H5N1

Ebola, Marburg and Lassa viruses must be designated as emerging diagnoses

Via News-Medical.net: Ebola, Marburg and Lassa viruses must be designated as emerging diagnoses. Excerpt:

The Ebola, Marburg and Lassa viruses are commonly referred to as emerging diseases, but leading scientists say these life-threatening viruses have been around for centuries. 

In a perspective in the Nov. 9 issue of the journal Science, researchers including a professor at The University of Texas Health Science Center at Houston (UTHealth) say it would be more appropriate to refer to these viruses as emerging diagnoses. 

"The infectious agents were identified around the middle of the 20th century but that does not mean that they were new," said Joseph McCormick, M.D., one of the authors of the perspective and regional dean of The University of Texas School of Public Health Brownsville Regional Campus, which is part of UTHealth. "Some of the viruses, including Lassa and Ebola, have been around for thousands of years." 

The viruses burst onto the scene in the 1960s when outbreaks decimated areas of west and central Africa. The viruses can lead to hemorrhagic fever, a condition characterized by bleeding, shock, vomiting and diarrhea. In severe cases, the death rate may reach 90 percent. 

These viruses thrive in animals - not humans. But people can get the viruses if they come in contact with infected animals or are exposed to virus-infected fluids or tissues. Infected people are moderately contagious with person-to-person transmission only through direct contact with infectious fluids such as blood or urine. Patients with Lassa virus can be successfully treated by antiviral medications. 

With the aid of epidemiologic, ecologic and genetic studies, researchers have learned that these viral hemorrhagic fevers are endemic in several areas of Africa. And, the Ebola viruses are endemic in other parts of the globe. 

"The Arenavirus family of viruses that occur on many continents, of which the African Lassa virus is a member, is an ancient family of viruses that have likely evolved along with their rodent hosts over millions of years," said McCormick, former chief of the Special Pathogens Branch of the Centers for Disease Control and Prevention. 

So what would designating the viruses as emerging diagnoses mean? "It means that these viruses have lurked as enzootic viruses in the environment and that their 'discovery' was related to the scientific capacity to make the diagnosis rather than their 'emergence,''' McCormick said. 

"However, it also means that we also now know more about the risks of encountering them and therefore, how to identify those who may be at risk for infection."

Uganda: Suspected Ebola death in Koboko

Via The Daily Monitor: Suspected Ebola death in Koboko. The full report:

A boda boda cyclist who was admitted to Koboko Health Centre IV with signs of the Ebola virus has died. 

The man, whose identity was not disclosed by the doctor who treated him, was brought in on Monday and passed away on Tuesday. 

The district health officer, Dr Alfred Driwale, told the Daily Monitor on Tuesday evening that they were treating the case of Ebola and it was under investigation. 

“The patient came with hemorrhagic fever and it is unfortunate that he died. The blood samples have been sent to Entebbe to confirm whether he died of Ebola or Marburg,” he said. 

Dr Driwale explained that the patient had fever, headache, general body ache, yellowing of the eyes, bleeding from the nose and ears, was vomiting blood and was in a state of mental confusion. This, he said caused suspicion. 

“We had to use protective gear when treating and burying him. But people should be calm because the disease is not yet confirmed,” he added. 

The man, from Kuluba Sub-county, was admitted after being unwell for three days. Upon admission, he was quarantined. A team from Arua hospital was called in to help. 

According to the doctors, the man had no recent history of travel to neighbouring DRC, South Sudan or Kampala.

Uganda: Kabale to close Marburg centre

Via The Daily Monitor: Kabale to close Marburg centre. Excerpt:

The Marburg Virus Isolation Centre at Rushoroza Health Centre III in Kabale will be closed tomorrow after a survey established that there are no new cases. 

The council secretary for health, Ms Loy Zikampereza, said a mother and her four-year-old child, who tested positive for the virus, were in stable condition. “The two currently admitted will have a special place prepared for them in Butobere in Kabale Town, where medical experts can easily monitor their situation,” she said. 

Kabale RDC Mathew Elayu, who chairs the district Marburg task force, issued an order to lift the ban on public gathering in markets, nightclubs and parties.“...but the public is advised to take precautionary measures, especially washing hands with soap and Jik solution every time they go home after work. Everyone should be on the lookout for new cases that might emerge,” he said. 

In Ibanda, 13 suspected Marburg virus patients were admitted to Ruhooko Hospital Isolation Centre. 

