One suspected fatal case of hemorrhagic fever in Orientale Province, DRC - Lassa fever confirmed

[alert]

Given the location, the list of suspects is quite long, and ranges from Ebola and Marburg, to CCHF, to yellow fever (neighboring Uganda has had an outbreak), to things that are not actually hemorrhagic fever, such as malaria, hepatitis, and typhoid.

http://www.afriquinfos.com/articles/2011/7/23/congo-183183.asp

HEALTH
A suspected case of hemorrhagic fever detected in Orientale Province
KINSHASA (Xinhua) - A suspected case of hemorrhagic fever have been reported in Orientale Province, in north-eastern DRC, said on Friday in the press, the provincial medical inspector, Jean-Marc Madinda. Saturday, July 23, 2011 | 4:04 UTC

Madinda says the patient, found July 18 in Dungu territory located 780 km northeast of Kisangani, capital of Orientale Province, and died several days later showed all the symptoms of hemorrhagic fever .

These include vomiting, bleeding, fever and death ensued after 48 hours.

Blood samples of the victim were sent to Kampala, Uganda, which borders the Province Orientale, and Kinshasa for analysis to diagnose the virus.

The necessary arrangements have been taken to prevent its spread and the population was aware of this, said Madinda.

In the DRC, Ebola haemorrhagic fever had already declared 1976-1977 to Ecuador (northwest) in 1995 in Bandundu (southwest), in 1999 and 2000 in the Eastern Province and in 2007 and 2008 Kasai Occidental (center).

[Pathfinder]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

French to English translation (Google)


Eastern Province: A suspected case of hemorrhagic fever reported in Dungu

July 22, 2011 under News, Eastern Province, Health.

Un patient who had symptoms of hemorrhagic fever died, Tuesday, July 19, at the general hospital center of Dungu, Haut Uele district in Orientale Province. He was twenty-eight years. Health authorities fear an epidemic in the region.

According to the chief medical officer of health of this area, samples were collected by MSF and sent for analysis in specialized laboratories in Kinshasa, Uganda and Gabon.

The victim was bleeding from everywhere. And she died the second day of hospitalization.

The family members then invaded the hospital and recovered the body they have buried the same day. They did not allow medical personnel to disinfect the body of the victim or keep it to avoid physical contact.

Many people who came into contact with the body of the victim refused to be placed under medical supervision.

This concern for health authorities, who fear severe consequences if the results of analysis of samples were positive.

They have also invited the people of Dungu caution, asking them to respect the elementary rules of hygiene. These include:

■ Wash hands with soap before eating
■ avoid physical contact with patients.

http://radiookapi.net/actualite/2011/07/22/province-orientale-un-cas-suspect-de-fievre-hemorragique-signale-a-dungu/

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

French to English translation (Google)


Eastern Province: A suspected case of hemorrhagic fever reported in Dungu

July 22, 2011 under News, Eastern Province, Health.

Un patient who had symptoms of hemorrhagic fever died, Tuesday, July 19, at the general hospital center of Dungu, Haut Uele district in Orientale Province. He was twenty-eight years. Health authorities fear an epidemic in the region.

According to the chief medical officer of health of this area, samples were collected by MSF and sent for analysis in specialized laboratories in Kinshasa, Uganda and Gabon.

The victim was bleeding from everywhere. And she died the second day of hospitalization.

The family members then invaded the hospital and recovered the body they have buried the same day. They did not allow medical personnel to disinfect the body of the victim or keep it to avoid physical contact.

Many people who came into contact with the body of the victim refused to be placed under medical supervision.

This concern for health authorities, who fear severe consequences if the results of analysis of samples were positive.

They have also invited the people of Dungu caution, asking them to respect the elementary rules of hygiene. These include:

■ Wash hands with soap before eating
■ avoid physical contact with patients.


http://radiookapi.net/actualite/2011...gnale-a-dungu/

Excellent find, Pathfinder. Two points worth adding. First, the original language indicates the victim is female, despite the translation ambiguities. Secondly, if the body was handled without disinfecting and buried by the family, this could produce a large outbreak if this is indeed caused by one of the contagious suspects.

[Pathfinder]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

Alert, the translation from french to english can be confusing concerning genders.

From the original french text:

Un malade
Il avait vingt-huit ans.

It seems that a man died, not a woman.

La victime (the victim) is feminine gender. "She" , in this case, is used for "the victim", not the patient.

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

Ooh. Confusing. But the article later continues "Et elle est morte au deuxi?me jour de son hospitalisation." Isn't "elle" a female reference here? Or is it still in feminine gender because of the word "victim"?

[Laidback Al]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

General location map of Orientale Province in northeastern Democratic Republic of the Congo and the location of Dungu where an individual died on July 19th with a suspected case of hemorrhagic fever.

[Anne]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

the patient was a male.

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

This is also the same location where 18 individuals died in a span of two weeks in February of this year due to an illness that, according to one report, had hemorrhagic symptoms and was never diagnosed:

http://www.flutrackers.com/forum/showthread.php?t=162812

[Pathfinder]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC

Excerpts from a few reports of OCHA in Eastern Province, dating from March to May 2011:

French to English translation (Google)

OCHA
March 2011 Monthly Humanitarian Action in the Eastern Province

Epidemiological situation: the end of the month was marked by a suspected viral haemorrhagic fever in Dungu. A death was reported in Gangala. Faced with this situation, the humanitarian community has adopted some preventive measures at the request of MSF. Thus, the FAO has provided three sprays in general referral hospital (GRH) Dungu. OCHA and UNHCR have given everyone a tent and Logistics cluster has promised to transport non-food items from Bunia to Dungu through funding from the Central Emergency Response Fund (CERF). In addition, UNICEF was ready to put a tank of 2000 liters jerry cans and seven and brief the UN agencies present in Dungu on preventive measures. HGR-Dungu had set up an isolation room to accommodate people with symptoms of viral haemorrhagic fever.

