October 22 2000 AFRICA

Uganda in terror as ebola spreads Wanyama Wangah, Gulu

WHEN Rose Akello, 38, fell horribly ill last month, her high fever and strange bleeding attracted little attention among the squalid mud and wattle huts of Gulu, a town in northern Uganda where people are resigned to disease and accustomed to premature death.

Akello's family nursed her as the blood seeped from every orifice. When she died, they washed her body in preparation for her burial. Other relatives routinely inherited her clothes.

The next day, however, her two-week-old daughter succumbed to the same symptoms. Two days later, it was the turn of the baby's 13-year-old sister. Three days after that, Akello's husband, Alfred Okoya, 42, died, too.

Even in a country ravaged by Aids, the family's sudden demise became a focus of acute concern. When the cause was identified, panic followed. Ebola, one of the deadliest viruses known to man, had struck, and by the time doctors had realised that the Kasubi district of Gulu was at the centre of an outbreak, the disease was already spreading fast.

By this weekend at least 51 people had died and 139 were reported to have been infected by the virus, which produces flu-like symptoms, then attacks the liver and other vital organs, partly dissolving them, and leaving most of those afflicted to bleed to death.

Officials in Gulu insisted the worst of the epidemic was be-hind them. But as an international team of experts - including Dr Simon Mardel, a British doctor from Barrow-in-Furness, Cumbria - fought to contain the virus, the World Health Organisation (WHO) gave a less optimistic prognosis.

Valary Abramov, a WHO spokesman, said it was much too early to predict when the outbreak would reach its peak. "We are now only through the first wave," he said.

Alarmingly, cases of ebola have been reported in Kitgum, the district next to Kasubi. It is believed to have been spread by a nurse who was taken there for burial after she died in Gulu's Lacor hospital, where most of the victims have been treated.

The virus was named after the Ebola River in Congo after its first 280 recorded victims died in the town of Yambuku in 1976. Jungle bats are one suspected source, but scientists have yet to confirm where the virus came from. A second Congo outbreak in 1995 killed 244 people in Kikwit.

Ebola's return has spread terror through Gulu, which is at the centre of a 12-year rebellion by the so-called Lord's Resistance Army and home to nearly 500,000 refugees, many of whom are crowded into camps in conditions ideal for the spread of disease.

Health officials toured last week dispensing advice on how to prevent ebola - passed on by contact with an infected person's body fluids - from running out of control. "We are trying to educate the populace to keep a distance," said Josephine Odongo, a Kasubi councillor. "The response is good. They are getting vigilant."

In Gulu, the traditional handshake has been virtually forsaken. Day schools have been closed, and visitors banned from boarding schools. Only medical staff and soldiers in protective gear are allowed to bury victims in body bags, and funerals must take place immediately.

At one recent funeral, mourners are said to have undressed and abandoned their clothes at the graveside, thinking they might be infected.

Health investigators claim to have identified the first victim of the outbreak as Esther Aweko, who complained of feeling hot, started bleeding from the nose and mouth and was taken to hospital, where she died on September 17.

How she contracted the virus remains unknown. Initial reports suggested that it might been brought into the area by Ugandan soldiers who had fought with rebels in neighbouring Congo. The army claimed the returning soldiers had been sent away immediately for training and had not been in contact with civilians.

Gulu people are less concerned with how the horror began than with who will be the next to die.

Sergeant Galdino Obwoma, a health worker with the army's 4th Division based in Gulu, has lost his sister, Keren Akidi, to the disease. His wife Cecilia and 12-year-old daughter helped to look after her. Now they are also in hospital.

"When my sister died, I buried her immediately and I attended the funerals, but did not touch anything," Obwoma said. "We are ostracised. I went to the office today and nobody wanted to talk to me, so I came back. People are living in fear."

http://www.sunday-times.co.uk/news/pages/sti/2000/10/22/stifgnafr02002.html

-- Martin Thompson (mthom1927@aol.com), October 22, 2000

Answers

Thank heavens this is not an airborne disease.

-- Nancy7 (nancy7@hotmail.com), October 22, 2000.

True, but we now have 747s, etc.

-- Martin Thompson (mthom1927@aol.com), October 22, 2000.

Mystery death spurs concern

By Samara Kalk October 20, 2000

The mysterious death of a 26-year-old African man is being investigated by the Dane County Division of Public Health to determine if the man succumbed to a communicable disease.

The man, whose name is being withheld by the Dane County Coroner's Office pending a positive identification and notification of his family, spent 21/2 months in Senegal before returning to his town of Madison residence a week ago.

Dane County Public Health Administrator Gareth Johnson said his office knows little about the man except that he returned from his extended visit in Africa with severe headaches. Johnson stressed there is little risk to the rest of the community if the man had a communicable disease, because he had been home ill since his return.

