South Africa: Zambia

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South Africa: Zambia

Post  cottontop on Tue Oct 07, 2008 4:26 am

Undiagnosed Mysterious Disease in South Africa: Zambia

This is from the Promed website:

Date: Mon 6 Oct 2008
From: Amy Cantlay inka@iwayafrica.com

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

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

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

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

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

13 Sep 2008 - Index Case dies.

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

14-27 Sep 2008 - Paramedic slowly deteriorates.

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

30 Sep 2008 - Paramedic dies.

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

5 Oct 2008 - Nurse who treated Index Case dies.

The information that I can gather is the following:

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

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

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

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

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

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

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

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

MORE:

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

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

MORE:

http://www.promedmail.org/pls/…
ProMED-mail thanks Dr. Cantlay for her commentary, which contributes some interesting detail. At this point, it would not be useful to speculate further on the identity of the infectious agent responsible for the deaths of the 4 Zambian patients. No doubt a firm diagnosis will be available shortly from a South African reference laboratory. Several different viruses cause viral hemorrhagic fever. Of these, Ebola, Marburg, Lassa or Crimean-Congo hemorrhagic fever viruses have not been recorded in Zambia up to the present. A comprehensive account of these and other viruses responsible for hemorrhagic fevers can be found at the US CDC website:
http://www.cdc.gov/ncidod/dise…
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Link found Oct. 9, 2008

Post  cottontop on Thu Oct 09, 2008 4:47 am

By Louise Flanagan

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.




“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. 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.

rest of story

http://www.int.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20081008055631284C178069
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Re: South Africa: Zambia

Post  cottontop on Fri Oct 10, 2008 5:44 am

South Africa: Government authorities collaborate to deal with mystery disease

The National Outbreak Response Team (NORT) is working around the clock to support the provincial Outbreak Response Teams with guidelines, active field surveillance and the tracing of contacts following the outbreak of suspected hemorrhagic fever in Gauteng.

Briefing reporters following cabinet’s ordinary meeting, Government Spokesperson Themba Maseko said a Rapid Response Team (RRT) has also been established, consisting of public and private health sector representatives, to coordinate efforts to deal with the situation promptly.

“This team meets on a daily basis to coordinate responses and to constantly monitor the situation in all our hospitals and clinics.”
(Snip)
Symptoms of the suspected infectious disease include vomiting; nausea; diarrhoea, high temperature and skin rash. The health department has said people at risk of contracting the suspected disease are those who have been in close contact with the affected patients.

According to Mr Maseko, government is already working with the World Health Organisation (WHO) and the US Centre for Disease Control (CDC) in order to access their global expertise in dealing with outbreak responses.

The CDC, he said, has undertaken to expedite the processing of samples to ensure that test results are made available as quickly as possible. Blood samples were sent to the US to determine exactly what the virus is.

“We are confident that the test results will shed more light on this virus so that appropriate measures could be put in place as soon as possible.”

Mr Maseko said government has urged the public not to panic as the situation was being dealt with. (Snip)

Any person who experiences the listed symptoms is advised to seek medical treatment or contact the Emergency Medical Services 24 hour hotline on 011 564 2083.

Full story

http://allafrica.com/stories/200810090644.html
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