We have a breaking report of a South African man who died earlier this week in Rio de Janeiro, Brazil, of a suspected arenavirus. Some 50 persons who either treated this patient or were exposed to him at a conference are actively being monitored very, very carefully.

This past October 13th, I blogged about a Zambian woman who died in South Africa of a new, previously unseen and as-yet-unnamed type of arenavirus. Not only did that woman die, but three other persons connected with the index case also died. And a nurse treating Patient Two, NOT Patient Zero -- almost died.

Last month it was reported that the woman, a Zambian who booked African safaris, had visited clinics several times before, and a diagnosis eluded both her and her doctors.

I am not the only person who has made the mental link between the deaths in South Africa and the death of the man in Rio. Reuters is reporting that Brazilian authorities are stating the dead man was actually a patient at the same hospital as the four arenavirus patients who died in the same South African hospital. If true, that would either mean the virus was endemic within the hospital, or it means the incubation perios is much longer than the new virus'incubation period of seven to thirteen days.

Arenaviruses, including lassa fever, are wicked nasty bugs that are hemorrhagic fevers, transmitted by the waste products of rats and other rodents.

This novel arenavirus has people in South Africa rightly stirred up. A man was recently declared negative for this new virus last month. Here is the proMED report on his illness and diagnosis:

A man presenting symptoms similar to viral haemorrhagic fever has been admitted to the Life Fourways hospital in Johannesburg. The 55 year old South African citizen, who lives in Malawi, arrived at the hospital on Thursday [6 Nov 2008] at 7 pm and was brought in to the trauma and emergency unit before being placed in an isolation unit as a precaution, said hospital spokeswoman Marietjie Shelly yesterday.

"He had high temperature, severe abdominal and kidney pain, and vomiting.

Initial blood tests gave no indication of internal bleeding," she said.

"Even though no diagnosis has as yet been made for the patient's condition, as is routine full infection control protocols were immediately implemented and he was placed in an isolation unit."

This was done as a precautionary measure to ensure the safety of hospital staff, patients and visitors. "He walked into the hospital, he wasn't flown in or brought in by ambulance," said Shelly.

The National Institute of Communicable Diseases had been informed about the latest admission, she said. A broad range of blood tests and screenings were currently in progress as these symptoms may also be indicative of other non-infectious conditions.

Just a month ago, American scientists identified a new type of arenavirus (bold mine) which caused the deaths of 4 people since September [2008]. A name was still being chosen for the virus. The 1st person known to have died from the virus was a woman who was flown from Zambia to South Africa in September for emergency treatment. 3 previous visits to health facilities had failed to determine what was wrong with her. (bold mine)Since then the paramedic who accompanied her, a nurse at the Morningside Medi Clinic, and a contract cleaner have died. Another nursing sister is currently receiving treatment at the Morningside Medi Clinic after presenting with symptoms. However, she had since been moved from the intensive care unit. "She's improved that much... however, she's is still in isolation," said hospital spokeswoman Melinda Pelser. Pelser said doctors indicated that the nursing sister was not infectious anymore. As a precautionary measure the woman would be kept in isolation for 3 more weeks.

A total of 39 people who had been in contact with her were still being monitored for signs of the virus.

Good, the man was negative.  But what if, as we suspect about H5N1, he sure looked like a candidate but tested negative?  So are there false negatives for this virus as we suspect are happening with H5N1?

Here is the WHO report on the initial outbreak as mentioned in the proMED report:

New virus from Arenaviridae family in South Africa and Zambia - Update

13 October 2008 -- The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the Arenaviridae family.

Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN).

Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up.

WHO and its GOARN partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts.

Most of your hemorrhagic fevers -- Marburg, Lassa Fever, and Ebola -- are not easily spread because the onset of symptoms is so quick. People usually cannot get out of their village due to the effects of the virus.

But this new arenavirus can apparently linger for a week or longer before taking down its host. the thought of a hemorrhagic fever being able to survive in its host for over a week before kicking in and the host kicking off is too frightening to imagine.

This incident also reminded me of a still-unsolved mystery aboard a Virgin jet from Johannesburg to London in 2006. Here is the original story from the UK Mirror:

KILLER BUG AIR SCARE

By Stephen Moyes 20/05/2006

A WOMAN who arrived in London on a flight from Africa yesterday is reported to have died from the deadly and contagious ebola virus.

Panic has spread among cabin crew and hospital staff after the death of the 38-year-old Briton.

The unnamed woman is understood to work at an embassy in the African kingdom of Lesotho.

Before boarding a Virgin Atlantic flight from Johannesburg to Heathrow she visited a doctor complaining of flu-like symptoms.

She was allowed to fly, but during Flight VS602 to the UK she suffered a violent fit which left her unconscious.

Virgin later released a statement saying the passenger did not die from Ebola. Of course, they never said what she did die of. Neither did the British authorities, as best as I can find on Google.

So let's wrap up. We have a South African man who dies after flying to Rio, who may or may not have been a patient at the SAME HOSPITAL as the three South Africans and one Zambian who died in Johannesburg on November. And a woman who took a flight in May 2006 from Johannesburg to London, who worked in an embassy in Lesotho, died of a mystery illness.

Let's hope somebody is taking the 2006 dead woman's fluids and looking for this new, mystery hemorrhagic fever.

I am very worried about this. I know, I know, it's only a handful of dead, but look at the potential. You talk about panic? It's one thing to talk about a flu pandemic killing people. Now imagine a killer virus that is like Ebola but as easy to catch as the flu, killing in a much more disgusting fashion.

Stay tuned.

A suspected bird flu cluster has been ruled out.

