under observation for showing
symptoms of the virus have been discharged.
However, departmental spokesperson Phumelele Kaunda said there were 2
contacts that were still under active surveillance after being
admitted for observation. The one patient is a paramedic who had
contact with the 1st patient and developed fever and flu-like
symptoms. He was admitted initially in Flora Clinic and then
transferred to Morningside Medi-Clinic with a diagnosis of kidney
stones. The other patient is a nurse who attended to the 2nd patient
and developed signs and symptoms similar to the 1st 3 patients. She
is being treated in isolation and received the anti-viral medication,
ribavirin. The patient is presently stable.
Gauteng Health MEC [member of the executive council] Brian Hlongwa
meanwhile has sent condolences to the families of those that were
killed by the viral infection, particularly families of health
professionals who died in the line of duty. "This illustrates the
dedication of our health professionals and the need of society to
respect and honour the work that they do," said MEC Hlongwa. He also
thanked the NICD, the National Health Laboratory Service, Centre for
Disease Control in Atlanta, and the World Health Organisation for
ensuring that the results were made available soon.
[Byline: Luyanda Makapela]
--
Communicated by:
ProMED-mail Rapporteur Brent Barrett
******
[4] Newswire
Date: Sun 12 Oct 2008
Source: News24, South Africa, South African Press Association (SAPA)
report [edited]
<http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_2408685,00.html>
Virus identified - nurse ill
----------------------------
The mystery viral haemorrhagic fever, which killed 3 people in South
Africa, has been provisionally identified as an arenavirus, the
National Institute for Communicable Diseases (NICD) and the
Department of Health said on Sunday [12 Oct 2008]. "The causative
agent of the disease... may be a rodent-borne arenavirus related to
the Lassa fever virus of West Africa," NICD's Dr Lucille Blumberg
told reporters at the Charlotte Maxeke Johannesburg Academic
Hospital. She said tests done by the NICD and the Centres for Disease
Control in Atlanta, US, indicated that the disease seemed to be a
kind of an arenavirus. The World Health Organisation (WHO) has also
been providing technical assistance in identifying the virus.
Arenaviruses cause chronic infections in multimammate mice -- a kind
of wild mouse -- that excrete the virus in their urine, which can
then contaminate human food or house dust. Viruses similar to the
Lassa fever virus have been found in rodents in Africa, but other
than in West Africa have not been found to cause diseases in humans.
She said there was no indication that arenaviruses, which could cause
disease in humans, were present in South African rodents. "It needs
to be determined whether it is a previously unrecognised member of
the arenaviruses and what its distribution is," she said.
The NICD's Robert Swanepoel said there were viruses of this family in
Southern Africa, but that this could be an undiscovered kind. He said
the kind of rodents who carried the virus was not generally found in
urban areas. "They are out there, but attracted [to human dwellings]
if there is inadequate waste disposal."
Crops and animal feed also sometimes attracted them, he said. He said
the kinds of viruses could range from causing mild fevers to being
lethal. There were only 3 cases to go on for the kind of arenavirus
now discovered, but "it looks like it is very lethal," he said.
Head of the NICD's Special Pathogens Unit, Dr Janusz T Paweska, said
the arenavirus diagnosis came about after a number of tests. Biopsies
conducted on the last 2 victims where infected tissues, skin, liver,
and muscles were tested were critically important in being able to
make a diagnosis. A blood sample obtained in Zambia from the 1st
victim also confirmed test results. He said doctors were now waiting
for the virus to grow in cell culture to conduct further tests to
identify what strain it was.
Gauteng Health MEC Brian Hlongwa said the 1st victim of the virus was
36-year-old woman, who was airlifted from Zambia to the Morningside
Medi-Clinic in Sandton on [12 Sep 2008] in a critical condition. She
is known to have lived in a smallholding on the outskirts of Lusaka
where she kept 3 horses and other animals, although the exact point
of contamination has never been discovered. She fell ill on 8 Sep
2008 and was treated in 3 different hospitals in Lusaka. Once in
South Africa she was treated for tick bite fever and other potential
infections, but died 2 days later.
On [27 Sep 2008] a Zambian paramedic who accompanied her into the
country was admitted into the hospital with similar flu-like
symptoms, fever, and a skin rash. In his case, viral haemorrhagic
fever was queried. He developed diarrhoea, severe headaches, nausea,
and vomiting and although he initially seemed to respond to
treatment, died on [2 Oct 2008] at the clinic.
A 3rd victim of the virus was a nurse from Morningside Medi-Clinic
who attended to index case. She became ill with fever 18 days after
the [index case] was admitted to the hospital and consulted a general
practitioner, receiving intravenous therapy. She was then referred to
Robinson Hospital in Randfontein and later transferred due to a
bedding shortage to Sir Albert Clinic. Here she was treated for a
suspected case of meningitis. Her condition deteriorated and she died
last Sunday [5 Oct 2008].
A 4th person, a contract cleaner working at Morningside Medi-clinic
Maria Mokubung, 37, died in Charlotte Maxeke. Earlier this week the
Health Department said her death was not related to viral
haemorrhagic fever. On Sunday [12 Oct 2008], Blumberg said a female
nurse and a male paramedic were currently in isolation after they
were in contact with the deceased. The paramedic had contact with
[the index case] and after developing flu-like symptoms and a fever
was admitted to Flora clinic. He was subsequently transferred to
Morningside Medi-Clinic and diagnosed with kidney stones. On Sunday
Blumberg said it was "less likely" he had the virus.
