Marburg virus threat spreads

ABC ^ | 04-07-05

[Mother Abigail]

Last Update: Friday, April 8, 2005. 10:00am (AEST)

Marburg virus threat spreads

The World Health Organisation has advised four countries around Angola to go on a Marburg alert after confirmation the deadly Ebola-like virus has now claimed 174 lives.

A senior health official says Angola remains the epicentre of the outbreak, but the neighbouring countries - including the Congo, the Democratic Republic of Congo, Namibia and Zambia - should all be on alert.

The death toll from the virus has more than doubled in the past three weeks, now spreading to seven of the poor southern African country's 18 provinces. The virus spreads through contact with bodily fluids, and there is no specific treatment.

[Mother Abigail]

It is useful to describe the Marburg virus in Angola as Ebola-like because its behavior is much more like the Ebola virus found in western Africa, than the Marburg virus discussed above, which originate from eastern Africa.  Much of the genetic similarity in the Marburg isolates listed above stems from the fact that the four 1967 isolates from Europe, all were transported to Europe via infected African green monkeys used for research purposes in the European labs. 

All of the transported monkeys came from Uganda, which is located in eastern Africa.  Similarly, the other Marburg isolates listed above are from locations in eastern Africa (Kenya and Zimbabwe).  These isolates produce a milder disease with case fatality rates of about 25-30%.  The record killing for Marburg was in the Democratic Republic of Congo, in the northeast corner of the country, near Uganda and Kenya.

In contrast, Ebola virus is found in western Africa, near the current outbreak in Angola.  The isolates are more complex genetically and they produce a higher case fatality rate.  The Marburg virus in Angola is killing at or near 100%.  It is more like the record Ebola outbreak in the western portion of the Democratic Republic of Congo, not far from the current Marburg outbreak in Angola. Thus, the Ebola outbreaks, as well as the current Marburg outbreak in Angola, were all in western Africa. 

The milder outbreaks of Marburg in eastern Africa have little relevance to the current outbreak in Angola, which is spreading at a record pace.  the outbreak will almost certainly top the kill record of 280 set by Ebola in Republic of Congo (Zaire) in 1976.

MA

[Mother Abigail]

April 7, 2005

>> New fears were expressed on Thursday that the Marburg virus had reached South African soil when a child in Morningside Clinic in Johannesburg showed symptoms of the infection.

Steps have been taken to prepare provincial hospitals in case haemorrhagic fever is diagnosed.

Solly Mabotha, spokesperson of the national health department, said isolation wards had been prepared in hospitals in all nine provinces and health practitioners had been thoroughly briefed on the symptoms of haemorrhagic fever.

The deadly virus has killed 159 people in Angola, so far, and a man is believed to have died of it in South Africa.

Mabotha said the child "has ties with Angola".

He said, however, that a thorough investigation had indicated that she did not show symptoms of the untreatable haemorrhagic fever, which is caused by the Marburg virus.

There is no laboratory in South Africa that can perform tests for the Marburg virus, it was learned on Thursday.  <<

Samples from both patients were sent to the CDC for testing. 

There seems to be a misconception on treatment.  There is no treatment for the virus, so progression to hemorrhaging is not an indicator of prospects for recovery.  So far in Angola, the case fatality rate is at or near 100% regardless of when the patient is admitted.  Early signs of infection are not very specific, but if the early signs are signaling Marburg, the prognosis is poor, especially if the infection was in Angola.

If the child is positive, there would be contact issues with passengers on the plane if the child recently arrived from Angola.  If the child was infected in South Africa, then there would be contact issue with whoever recently arrived from Angola.

As the numbers increase in Angola, especially in Luanda, it will become increasing difficult to avoid exporting the virus via passengers leaving Luanda.  The movement out of Uige seems to have spread the virus quite widely, and the infected cases in Angola have exploded to 200.

MA

[starfish923]

No wonder humanity migrated from Africa -- too many damn viruses.

[Dog Gone]

I just don't know what to say about this except that I hope it burns out in Angola.

The fact that you can board a direct flight from my hometown to there is not comforting. I think those jets come back.

[Citizen Tom Paine]

Are there any direct flights from these countries to the continental US? Can a carrier be recognized in the airport? If not, how long until it gets here?

[mitchbert]

Air links with countries that this appears in need to be cut immediately. At the very least, people who have been in hot zones must be prohibited from travel until the known incubation period has passed.

Marberg isn't the flu. Loose in a major population center it could wreak unimaginable havoc. I don't even want to imagine what the former Soviet Union was able to do with this bug when they studied it.

Ken Alibek as I recall had a few thoughts about Marberg. I recall reading some descriptions of it's testing in a weaponised form on primates. Not pleasant.

[Domestic Church]

Pingaling!

[armymarinemom]

What is the turn around time from samples going from South AFrica to the CDC? The Child on the flight is a potential nightmare.

[null and void]

*shrug* When the Great Rift Valley opened up and created an orological desert down wind with swords of flame keeping our ancestors from from their Eden...

[philo]

What's the incubation time from contact to symtoms?

[ElkGroveDan]

Don't they have McAfee over there?

[neverdem]

FReepmail me if you want on or off my health and science ping list.

MA, thanks for the ping.

[LearnsFromMistakes]

I figure the Mac users will be here shortly...

[BurbankKarl]

I thought this was a computer virus thread!

[Mother Abigail]

Incubation Period:  Usually 5-7 days, but can range from 3-10 days.

Symptoms.   Sudden onset of fever, chills, and malaise, with extreme prostration and weight loss.  The fever typically lasts 7 days.

