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Killer-fever link found by luck
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| October 08 2008 at 06:40AM |
Get IOL on your mobile at m.iol.co.za |
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By Louise Flanagan
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. Continues Below ↓ 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.
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.
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COMMENTS CLOSED
Showing page 1 of 2 comment pages, 17 total comments
58 Weeks ago Ed Rybicki wrote :
All it takes is a masty virus to upset everyone...all over again! Folks, don't you remember 1996, and the saga of the Gabonese doctor who came in with Ebola? Who lived, but infected a nurse, who died? Before it was established what it was, proper barrier nursing had been set in place; once it was known - quarantine and tracing of contacts, etc. Net result: one unfortunate casualty, and Jo'burg was safe. Which is what will happen here.
Trust the medical folk; they've done well so far.
58 Weeks ago Anonymous wrote :
i believe the fever is dangerous and i dont understand why the doctors say it is not air borne, i mean they have nt yet made a specific diagnosis. To all the nurses and health profetionals out there, my teacher always tells me treat every specimen as potentially infective, so you treat every patient as potenially infecive, look after your safety and those you around at all times.
To hospitals i think safety precautions should really be promoted at this critical period, cause you never know who could be a carrier.
58 Weeks ago Ingamula wrote :
It was definately not luck.. If it was luck than I am sceptical about South African Docters. Thanks goodness our dear Manto is no more Minister of Health.Imagine what she would have claimed out of this saga.May the families of the deceased find comfort and may those that are sick with this virus have a speedy recovery.
58 Weeks ago Anonymous wrote :
Anonymous from Pretoria
What i want to know is that our people are save from this disease because this disease is more securable. because we fear for our children this disease is painful.
58 Weeks ago Margaret wrote :
Luck? Blind Luck? How can anybody say that this link was discovered by sheer luck? Let's be honest, this was divine inspiration from the one who is way above our understanding and any doctor's ability to diagnose. Let's give the credit where it is due, to the Almighty, who knows everything. And thank Him for the fact that He disclosed this information to somebody who had the knowledge to apply it to the situation.
58 Weeks ago Elizabeth wrote :
It would seem that there are a bunch of ignorami out there who don't understand about workings in a hospital. Just give the doctors some 'slack' .. they work hard enough. Or put your loud mouths into action & just see what it's like to work in an emergency unit at one of our hospitals. Quite scary!!
58 Weeks ago sayeed wrote :
i had tick bite fever some 15 years ago after a family picnic outing at shongweni dam. my G.P. a Dr. Cotterel diagnosed and treated me.no blood samples. i happen to phone my bro-in-law who was also at this outing for a casual chat & was told he was ill. when called at home ,he described his symptons and said his doctor was treating him for flu. it did'nt take me long to figure that he also had the same tick bite fever and i told him so . his doctor agreed to the new diagnosis. i kmew we definitely had the same when he visisted walking awkwardly as i had been as the nodes of the groin swell.the point i make--it was not necessary for blood samples to b taken
58 Weeks ago Anonymous wrote :
To everyone that flamed poster one, they are to a point correct. Every time I've been to the ER for whatever the reason, serious to minor things, It has been a requirement for blood samples to be taken. At the end of the day however, you would be testing for probables. The tests would be on the immediate symptoms and not what is happening inside / non visible as is the case with internal bleeding of this nature. I must be honest and say I am not a doctor, a concerned citizen more so. I think SA should investigate using some TAX/VAT money which I work hard for every month and give away freely, on mandatory screenings from people entering our country from other African countries considered high risk / plausible areas for such infection. Not everyone has to agree with me though ;)
58 Weeks ago Anonymous wrote :
It is a fallen world , the same as IT is not an exact science neither is medicine. Give the doctors a break. Sin has caused disease and much pain in the world. The biggest disease is sin and man's wickedness. Doctors have been given knowledge by God only.
58 Weeks ago medstudent4 wrote :
When Van Deventer presented, there was no reason to do tests for viral haemorrhagic fevers as they thought it was tick bite fever. Are you doctors? What makes more sense you think its tick-bite fever so you test for rare viruses or do you test for tick-bite fever? Two completely different types of tests. Also since it takes at least ten days to get the test for tick-bite fever back and the patient sometimes doesn't last that long, you generally start to treat it based on the clinical picture. Additionally the link that lead to doctors believing it is a viral haemorrhaic fever was only made two weeks later after a second patient presented. And as stated in this article, the connection between the two patients was only made by chance. Be careful of criticising people unless you're an expert. Diagnoses are difficult enough and our doctors have reacted very well in this situation. Dr Blumberg is an incredably able infectious disease specialist and if she's involved with dealing with this outbreak you have no need to worry.
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