The District Health Officer, Dr Julius Bamwiine, said yesterday they were about to discharge two people who had tested negative. He said they were expecting the results of six others, while blood samples for the rest had just been sent to Uganda Virus Research Institute in Entebbe. 

Staff to resume work 

At Mbarara Hospital, a staff is under surveillance after developing symptoms similar to the Marburg virus, Sr. Eugenia Namulindwa, the head of the isolation unit, said. 

She said 18 members of staff, who got in contact with a person that died of the virus on October 23 were expected to resume work yesterday after the set 21 days of monitoring elapsed as they had tested negative. 

“We have one member of staff that has shown Marburg virus symptoms but we have taken her blood samples for testing,” she said.

Uganda: A new outbreak of Ebola (updated)

Via Xinhua: Deadly Ebola hemorrhagic fever breaks out in central Uganda. Excerpt:

The deadly Ebola hemorrhagic fever has broken out in the central Ugandan district of Luwero about one month after the World Health Organization (WHO) declared the East African country free of the disease. 

Joaquim Saweka, the WHO country representative told Xinhua by telephone on Wednesday that the outbreak was confirmed on Tuesday following laboratory tests that turned out positive for the disease. 

"Yes that is true, we have dispatched one team to make preliminary assessment and also set up an isolation unit," he said. 

The epicenter of the outbreak is in Sombwe Parish, Nyimbwa Sub County, Luwero district which is located about 40km north of the capital Kampala. 

Joseph Okware, the Luwero District Health Officer was quoted by Daily Monitor on Wednesday as saying that two people belonging to the same family had died of the disease over the weekend. 

The outbreak comes at a time when the country is still experiencing the deadly Marburg fever in several parts of western Uganda. 

In July this year the Ebola outbreak in the Midwestern Ugandan district of Kibaale left at least 20 people dead.

I completely missed this story in today's Daily Monitor, but it turned up after a search. So we now have two confirmed Ebola deaths and two suspected deaths that tested negative for Marburg (but weren't tested for Ebola). The Monitor mentions in passing that Marburg continues in western Uganda, though we haven't seen any reports on it for several days.

Update: Further to Marburg, New Vision has a report today that the disease is under control. It makes no mention of the new Ebola outbreak.

Uganda: "Disease response still inadequate"

Via The Daily Monitor, an editorial: Disease response still inadequate.

Reports that a one-and-half-year old boy has died of Marburg virus once again brings to focus the need for sustained awareness and more vigilance. The latest victim, who died at Ruhoko Hospital in Ibanda District on Wednesday, brings the total death toll due to Marburg virus to nine since the outbreak was officially announced last month. 

Though the outbreak was first confirmed in the western district of Kabale, disturbing reports indicate that it has so far spread to three other districts in western Uganda. The latest victim, only identified as Alexander, is the second person from Ibanda District to have died from Marburg virus having lost his mother to the same disease. 

It is worrying that more people are still dying a month after the disease was reported. Despite assurances from the Health ministry that the disease is under control, there are loopholes that require urgent attention. Admittedly, the health authorities are doing what is within their power to contain further spread and educate the population. 

However, there is need to increase surveillance and continually remind communities to be vigilant. Given our past experiences with Marburg and Ebola outbreaks, we ought to take precautionary measures more seriously. This may be challenging in rural areas but it is important to have a comprehensive strategy to contain and prevent similar outbreaks through sustained awareness as well as quick responses. 

However, given the sluggish and negligible manner in which the nodding disease in northern Uganda was, for instance, handled, Ugandans must demand better health service delivery, more so in emergency situations such as Ebola and Marburg outbreaks and special cases such as the nodding disease syndrome. 

Also, given the nature of rural communities where people rarely seek treatment partly due to lack of easy access to health facilities and ignorance, it is possible that outbreaks may come to the attention of health authorities late, making it extremely difficult to trace people who may have come into contact with affected people, yet Marburg is highly fatal. 

Going forward, it is crucial to have in place functional integrated disease surveillance across the country. This will strengthen our response to outbreaks and, most importantly, build vital resources and information on various diseases, preventive measures and possible treatment.

Uganda: One-year-old dies of Marburg in Ibanda

Via The Saturday Monitor: One-year-old dies of Marburg in Ibanda. Excerpt:

A one-and-half-year old boy has reportedly died of Marburg virus at Ruhoko Hospital in Ibanda District. 