Public health officials have identified the nine or 10 people who had been in contact with the dead man since his return. So far, none has shown similar symptoms and all are cooperating with officials.

"We are keeping close tabs on the man's close contacts. All have volunteered to restrict their activities,'' Johnson said.

The man's roommate left Wednesday night for work and when he returned Thursday morning, the man was dead.

"That is as much as we know for certain at this point,'' said Johnson.

An autopsy was conducted Thursday and local officials are awaiting tissue sample results, said Deputy Coroner Pete Thorpe, who was not allowed in the autopsy exam room due to fear of infection. Only the medical examiner and an assistant were present, he said.

Thorpe said he has tried to reach relatives of the victim in New York but that it has been difficult due to language barriers.

The man was not a University of Wisconsin-Madison student and had a Social Security card that was good only for work purposes, he said.

Thorpe said officials are concerned about communicable diseases out of Africa and that is why precautions are being taken.

"It isn't what we thought it was at first. We don't think it's Ebola. That is the main one everyone is worried about,'' he said.

But the pathologist has not ruled anything out completely, said Thorpe.

"It is still kind of hanging in limbo. A lot of us have been in contact with this and spent some anxious moments on this,'' he said.

If the cause of death is malaria, which is contracted by mosquito, the rest of the community is at no risk, said Health Administrator Johnson.

"Part of the difficulty we have here is that the range of possibilities is fairly broad,'' Johnson said.

What worries health officials are a variety of viral hemorrhagic fevers, like the Ebola virus that recently killed 41 people in Uganda and has possibly infected 70 more.

"It's some of the stuff movies are made of,'' said Johnson, noting, however, that in analyzing the possibilities of death, Ebola ranks low.

It is unclear if the man was employed or not, said Johnson. The question of employment is not relevant in the case, he said, since the man had not worked since he came back to the area last Friday.

Tissues from the autopsy were sent to the Centers for Disease Control and Prevention in Atlanta Thursday and the Dane County Health Department will have the preliminary results by Monday, said Johnson.

The State Department of Health and Family Service's Public Health Division also contacted the CDC and is investigating the man's activities from the time he arrived back in the United States.

While precautions are being taken, Johnson stressed again that the community at large is not at risk.

"The bottom line here is that this is a terrible tragedy for the man who passed away and his family, but the rest of the community is not at risk and will not become at risk,'' he said.

http://www.thecapitaltimes.com/news/local/2000/10/20/death_102000.html

-- Martin Thompson (mthom1927@aol.com), October 23, 2000.

CBC announced yesterday it had a crew ready at the site to report. I wonder what precautions reporters take to avoid acquiring a disease like this, and I wonder what diseases reporters unknowingly bring home with them....

In that regard, I believe UN peacekeeping missions also bring home diseases from their theatres of operation.

-- Rachel Gibson (rgibson@hotmail.com), October 23, 2000.

China on red alert over Ebola virus

China has put border inspectors on alert to keep out people or animals infected with the Ebola virus that has killed 54 people in its latest outbreak in Africa.

The State Administration for Exit-Entry Inspection and Quarantine issued an urgent directive over the weekend, ordering quarantine inspectors to check all passengers and animals coming from the epidemic area in Uganda, a state-run newspaper has reported.

Any passengers from the epidemic region displaying Ebola's flu-like symptoms are to be isolated and their belongings disinfected, the report said.

The virus spreads through human contact, causes massive internal bleeding and has no known cure. Health officials in Uganda on Sunday identified 10 new cases in addition to the 54 deaths that have occurred this month.

Aside from trying to prevent the virus' entry to China, the government is also asking local agencies to provide health information to any Chinese people heading for Uganda, the China Daily said.

Last updated: 04:31 Monday 23rd October

2000.http://www.ananova.com/news/story/sm_93152.html? nav_src=newsIndexHeadline

-- Martin Thompson (mthom1927@aol.com), October 23, 2000.

Thanks, Martin! That makes me feel better. :)

-- Rachel Gibson (rgibson@hotmail.com), October 23, 2000.

Ebola may shut off immune defenses Study offers new insights on the deadly virus REUTERS Oct. 23 B The Ebola virus may be so deadly because it can disarm the immune system, scientists said on Monday. They found a protein that the virus uses to disable the production of interferon, a compound the immune system deploys to kill virus-infected cells.

EBOLA, named after a river in Zaire, now Democratic Republic of Congo, was first identified in 1976. It causes fever, shock and is marked by a horrifying seepage of blood. BEbola virus infections frequently result in severe hemorrhagic fever, and epidemics of the Ebola virus, Zaire subtype, have resulted in mortality rates greater than 80 percent,B the researchers wrote in their report.

It was published in TuesdayBs issue of the Proceedings of the National Academy of Sciences. At least 54 people have died in the latest outbreak in Uganda, which experts are struggling to suppress. A 1995 outbreak of Ebola in Kikwit, Congo, killed 245 people. The team of German and U.S. researchers, at the Mount Sinai School of Medicine in New York and Philipps Universitat in Marburg, Germany, were trying to figure out why the virus is so deadly.

