Killer virus: 121 now on danger list

HEALTH officials are keeping a close eye on 121 people known to have come into contact with victims of the mystery virus that has killed three people in and around Johannesburg.

Paramedic Hannes Els, 33, and Morningside Medi-Clinic nurse Gladys Mthembu, 34, died after caring for the first victim of the virus, Zambian Cecilia van Deventer, 36.

Fifty-five of the quarantined individuals were linked to the Morningside Medi-Clinic, and 66 were from the Leratong Hospital.

Response teams are monitoring them closely.

Mthembu's 11-year-old son and his 28-year-old nanny are being kept in isolation at the Morningside hospital, although they have not shown symptoms of the disease.

Maria Stuurman, 51, the supervisor of a cleaner initially believed to be the fourth victim of the virus, was yesterday admitted to the Chris Hani Baragwanath Hospital with symptoms similar to those presented by victims.

Dr Chika Asomugha, medical adviser at the Gauteng health department, said Stuurman had flu-like symptoms, but none associated with haemorrhagic fever. She was likely to be discharged soon.

A panel of experts yesterday assured the public there was no need to panic about the virus. Dr Lucille Blumberg, of the National Institute of Communicable Diseases, and two doctors who treated Van Deventer, Els and Mthembu, said the risk of the virus spreading in the general population was low.

Nurses, doctors and other healthcare workers were at risk because they were most likely to have direct contact with bodily fluids of patients infected with the virus. This would include people who handled the bodies of those who died as a result of the disease.

Asomugha said mortuary workers and families would be instructed that the bodies of Els and Mthembu must be kept in sealed bags and that they should be buried in special lead-lined coffins, if not cremated.

Dr Nivesh Sewlall, of Morningside Medi-Clinic, said it would be difficult to contract the virus as one would have to have direct, unprotected contact with the blood, faeces or urine of a victim.

Doctors in South Africa and Lusaka, Zambia, are trying to piece together the last days of Van Deventer's life. She contracted the mystery virus and infected three others who subsequently died.

The Times is in possession of letters sent to South African authorities to try to ascertain which virus killed Van Deventer, Els and Mthembu.

Dr Craig Oranmore-Brown has gathered information that Van Deventer went to safari camps on the Zambezi River on July 22. In August, Van Deventer, who was an avid horse rider, played in a polo-cross tournament on a game farm near Lusaka.

"It's possible a tick could have been brought in in this way. Cecilia was keen on horses and regularly got tick bites. She also sustained an injury to her foot," Oranmore-Brown said.

On September 4, Van Deventer developed flu-like symptoms, but she travelled to South Africa for a wedding. She returned to Lusaka and her condition "deteriorated". Her sister, Magda, took her to doctors in Lusaka. On September 12, Magda called the emergency service. Els, the paramedic on duty, took Van Deventer to hospital. She was airlifted to the Morningside Medi-Clinic.

She died on September 13. Els started to develop flu-like symptoms the next day. He was flown to the Morningside Medi-Clinic on September 27 and died on September 30.

Professor Robert Swanepoel, of the special pathogens unit at the National Institute for Communicable Diseases, has been trying to unravel the cause of the outbreak. He wrote to colleagues and noted that Van Deventer was brain dead on arrival at Morningside. He said she had a wound resembling a tick bite between her toes.

"It suggests she had rickettsiosis, which can be fatal. One also thinks of Crimean-Congo haemorrhagic fever. We've never had a patient with both CCHF and rickettsiosis, but maybe this can happen," Swanepoel wrote.

Dr Guy Richards, director of intensive care at the Charlotte Maxeke Johannesburg Academic Hospital [formerly Johannesburg Hospital ], treated the cleaner thought to be the fourth victim of the virus. He said Maria Mokubung's symptoms were "atypical" of haemorrhagic fever. She apparently passed away due to a neurological disease and had been ill for some time.