The District Health Officer, Dr Julius Bamwine, on Thursday confirmed to Saturday Monitor that the victim, only identified as Alexander, died on Wednesday night. 

“I can confirm to you that one of the victims from Kikyenkye, who had tested positive to Marburg virus died last night. He is a son to Mr Mande who lost his wife to the same disease recently,” Mr Bamwine said. 

The baby becomes the second person from Ibanda to die of the virus but the ninth to succumb to the killer virus in the region. 

The Health ministry confirmed the Marburg outbreak a month ago in the western district of Kabale. It has since spread to three other districts in Western Uganda. Alexander’s mother, Rosette Katusiime, died of the virus at Mbarara Regional Referral Hospital on October 23. Her husband had also tested positive. 

The boy was admitted at Rukoho Hospital with other four suspected cases last week. The number of suspected cases has since gone up to 12. Dr Bamwine said they are in the process of discharging eight people who have tested negative while four still remain under surveillance as they wait for their results from Uganda Virus Research Institute in Entebbe. 

At Mbarara hospital, the three suspected cases admitted last week have tested negative and been discharged but two more cases were on Wednesday admitted with symptoms similar to those of the Marburg virus. 

“We have two male suspected Marburg patients; one is from Kisenyi in Kakoba Division, Mbarara Town. He had severe nasal bleeding while the other is from Rwampara County in Mbarara. He was vomiting and passed stool with blood,” said Ms. Eugenia Namulindwa, the in-charge of the isolation unit. 

Seven other people have died of Marburg Virus in Kabale District since October 19 and two are positive and remain admitted at Rushoroza Isolation Centre.

Indonesia: No evidence of Ebola in orangutans

Via The Jakarta Post, a letter from Erik Meijaard in Jakarta and Serge Wich in Liverpool: No evidence of Ebola in orangutans. The entire letter:

The article on The Jakarta Post website on Nov. 2 titled Ebola virus found in Kalimantan’s orangutan is highly misleading. 

The article states that Nidom and his colleagues have “detected evidence of Ebola virus in several orangutans in Kalimantan”, and that “65 out of 353 orangutans tested positive for Ebola virus”. 

Both statements are untrue. 

Anyone can check the original research article, which is freely available online in the open access journal PLOS ONE, to verify that neither the Ebola nor Marburg virus has been detected in orangutans. 

The paper only tells us that the tested animals have antibodies that react with the Ebola virus. As no viruses (or actually filoviruses) were detected, we cannot know whether the antibody positive animals are also virus positive, and thus potentially be a reservoir for the disease. 

It is important to note that the findings in the paper could also be explained by exposure to some other pathogen that induces cross-reacting antibodies with Ebola. 

In short, we repeat, we do not know whether orangutans have Ebola or Marburg. 

These scientific nuances matter greatly. As scientists we should always ensure that we honestly tell what our research findings indicate. Regrettably, the Post article crosses the line between objective, scientific reporting and unsubstantiated scaremongering. 

Of course, we need to be careful. If orangutans do have dangerous Ebola or Marburg like diseases, this should be researched and reported to ensure that the public is informed about possible health risks, and necessary steps can then be taken by the authorities to prevent the disease from spreading. 

As long as we do not know this for sure, we should stick to the facts. 

As an orangutan conservation scientist I am concerned. Orangutans are frequently killed in both Kalimantan and Sumatra, for a range of reasons. If the news that orangutans have Ebola spreads through local media, it might very well increase the incidence of orangutan killings. 

People might not just consider orangutans a nuisance species that affects their crops, but a potential risk to their lives — and take action. 

The conservation implications of this inaccurate reporting could therefore be serious. 

We plead with Nidom and his colleagues to clarify their findings — what they know and what they don’t know — so that the public and authorities are accurately and objectively informed.

Uganda plans wildlife cull as deadly Ebola and Marburg affect tourism

I hardly know whether to believe this item from The Africa Report.com: Uganda plans wildlife cull as deadly Ebola and Marburg affect tourism. It hasn't turned up in the Ugandan media I usually check, so maybe it's a trial balloon or just plain bizarre. Excerpt:

The deadly Ebola and Marburg diseases, which hit Uganda recently, are negatively impacting on the country's tourism.   

A number of foreign tourists have reportedly cancelled their trips to Uganda due to fear of the disease. 