They identified a protein, called VP35, that seems to suppress production of type-1 interferon. It acts as an interferon antagonist. Researchers have found that other viruses, such as measles, cowpox, influenza A and herpes simplex, also disable interferon production.

Some people may be able to overcome this mechanism. At least one case of a person who was infected with Ebola without symptoms has been reported, and the researchers, headed by Peter Palese at Mt. Sinai, said this patient produced a stronger immune response than usually seen in those who succumb to Ebola. BIt is clear from the study of other viruses that the presence of an IFN antagonist is required for full virulence,B the researchers wrote. Such knowledge might be used to create a vaccine against the infection. In July, a team of U.S. researchers found that a protein that disrupts blood vessel walls helps cause the hemorrhaging that marks Ebola infection. There is no treatment or vaccine against Ebola, one of many different viruses that cause hemorrhagic fevers.

http://www.msnbc.com/news/480383.asp

-- Martin Thompson (mthom1927@aol.com), October 23, 2000.

24/10/2000 08:44 - (SA) Ebola cases up to 160

Kampala - One death and a further 11 cases of the gruesome Ebola disease were reported in northern Uganda on Monday, bringing the total number of known infected people in the outbreak, which has killed 55 people, to 160.

These latest figures, released by the World Health Organisation (WHO), cover patients reporting to hospitals in the northern town of Gulu in the 24 hours leading up to 8.00am on Monday.

"Some of the new cases came in by ambulance while some reported to hospital themselves. But there is also an active search going on in the villages with people keeping their eyes open for new cases," WHO spokesman Andy Seale told AFP.

Health teams were on Monday due to travel to Opit camp, east of Gulu town and Pawiro village, to the north, to check out reports of suspected new cases, Seale added.

Several suspected cases of Ebola have already been reported in camps at Amoru, Atiak and Pabo, which house some of the thousands of people displaced by an insurgency in the region.

No known cure exists for Ebola, a viral infection which causes fever, diarrhoea, vomiting and eventual severe haemorrhaging of internal organs such as the spleen and the liver, but fatality rates can be brought down with the swift treatment of symptoms and effective quarantine arrangements.

On Sunday, scientists from the Atlanta-based Centre for Disease Control began testing blood from some of the infected victims to verify on a case-by-case basis that patients were indeed suffering from Ebola.

Fifteen patients in Lacor Hospital were tested, and all were found to be infected with the virus, which can cause its victims to bleed to death.

This is the first time in an Ebola outbreak that a mobile laboratory has been brought to the scene to analysis the virus on site.

The CDC is working out of St Mary's Lacor Hospital, an Italian- founded mission hospital 5km outside Gulu town.

The strain of the Ebola virus in Uganda is genetically similar to that of an earlier Ebola outbreak in Sudan in the 1970s.

Ebola-Sudan has a lower mortality rate than the related Ebola-Zaire, which can kill up to 90 per cent of its victims. - Sapa-AFP

http://news.24.com/News24/Health/Health_News/0,1113,2-14- 660_930562,00.html

-- Martin Thompson (mthom1927@aol.com), October 24, 2000.

Logan Plane Held When Passenger's Eyes Bleed Delta Jet Quarantined, Man Refuses Treatment

BOSTON, Updated 12:48 p.m. EDT October 24, 2000 -- A Delta Airlines plane is under quarantine at Logan Airport after a passenger started bleeding from his eyes.

Logan spokesman Phil Orlandella says the man had recently been traveling in Brazil, and a nurse on board said he may have been suffering from conjunctivitis.

The plane with 131 passengers and a crew of nine landed at Logan Tuesday morning after a flight from Atlanta.

Orlandella said health officials boarded the plane in protective gear. He says the man refused hospital treatment.

The other passengers were being kept on the plane, but Orlandella said he expected them to be released soon.

Logan Plane Held When Passenger's Eyes Bleed Delta Jet Quarantined, Man Refuses Treatment BOSTON, Updated 12:48 p.m. EDT October 24, 2000 -- A Delta Airlines plane is under quarantine at Logan Airport after a passenger started bleeding from his eyes.

Logan spokesman Phil Orlandella says the man had recently been traveling in Brazil, and a nurse on board said he may have been suffering from conjunctivitis.

The plane with 131 passengers and a crew of nine landed at Logan Tuesday morning after a flight from Atlanta.

Orlandella said health officials boarded the plane in protective gear. He says the man refused hospital treatment.

The other passengers were being kept on the plane, but Orlandella said he expected them to be released soon.

http://www.thebostonchannel.com/bos/news/stories/news-20001024- 113926.html

-- Martin Thompson (mthom1927@aol.com), October 24, 2000.