The 2nd person in isolation is a nurse who had contact with the
paramedic that died. She has developed symptoms similar to the 3
deceased and is receiving anti-viral medication called ribavirin. The
department of health said she was presently stable. Asked whether she
could have contracted the virus, Blumberg said her condition was
"highly suspect." She said she could not say further how her
condition was likely to progress.
This week [week of 6 Oct 2008] 3 other people who had been
hospitalised after contact with the deceased were discharged. On
Friday morning [10 Oct 2008] the 11 year-old son of the nursing
sister who died and his 23-year-old nanny were discharged. A cleaning
supervisor at Morningside Medi-Clinic who had been admitted to the
Chris Hani Baragwanath Hospital on Monday [6 Oct 2008] with symptoms
of viral haemorrhagic fever was also released. All 3 continued to be
monitored as part of the disease surveillance system currently
tracking 151 people who had contact with the deceased.
Blumberg said arenaviruses could cause a disease, which spreads from
human to human through contact fluid. In hospital settings, special
precautions were needed when nursing patients. People in contact with
those who have contracted the virus must be monitored for 21 days
following their last contact with the patient. Their body temperature
is monitored and those who develop fever or illness are admitted to
an isolation ward in the hospital. Blumberg said there was a drug,
which showed promising results in treating patients if their illness
was recognised early. Those who have been in contact with patients
but are well do not spread infection.
On Sunday [12 Oct 2008], Hlongwa said the diagnosis of the virus was
a step forward. However, it was still vital to conduct more tests to
find out what kind of arenavirus it was, he said. Health department
director-general Thami Mseleku cautioned South Africans not to now
fear that every mouse that came their way contained the virus. Since
the virus first broke out, medical officials have been at pains to
emphasise that the general public is not at risk as only people who
were in direct contact with the bodily fluids of a person who had a
confirmed case of the virus could be infected.
--
Communicated by:
ProMED-mail and a similar report ProMED-mail Rapporteur Mary Marshall
<promed@promedmail.org>
[These 3 accounts confirm that an unidentified arenavirus was
responsible for the deaths of the 3 patients in South Africa.
Contrary to a previous account a sample from the index case was
available and has tested positive for the unidentified arenavirus.
Also a 4th critically ill surviving patient (who nursed the index
case) in South Africa has tested positive for the same virus. None of
the other suspected cases have been confirmed so far. As the virus
has not yet been propagated in cell culture it must be presumed that
the identification is based on PCR assay.
The family _Arenaviridae_ is split into Old and New world groups,
which are only distantly related. There are 5 species of Old World
viruses -- Ippy virus, Lassa virus, lymphocytic choriomeningitis
virus (LCMV), Mobala virus, and Mopeia virus. The cosmopolitan LCMV
is a mouse virus, whereas Lass virus and Mopeia virus share a common
rodent host, species of the multimammate mouse (genus _Mastomys__). A
photograph of a multimammate mouse can be seen at
<http://animal.nibio.go.jp/ypc_img_1413_600.jpg>.
Lassa virus is present in west and central Africa and has been
associated with disease in humans and other primates, whereas Mopeia
virus is present further south and not known to be associated with
disease in humans or primates so far. - Mod.CP]
[see also:
Undiagnosed fatalities - S. Africa ex Zambia (07): arenavirus 20081012.3234
Undiagnosed fatalities - South Africa ex Zambia (06): WHO 20081010.3211
Undiagnosed fatalities - South Africa ex Zambia (05) 20081008.3192
Undiagnosed fatalities - South Africa ex Zambia (04) 20081008.3188
Undiagnosed fatalities - South Africa ex Zambia (03) 20081007.3178
Undiagnosed fatalities - South Africa ex Zambia (02) 20081006.3157
Undiagnosed fatalities - South Africa ex Zambia: RFI 20081005.3139
Human lymphocytic choriomeningitis virus - USA (03) 20080726.2276
Human lymphocytic choriomeningitis virus - USA (02) 20080516.1635
Human lymphocytic choriomeningitis virus - USA: organ donation 20080412.1339
Lassa fever - Nigeria (02) 20080611.1847
Lassa fever - Nigeria: (Ebonyi) 20080323.1100
2007
----
Arenavirus, organ transplants - Australia (VIC)(02) 20070430.1402
Arenavirus, organ transplants - Australia (VIC) 20070423.1325
2003
----
Arenaviruses and rodent taxonomy (02) 20030412.0891
Arenaviruses and rodent taxonomy 20030411.0879
Lassa fever - Sierra Leone 20030409.0863
Lassa fever, imported - UK ex Sierra Leone 20030210.0360
2000
----
Arenavirus infection, human USA (CA): Confirmed (02) 20000813.1344
Arenavirus infections, human - USA (CA): Confirmed 20000804.1301
Arenavirus infection, human - USA (Calif.): comment (02) 20000708.1137
Arenavirus infection, human - USA (Calif.): comment 20000704.1110
Arenavirus infection, human - USA (California) 20000703.1104
Lassa virus, seroprevalence 20000119.0080
1996
----
List of recognized arenaviruses 19961218.2106]
...................................mpp/cp/mj/mpp/cp/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at
<http://www.isid.org/ProMEDMail_Premium.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################
|