The country's Ministry of Tourism has resolved to cull all wild animals in national parks, as they suspect these could be carrying the fatal viruses. 

Mid this year, there was an Ebola outbreak, where 14 people died. A Marburg virus outbreak, a few weeks ago, has so far claimed 10 lives. 

Tourism Minister, Maria Mutagamba said her ministry was working with the Health Ministry to carry out research and identify animals carrying the viruses so they could adopt preventive measures. 

Ebola and Marburg diseases are believed to originate from wild animals, and as Ugandans are fond of game meat, they are prone to infection from the deadly diseases. 

"We are looking at several ways of fighting the deadly diseases. Fencing the game parks so that local people do not access them would be the best option but it is very expensive. 

"We shall eliminate animals suspected to be carrying viruses of Ebola and Marburg," Mutagamba said. 

She said because of Ebola and Marburg diseases a number of foreign tourists cancelled their trips to Uganda, leading to loss of income. 

A medical expert, Dr Asuman Lukwago said suspected cases of Marburg had been found in monkeys, chimpanzees and bats. 

He said when some people poach wild animals in game parks, they end up killing and eating those infected with deadly virus and they also get infected. 



But Uganda wildlife authority spokesperson, Lillian Nsubuga wonders how animals would be identified for the cull, as there are thousands of them.



Indonesia: Orang-utans infected by mystery Ebola-like virus

Via New Scientist, a very informative article: Orang-utans infected by mystery Ebola-like virus. Click through for the full report and a lot of links. Excerpt:

They are already the most endangered great apes. Now orang-utans may face an additional threat: Ebola virus, or something a lot like it. Bornean orang-utans have antibodies that recognise not just the Asian species of Ebola virus, but all four African Ebola viruses and a similar African virus called Marburg. 

None of the African viruses has ever been seen outside Africa before. The discovery was discussed at a conference last week by the study's leader, Chairul Anwar Nidom of Airlangga University in Surabaya, Indonesia. 

Orang-utans are the only Asian great apes: chimpanzees, bonobos and gorillas are African. Largely due to forest clearing for palm-oil plantations, only 40,000 orang-utans are thought to survive in the wild on the islands of Sumatra and Borneo, down from 60,000 a decade ago. 

As part of a survey of wild mammals for H5N1 bird flu, which is endemic in Indonesian poultry, Nidom's team collected blood from 353 apparently healthy wild orang-utans in two reserves in eastern and central Borneo. They tested the samples for antibodies to flu and other infections to check the animals' disease history. 

Sixty-five apes, from both locations, carried antibodies that bound to proteins from one of the African Ebola species, or from Marburg (PLoS ONE, doi.org/jpk). 

Ebola kills African chimpanzees and lowland gorillas, and could pose a threat to both species. However, the orang-utans had clearly survived. Five others also carried antibodies to the Asian species of Ebola called Reston, which has been found in macaque monkeys and pigs in the Philippines, not far from Borneo. 

Nidom notes that filoviruses like Ebola can be lethal in some species but not others – Reston Ebola kills cynomolgus macaques, but not rhesus macaques or humans. The African viruses might be similarly variable.

Mike Coston at Avian Flu Diary posted a very good item on Marburg yesterday, including a map showing the extent of the bat species that seems to be the reservoir for both Ebola and Marburg: from Africa all the way to northern Australia.

Uganda: The Marburg virus puzzle

Via The Independent, a long, informative article: The Marburg virus puzzle. Excerpt:

Since the ministry of Health declared an outbreak of the viral hemorrhagic fever, Marburg, in Kitumba sub-county in Kabale district on Oct.19, questions have been asked about the real cause, origin and efforts to find treatment for the disease. 

Although the Marburg virus was first identified and traced to Uganda in 1967, the latest attack is the third in five years since 2007. It also follows very closely to a July attack of another viral hemorrhagic fever, Ebola, which killed 17 people in Kibaale district in the same region. It was the third Ebola outbreak in five years. 

In search of answers about the increasing spate of hemorrhagic fever outbreaks, The Independent spoke to Dr. Bernhard M. Thimm, the German Microbiologist and Epidemiologist who exported the Green Vervet Monkeys (Cercopithecus aetiops) to the Germany city of Marburg in 1967 and sparked the hunt for the virus that continues to this day.

Read the whole article, which explains how monkeys (and humans) are infected by bats.