H5N1

US: Potentially deadly hemorrhagic virus "misplaced"

The Twittersphere today is noisy about this post in the blog Decoded Science: Vial of Potentially Deadly Guanarito Virus 'Misplaced' by UTMB. Excerpt:

The University of Texas Medical Branch (UTMB) in Galveston houses many infectious viruses and potential weapons of biological mass destruction – and one of them is unaccounted for. 

The big news on campus occurred on Saturday, March 23, 2013, when University President Callender issued a message to employees at UTMB saying that one of the vials of an infectious virus has been lost. The missing vial from the Galveston National Laboratory  contains less than a teaspoon of the virus called Guanarito. 

The Guanarito Virus 

‘Guanarito’ is an infectious virus native to the country of Venezuela, which can cause hemorrhagic fever. Although it can be deadly, doctors don’t think it transmits from person to person. 

According to the Centers for Disease Control and Prevention, the Guanarito virus is part of the Arenaviridae family. The Arenaviridae family of five viruses is mainly associated with rodent-transmitted diseases in humans. Humans can become infected with these viruses via contact with the rodents, or materials that are contaminated with excretions from an infected rodent. We can also become infected through contaminated food or if we have a cut, the virus can enter through the broken skin. 

Venezuelan Hemorrhagic Fever 

Hemorrhagic fever is a term doctors use to describe a ‘severe multisystem syndrome.’ Multiple viruses cause hemorrhagic fever, so the symptoms can vary depending on which virus caused the illness. Regardless of the virus, however, the first symptoms to appear include fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion. 

A more serious case can result in bleeding under the skin, bleeding in the internal organs, or bleeding from eyes, ears, nose, and mouth, although patients rarely die from the bleeding. Patients that have a severe case may have shock, coma, delirium, and seizures. 

Most patients recover within a week or two with supportive treatments; however, if left untreated, then the fatality rate can be about 30 percent or higher.

Lassa fever: Why there are more public health questions than answers

Via The Guardian: Lassa fever: why there are more public health questions than answers. Excerpt:

I'm in a village in eastern Sierra Leone staring at a row of dead rats snared in branches, leaves and grass. The contraptions are called funnel traps, or tolei in the local Mende dialect. We're hoping these devices and other easily accessible or producible materials will lower the rodent populations in villages sufficiently to prevent Lassa fever. 

With a DfID-funded project called Wash (water, sanitation health), Facility Sierra Leone, Tulane University and Kenema Government Hospital are working in 20 villages introducing Lassa fever education and rodent control training. For the project to be successful, we have to control one of the most ubiquitous rodents in sub-Saharan Africa, Mastomys natalensis — the multimammate rat. 

Lassa fever is common in this part of the country where the disease can wipe out entire households and cause panic throughout villages. The disease has a gradual onset of fever, aches and pains that are indistinguishable from malaria or typhoid — diseases as familiar to villagers as the common cold. 

For some, Lassa fever will progress from these non-specific symptoms to sore throat, facial oedema, haemorrhaging and death. Although Lassa fever and its severe consequences are well-known by residents in this region, fewer know the rat that commonly infests their homes can spread the disease. 

I work with a team based out of KGH. This is the Sierra Leone ministry of health and sanitation's main hub for Lassa fever activities and the only place in the entire country a person can go for laboratory testing and treatment. For the past four years, I've had the privilege of working with five members of the community outreach and disease ecology units based there. We are trying to turn their combined 115-plus years of experience working on Lassa fever into strategies to control the disease. 

We think that connecting the dots from rat to Lassa fever in at-risk communities will mobilise residents. With some training and monitoring, maybe we can make a dent in the burden of this disease. 

We're using the WHO guidelines for control of Lassa fever which include the use of food storage containers and cats along with other interventions such as house repairs and rodent extermination. Eventually, we hope to integrate these methods into sanitation and hygiene programmes, such as community-led total sanitation campaigns, throughout Sierra Leone. 

