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.
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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.
Sewlall called it one of the fastest linkings of the first cases in an outbreak.
The last time Morningside treated a case of haemorrhagic fever was about 14 years ago, when there was an ebola outbreak in Johannesburg.
On Tuesday experts said more than 100 people were being monitored for signs of haemorrhagic fever but none had shown signs of it yet.
These are the people who were in contact with any of the four people who have died.
The first two deaths and that of a Morningside nurse are believed to be linked while the fourth, a Morningside cleaner, may be.
No further deaths have been reported and although a handful of people were taken to hospital for further observation, none has shown further symptoms.
At Morningside Medi-Clinic, 55 contacts were identified - including the two staff who died - and Sir Albert Robinson Hospital in the West Rand added 66.
Those being monitored will have their temperature taken every six hours every day for 21 days to watch for the onset of fever. Meanwhile they can go to work without danger of infecting anybody.
"You only pass the virus along once you become ill," he said, explaining that quarantining them was unnecessary unless they became ill.
The 11-year-old son of the Morningside nurse who died, Gladys Mthembu, and his caretaker were admitted to Morningside, but Sewlall said this was more for trauma counselling than fears of illness.
Experts said the public should not panic.
"The public at large is not at risk," said Professor Guy Richards, head of critical care at Charlotte Maxege Johannesburg Academic Hospital.
Richards emphasised that those at risk were only people who came into contact with bodily fluids of those who had died. The disease was not air-borne.
Experts dismissed cautions over travel to Zambia, saying malaria was a more likely problem there.
Van Deventer lived in Zambia and is believed to have caught the virus from a tick. No other related cases have been reported in Zambia and an NICD expert is in Zambia tracking all Van Deventer's contacts.
"It's clear that she most likely acquired it in Lusaka," said Blumberg.
While Blumberg, Richards and Sewlall agreed the illness was definitely a viral haemorrhagic fever, the specific fever has not yet been identified.
"We don't have a diagnosis as yet," said Blumberg.
Blood samples were not taken from Van Deventer as doctors ultimately decided she probably had non-infectious tick-bite fever, but samples were taken from the other three who died and sent to NICD for analysis.
Blumberg said it would have been useful to have a sample from Van Deventer too.
She said identifying the virus was difficult because if samples were taken from seriously ill patients they would show the damage caused, but not the virus.
Richards said viruses were very difficult in clinical terms to distinguish from one another.
"Viruses are tricky in that they alter themselves slightly."
Samples were also sent to the Centres for Disease Control (CDC) in the US.
- This article was originally published on page 1 of Pretoria News on October 08, 2008
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