At one point, the seventeen villagers from Makassar, Indonesia, were held under guard, so they would not run away.

Now, apparently, they can go home of their own free will.  Bird flu has been officially ruled out as the source of their malaise, according to the always-reliable Health Ministry (can you see my tongue in my cheek?). 

What it WAS was not mentioned.  But we apparently know what it wasn't, and it wasn't H5N1.  Thank goodness.

Last year, an outbreak of what appeared to be a new form of the hemorrhagic fever Ebola surfaced in western Uganda. I blogged about this apparent new strain frequently.

Now, in the journal PLoS pathogens, the existence of a new form of Ebola is confirmed. Its name: Bundibugyo ebolavirus. From the proMED email:

The new virus is genetically distinct from all other known Ebola virus species, differing by more than 30 percent at the genetic level. More traditional ELISA (enzyme-linked immunosorbent assay)-based assays detected the new virus; however, the unique nature of this virus created initial challenges for traditional Ebola virus molecular diagnostic assays and genome sequencing approaches.

To determine the genetic signature of this new Ebola virus species, scientists used a recently developed random-primed pyrosequencing approach, quickly determining the genetic sequence of over 70 percent of the virus genome.

Knowledge of this sequence then allowed for the rapid development of a sensitive molecular detection assay, which was deployed to the field as part of the outbreak response. This draft sequence also allowed for easy completion of the whole genome sequence using a traditional primer walking approach and prompt confirmation that this virus represented a new Ebola virus species. Current worldwide efforts to design effective diagnostics, antivirals, and vaccines will need to take into account the distinct nature of this new member of the Ebola virus genus.

So we officially have a new strain of Ebola, some 30% different from previous strains.  I do not know if 30% is par for the course or way different, but it does mean that the Ebola virus continues to evolve while maintaining its ability to kill over 50% of the people it infects.

Two veteran posters from the major flu sites have joined forces to produce a very high-quality blogsite. Commonground and Treyfish have hung their shingle for Pandemic Information News, a visually attractive site packed full of useful information.

The URL is http://pandemicinformationnews.blogspot.com/ . Be sure to check it out and add it to your daily reading list.

Well, it didn't take long for Indonesia to reaffirm its standing as Bird Flu Capital of the Planet. A bunch of chickens died en masse and some villagers started feeling sick in Makassar, South Sulawesi, and presto! The Indonesian government moves in and starts testing. Plus, the Health Ministry actually starts talking about it! This sudden government transparency is both a surprise and a welcome development.

Note it is not Supari, but rather the acting head of communicable disease control who is making the announcement.This may or may not be H5N1. We have seen so many false alarms recently that I do not normally even mention them unless we have very strong suspicions and anecdotal evidence that bird flu is the culprit.

In this case, I will make an exception, expecially since the Indonesian government has.

Here's the Reuters story:

Indonesia to test 17 for bird flu in Sulawesi 13 Nov 2008 12:53:23 GMT Source: Reuters

JAKARTA, Nov 13 (Reuters) - Seventeen people from the same neighbourhood in the Indonesian city of Makassar in South Sulawesi are due to be tested for bird flu after falling sick, a health ministry official said on Thursday. Chandra Yoga Adhitama, acting director-general of communicable disease control, said the group had been hospitalised after chickens in the surrounding area suddenly died.

"Some were hospitalised yesterday and some today. I think it is a precaution by our officials after chickens died there," Adhitama said.

He described the general health condition of the 17 as good and said that blood samples had been taken and would be sent to the health ministry laboratory in Jakarta for testing.

"We are continuing to monitor their condition," he said, adding that only four of the group were adults.

Suspected cluster cases can raise concerns about rare human-to-human transmission or that the virus might have mutated into a form that can pass easily among people.

The country's largest known cluster of bird flu cases in humans occurred in May 2006 in the Karo district of North Sumatra province, where as many as 7 people in an extended family died.

The World Health Organisation said at the time that limited human-to-human transmission could not be ruled out but that the virus samples from the scene did not show any significant genetic mutations.

Bird flu remains mainly an animal disease but experts fear the H5N1 virus might mutate into a pandemic strain that would sweep the globe, possibly killing millions and hobbling economies.

Indonesia has the highest toll of any nation and a health official said on Wednesday that a 15-year-old Indonesian girl has died of bird flu in central Java, bringing the country's death toll from the disease to 113. (Reporting by Telly Nathalia; Editing by Ed Davies and Valerie Lee)

And from the Jakarta Post:

17 treated in Makassar for suspected bird flu

Andi Hajramuni , The Jakarta Post , Makassar | Thu, 11/13/2008 8:23 PM | National

Wahidin Sudirohusodo Hospital in Makassar, South Sulawesi, has been treating 17 patients since Wednesday for suspected bird flu.

The suspects, 13 of them children, are residents of Sudiang subdistrict. Seven were admitted to the hospital Wednesday, the rest arrived Thursday.

Hospital spokesperson Andi Kurnia Bintang said the patients were suffering from high fever, coughing and breathing difficulty, all symptoms closely associated with bird flu.

"Rapid tests showed they may be infected with the H5N1 avian influenza virus, but we are waiting for blood test results to come back from the Hasanuddin University lab," Kurnia said.

Kurnia said 31 chickens had died in the subdistrict in the past week before three toddlers started to show symptoms Monday.

Separately, head of Makassar's husbandry office, Sulistiawati, said that his office had found several chickens which tested positive in the bird-flu quick test.

She said she had sent officers to cull 20 birds and spray disinfectant at chicken farms in the area. (dre)

Stay tuned.