The reality is we don't yet know what will work to reduce Mastomys to prevent Lassa fever at the community level. The virus was first identified in 1969 and the rodent as harbouring the virus (that is, being its 'reservoir') in 1973. Lassa virus is among the 'viral haemorrhagic fevers' — the terrifying group of viruses that people make movies and write books about. These diseases get attention, not because of the disease burden in endemic countries, but because of the fear they induce in wealthier nations — the fear that a deadly virus will emerge out of Africa (accidentally or intentionally) and cause mass hysteria, morbidity and mortality. 

Expenditures for Lassa fever research have reflected this perspective and have concentrated on detection, vaccine development and treatment rather than prevention and control in endemic areas. So here we are, 40 years after the reservoir was identified, without one empirical piece of evidence on how to prevent Lassa fever and very limited information on how the virus is maintained in rodent populations. 

Many are sceptical Lassa fever can be prevented with rodent control, maintaining that for sustained reduction we need a vaccine. Yet vaccine development of a neglected disease only endemic in west Africa seems unlikely in the near future. The US Centers for Disease Control and Prevention, an organisation that studied Lassa fever from the early 1970s to 2003, states "the complete control of this rodent is impractical." 

In the meantime, more and more cases are reported from Sierra Leone and Nigeria, where the disease is also endemic. The only strategy we now have in our toolbox is good old-fashioned sanitation and hygiene.

Cambodia: Dr. Richner's open letter

Dr. Beat Richner is the physician and cellist who has run Kantha Bopha Hospital for twenty years. Today on his Facebook page he has an Open Letter to the Royal Government of Cambodia, asking for additional funding.

While Dr. Richner talks about his struggles last year with both hemorrhagic dengue and with WHO and the Cambodian Ministry of Health, he doesn't say a word about the current spate of H5N1 cases his hospital has been dealing with in recent weeks. But he sounds like a man at the end of his rope. And that, in turn, sounds very bad for Cambodians and their children.

American hemorrhagic fevers: A crash course

Though not for hypochondriacs, Infection Landscapes offers wonderful introductions to various unpleasant ailments. This week the subject is American Hemorrhagic Fevers. Excerpt:

This week we cover the American hemorrhagic fevers, which are a group of hemorrhagic fevers occurring primarily in different parts of South America. These are all caused by arenaviruses and will constitute the final installment of the extended series on hemorrhagic fevers. 

The Pathogen. We are going to focus on the four major American hemorrhagic fevers (AHF): Bolivian hemorrhagic fever (BoHF), Argentinian hemorrhagic fever (ArHF), Venezuelan hemorrhagic fever (VHF), and Brazilian hemorrhagic fever (BrHF). 

BoHF is caused by Machupo virus, ArHF is caused by Junin virus, VHF is caused by Guanarito virus, and BrHF is caused by Sabia virus. All of these viruses are members of the Tacaribe (New World) serocomplex in the Arenaviridae family.

Beyond this point, there will be blood.

A quick course in Lassa hemorrhagic fever

One of the treasures of Flublogia is the blog Infection Landscapes, which provides a great deal of information about infectious diseases. The latest post is on Lassa Hemorrhagic Fever. Excerpt:

This week at Infection Landscapes we begin to discuss the last group of viruses to be considered in this extended series on hemorrhagic fevers: the arenaviruses. In general, there is a greater prevalence of human infection in endemic areas than the other viruses causing hemorrhagic fevers that we have discussed in this series. We begin the section on arenaviruses with Lassa fever and follow next time with the American arenaviruses.

Sudan: "Catastrophic" undiagnosed fever kills 78; yellow fever kills 58

Via allAfrica.com, a report from Radio Dabanga: Sudan: Fever Kills 78, Reaches 'Epidemic Level'. We seem to be dealing with two outbreaks—one of yellow fever and one of an undiagnosed hemorrhagic fever.  Excerpt:

Darfur — The spread of yellow fever in Darfur reached an 'epidemic level' that requires immediate intervention from the central government, according to an announcement made by Member of Parliament Ibrahim Abbaker on Wednesday, 7 November. 

According to an official from the Ministry of Health from Khartoum, the number of cases of hemorrhagic fever in Darfur has reached more than 220. He revealed that 78 people have died so far in 18 localities. 