http://reliefweb.int/sites/reliefweb.int/files/resources/Rapport_complet_13.pdf

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HUMANITARIAN SITUATION IN THE DRC
At April 8, 2011

East: On the suspicion of haemorrhagic fever reported in Dungu in the
Week of March 22 to 28, health authorities have sent samples to Entebbe (Uganda)

http://www.rdc-humanitaire.net/attachments/article/788/08%2004%2011%20Point%20sur%20la%20situation%20huma nitaire%20RDC.pdf
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OCHA
13/04/2010
Eastern Province

A team of WHO and the DPS has gone this week Titul, territory Buta (Bas-Uele), again to investigate a suspected haemorrhagic fever in the health area. As a reminder, this area had reported health 6 cases with 3 deaths of 2 to 19 March. According to WHO laboratory tests of two samples that were sent in Franceville, Gabon, gave negative results. The same agency notes that the total of reported cases is currently 8 cases and 3 deaths, and the clinical picture of these cases is reminiscent of a hemorrhagic fever.

ochaonline.un.org / OchaLinkClick.aspx? link = ocha & docId = 1163720
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OCHA
31/05/2011 Eastern Province

Members of the Provincial Inter-Agency Committee (IASC) and the Inter clusters plead for positioning
the World Health Organization (WHO) in Dungu to lead the Health Cluster in U?l?s.
This demand is particularly relentless suspicion and after several illnesses in the region
(Diarrhea, waterborne diseases, cholera, viral hemorrhagic fever, etc.)..

http://www.rdc-humanitaire.net/attachments/article/979/WEEKLY%20PO%2005%20du%2024%20au%2031%20vf.pdf

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC - negative for Ebola and Marburg

A slight discrepancy in the date of death, but likely the same case. Fortunately, it looks like the caregivers may have dodged a bullet...

http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_1844.pdf

[snip]

Suspected haemorrhagic fever in the district of Haut-Uele. A person with symptoms of fever
hemorrhagic died Sunday, July 24 last Dungu. A first analysis by the NGO Doctors
Sans Frontieres (MSF) did not find Ebola or the Marburg. Further analysis provided to identify the disease.

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC - tests negative for Ebola and Marburg

Hat-tip Pathfinder. Wow. Thought they had given up on this one. Lassa is far more common in Western Africa; this is actually the first report of it I have seen in DRC. This should probably be sent to ProMED (and might explain the sporadic non-Ebola VHF cases in DRC over the past few years).

Moving and renaming the thread...

http://reliefweb.int/sites/reliefweb.int/files/resources/Rapport_complet_176.pdf

About the suspected case of viral haemorrhagic fever reported last July in Dungu, the Pasteur Institute Instead of Paris confirmed Lassa fever, according to information of the Central Area Health
Dungu.

[alert]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC - Lassa fever confirmed

This now becomes a remarkable and unusual event. It is not fully clear how this happened, or even what has happened, as all we have is the one blurb in the report, but it is clear that something unusual has occurred.

It is possible that this is some kind of imported case ex West Africa. While we likely would have had mention of travel in the original post, he could have had contact with a traveller, an imported animal, or contaminated object from West Africa. Lassa importations ex West Africa are fairly common:

http://www.flutrackers.com/forum/sho...d.php?t=163709 (to Sweden)

http://www.flutrackers.com/forum/showthread.php?t=96609 (to the UK)

and at least several to the USA (http://www.wired.com/wiredscience/20...#ixzz12FCEuRGy).

This would be the first such importation elsewhere in Africa, though. Even more alarming, perhaps Lassa is actually enzootic in the DRC, and this merely represents the first report of a confirmed case.

Alternatively, perhaps this is not actually Lassa fever, but a closely related virus. At least half a dozen novel arenaviruses have been detected over the past couple decades, including:

http://www.flutrackers.com/forum/sho...d.php?t=170572 (USA)

http://www.flutrackers.com/forum/showthread.php?t=65557 (Bolivia)

http://www.flutrackers.com/forum/sho...d.php?p=343104 (Australia, possibly ex Europe)

http://www.flutrackers.com/forum/showthread.php?t=82019 (Zambia, South Africa)

That last one also had some distant links to DRC (the index case had contact with a horse from DRC), but notably that virus was NOT cross-reactive to Lassa and is unlikely, IMO, to be the current culprit.

Further information here on the virus isolated from this patient is eagerly anticipated.

[Pathfinder]

Re: One suspected fatal case of hemorrhagic fever in Orientale Province, DRC - Lassa fever confirmed

Translation Google

InVS
Weekly International 10 to 16 August 2011
17/08/2011

August 08, 2011, the Pasteur Institute in Paris has confirmed a case of Lassa fever in a patient hospitalized in the Democratic Republic of Congo (DRC) in Orientale Province in the north-east.

Virus Lassa fever circulates widely in West Africa where it infects between 100 000 and 300 000 people annually and causes about 6000 deaths.
Nigeria, Guinea, Sierra Leone and Liberia are considered endemic, rural forest areas are particularly at risk.

This is the first time a case is documented in the DRC and in this part of Africa. The indigenous nature of the case seems likely but is under investigation.

The occurrence of cases of Lassa fever in the DRC is not a warning but of international concern because of the presence of expatriate staff in the area and population movements, including frequent cross-border, the situation is closely monitored.

[...]

http://www.invs.sante.fr/fr/Publications-et-outils/Bulletin-hebdomadaire-international/Tous-les-numeros/2011/Bulletin-hebdomadaire-international-du-10-au-16-aout-2011