The official disclosed to Radio Dabanga that the World Health Organization (WHO) sent samples of the virus to Dakar, in Senegal, for examination. This way, he explained, authorities will find out the exact nature of the disease that is spreading across Darfur. 

The source hopes that the Sudanese Ministry of Health will receive the result of the tests this week still, so that vaccines against the disease can be ordered and a campaign targeting 3.5 million people in Darfur can be launched. 

He expects that, once ordered, the vaccines would arrive within two weeks in Darfur, Radio Dabanga was informed. 

'Catastrophic' 

The ministry of health from South Darfur announced that 47 people had been infected with the fever by Tuesday, describing the situation as 'catastrophic'. In a statement, the ministry stressed the importance of providing vaccinations to citizens of Darfur. 

At the same time, Issa Mohamed, minister of health of Central Darfur, revealed that yellow fever cases rose to 141, including 58 deaths, until Tuesday. 

In West Darfur, the government announced that the total cases of yellow fever reached 51 by Tuesday, and that 22 people have died. 

Ministers prevented from talking 

The federal Ministry of Health has reportedly issued strict orders to health ministers from Darfur preventing them from talking or making any statements to the media concerning the yellow fever epidemic and its mortality rates. 

Instead, ministers are expected to provide facts about the disease to the federal department of epidemiology three times a week, sources told Radio Dabanga. This way, they explained, the federal government can process the information before releasing it to the media.

Cambodia: Kantha Bopha hospitals in October

Via Dr. Beat Richner, founder-director of Kantha Bopha hospitals, his monthly report for October:

Figures and Facts in October 2012 Kantha Bopha in Phnom Penh:

Admissions for Hospitalization of severely sick children: 5902
Admissions for Hospitalization of severe cases of Hemorrhagic Dengue Fever: 958

Surgical oprations: 695

Kantha Bopha III (Jayavarman VII) in Siem Reap Angkor:
Admissions for Hospitalization of severely sick children: 5407
Admissions for Hospitalization of severe cases of Hemorrhagic Dengue Fever: 1081

Deliveries: 1657 !!
Surgical operations: 648

Figures and Facts from January 1st to October 31st 2012 Kantha Bopha in Phnom Penh and Siem Reap Angkor:
Admissions for Hospitalization of severely sick children: 114 569
Admissions for Hospitalization of severe cases of Dengue: 26 199

Although the Hospitals are still overcrowded we could go on with heart surgery in Siem Reap Angkor and Neurosurgery (brain tumors) in Phnom Penh.

The Epidemic of the Hemorrhagic Dengue Fever is still going on. We are only counting the severe cases being hospitalized: 26 199 !! These are more than 2007! The not severe cases are followed up and treated in the outpatient stations. They are not counted. Only 30 % of the families have got Abate in order to treat the water stored around the houses where the mosquitoes are breeding.

We are grateful for all donations. If small or big. Most families of our patients are poor. They could not pay. That is why all treatment for all is free. 

Infection Landscapes: Rift Valley Fever

Via the excellent blog Infection Landscapes: Rift Valley Fever. Excerpt:

This week we will cover the last of the Bunyaviridae in this extended series on the viral hemorrhagic fevers. This is the Phlebovirus that causes Rift Valley fever. Rift Valley fever is another zoonotic vector-borne infection and occurs throughout much of Africa and parts of the Arabian Peninsula.

Bas-Congo virus: The US State Department takes note

Via allAfrica.com, a report by the US Department of State: Congo-Kinshasa: International Researchers Identify Deadly Congo Virus. Excerpt:

An international research team has identified a previously unknown virus that caused two deaths in the Democratic Republic of the Congo in 2009. 

The unusual characteristics of the virus and its deadly consequences still puzzle the team, however, and research continues to better understand how the virus is transmitted and what might stop it. 

This much is known: the virus induces acute hemorrhagic fever, a fast-moving viral disease that can kill in days. In the DRC, two teens, a boy and a girl, died. A third person, an adult male, developed the disease but recovered. 

Acute hemorrhagic fever causes fever, dizziness, muscle aches and exhaustion. Patients with severe cases of hemorrhagic fever, which can be caused by a number of different pathogens, often show signs of bleeding under the skin, in internal organs or from body orifices such as the mouth, eyes or ears. 

The new microbe is named Bas-Congo virus (BASV), after the province in the southwest corner of the DRC where the three people lived. 

"Known viruses, such as Ebola, HIV and influenza, represent just the tip of the microbial iceberg," said Joseph Fair, a co-author of the research published in late September in PLoS Pathogens. Fair is vice president of Metabiota, a California-based company specializing in disease and pathogen detection, evaluation and response. "Identifying deadly unknown viruses, such as Bas-Congo virus, gives us a leg up in controlling future outbreaks," he said. 

The two cases in 2009 occurred in a 15-year-old boy and, a week later, a 13-year-old girl who attended the same school. Both fell ill suddenly and declined rapidly. A week after the girl's death, a nurse who cared for her developed similar symptoms. He was transferred to a hospital and survived. 

"These are the only three cases known to have occurred, although there could be additional outbreaks from this virus in the future," said Dr. Charles Chiu, an assistant professor of laboratory medicine at the University of California, San Francisco, who led the effort to identify the virus. 

Chiu and his team continue to work on new methods to detect the virus so health officials in the DRC and elsewhere can quickly identify it should it emerge again.

New virus in Africa looks like rabies, acts like Ebola

Just what we don't need at the moment. Via NBC News, a report by Maggie Fox: New virus in Africa looks like rabies, acts like Ebola. Excerpt:

A virus that killed two teenagers in Congo in 2009 is a completely new type, related to rabies but causing the bleeding and rapid death that makes Ebola infection so terrifying, scientists reported on Thursday. They’re searching for the source of the virus, which may be transmitted by insects or bats. 

The new virus is being named Bas-Congo virus, for the area where it was found.  Researchers are finding more and more of these new viruses, in part because new tests make it possible, but also in the hope of better understanding them so they can prevent pandemics of deadly disease. 

The virus infected a 15-year-old boy and a 13-year-old girl in the same village in Congo in 2009. They didn’t stand a chance, says Joseph Fair of Metabiota, a company that investigates pathogens. Fair is in the Democratic Republic of Congo now, under contract to the U.S. Agency for International Development (USAID) to help battle an ongoing Ebola outbreak. 

“They expired within three days,” Fair said in a telephone interview. “It was a very rapid killer.” 

A few days later a male nurse who cared for the two teenagers developed the same symptoms and survived. Samples from the lucky nurse have been tested and it turned out a completely new virus had infected him, Fair and other researchers report in the Public Library of Science journal PLoS pathogens. 

The DNA sequences went to Dr. Charles Chiu, of the University of California, San Francisco. 

“We were astounded that this patient had sequences in his blood from a completely unknown and unidentified virus,” Chiu said. They weren’t expecting that. 

“Congo is very much known for having Ebola and Marburg outbreaks. Yet about 20 percent of the time we have hemorrhagic fever outbreaks that are completely negative, which means unknown causes and they are not Ebola.” 

The sequencing puts this new virus on its own branch of the bad virus family tree -- somewhat related to Ebola and the virus that causes Lassa fever, another horrific killer, and most closely related to the rhabdoviruses. This family usually only infects animals with one notable exception -- rabies. 

But rabies is not known to cause hemorrhaging. It’s plenty horrible on its own, of course, killing virtually all patients if they aren’t vaccinated soon after infection.  

A nurse who took care of the first infected nurse had antibodies to the new virus. It doesn’t look like the teenagers infected one another, says Fair, but they probably infected the first nurse, who probably infected the second. Tests of other villagers have found no more evidence of the virus, however, which is good news. 

“Although the source of the virus remains unclear, study findings suggest that Bas-Congo virus may be spread by human-to-human contact and is an emerging pathogen associated with acute hemorrhagic fever in Africa,” the researchers wrote.

For more on this new virus, see NPR's health blog Shots, MedicalXpress, and ScienceNow.