On the fifth day of fever, a maculopapular petechial (tiny--pinpoint or pinhead size papula) rash appears, and hemorrhaging begins.
 
Other symptoms are headache, myalgia, and inflammation of the eyelid and eye membrane, intestine, and liver.  Excessive effusions from internal organs occurs, followed by pulmonary interstitial edema and renal dysfunction.  

MA

[Robert A. Cook, PE]

Given our recent failures of Constitutional accuracy in the Supreme Court, isn't it rather a case of "Marbury vs. Madison"; virus that is spreading uncontrolled and MUST be contained?

[Diogenesis]

Marburg virus [Location of isolation: Marburg; Germany]
CHARACTERISTICS: Filoviridae; 800-100 nm elongated filamentous virion, single stranded, negative sense RNA

Virus is assigned to the genus 01.025.0.01. "Marburg–like viruses"; family 01.025. Filoviridae; order 01. Mononegavirales.

EPIDEMIOLOGY: 1967 - outbreak in Germany and Yugoslavia following exposure to African green monkeys imported from East Africa (31 cases with 7 deaths); 1975 and 1982-4 cases reported in South Africa (originated in Zimbabwe); 1980 - two cases in Kenya

Virions have a complex construction and consist of an envelope, a nucleocapsid, a polymerase complex, and a matrix. Virions are enveloped. Virions are filamentous, or pleomorphic with extensive branching, or U-shaped, 6-shaped, or circular forms occur (particularly after purification) flexible; about 80 nm in diameter; 790 nm long (after purification). The surface projections are distinctive knob-shaped peplomers evenly covering the surface. They are spaced widely apart; evenly dispersed and embedded in a lipid bilayer. The surface projections comprise surface glycoproteins (GP) and are composed of one type of protein. Surface projections are 10 nm long; spaced 10 nm apart. The nucleocapsid exhibits helical symmetry. The nucleocapsid is helical; is cross-striated; 50 nm in diameter. Axial canal is distinct; in 20 nm in diameter; basic helix is obvious; pitch of helix is 5 nm. Morphologically aberrant forms are observe (after centrifugation).

The incubation period for hemorrhagic fever Marburg virus is 2 to 21 days.

Intrahepatic Marburg

[TBall]

I'm wondering if the incubation period for this one might not be longer. I just saw found this article which does not sound good.

http://www.recombinomics.com/News/04070505/Marburg_Johannesburg.html

[djf]

I know that during some of the Ebola outbreaks there was some limited success with transfusions from survivors to newly infected persons. Has there been anything like this tried? This outbreak seems to be worse than any of the Ebola ones. I can't believe there are no travel restrictions in effect.

[Domestic Church]

At suppertime the news blip at the bottom of FoxNews had something about Delta airlines handing over passenger lists due to some health risk...they listed potentials such as dengue fever, Sars, etc...I thought Marburg.

Put your ear to the ground.

[TBall]

This article explains why this one is worse.

http://www.recombinomics.com/News/04060507/Marburg_Ebola_like.html

[Mother Abigail]

The incubation period for this present outbreak has been consistently within the 3-10 day range.

The problem is that the disease often presents as flu in the early stage, leading to the spread of the virus among family and HCWs.

Contact tracing has started to lag as the outbreak has spread into more provinces and into the slums.

MA

[Pro-Bush]

Ditto! Comcast is having High Speed Internet service issues here in Sacramento - thought it may be a computer virus.

[ExtremeUnction]

So far, it seems, it's been difficult to spread this deadly array of viruses and their related diseases. Let's hope it stay this way, and not become the rapidly mutating AIDS type of virus, that for starters, has infected 1/4 of the African continent's inhabitants.

[Oorang]

And to top it all off:

Suspected Marburg cases hospitalised in Italy, DR Congo

[GOPJ]

Thanks for the ping.

[Billthedrill]

Following this one closely. A virus with Marburg's communicability and a 100% fatality rate is a real horror show. Prayers up for the health care workers facing this with only paper masks and rubber gloves.

It's a heck of a thing when you can describe a 25-30% death rate as "milder" - and be correct. That was the estimated fatality rate of the Black Plague.

[Mother Abigail]

There is no effective treatment for this virus variant.

Case fatality is running at 100%.

There is speculation, and just that, that this bug may have picked up some genetic variations that make it more deadly.

Too early to make that call, because this virus is so rare and the outbreaks so different, that we are only in the learning curve.

MA

[Shadrak]

Here's a snip of an interview with Ken Alibek from July 14, 1999.

EmergencyNet: Here's a hypothetical -- if you were a terrorist and wanted to attack the U.S. -- what chemical/biological/nuclear agent would you chose to cause the greatest mortality and morbidity?

Alibek: Marburg and ebola infections, plague, smallpox, anthrax and (unfortunately) many others.

EmergencyNet Exclusive: Questions and Answers On Bio-Warfare/Bio-Terrorism (Q & A) with Dr. Ken Alibek

[TBall]

From your article "Secondary transmission of Marburg is also less severe than the initial case, she added."
and then it goes one to say "Twelve of the deaths in Angola were medical staff who treated patients with Marburg, she said." I guess I don't know what secondary transmission means?

[Diogenesis]

You underestimate the possible incubation period.

Transmission and Tissue Tropism

"The mode of primary infection in any natural setting is unknown with Marburg and Ebola viruses. All secondary cases have been nosocomial or caused by intimate contact with a patient. Transmission occurs usually by contaminated blood samples. One Marburg case was acquired by sexual contact more than 60 days after the original infection. In addition, there is evidence to suggest respiratory spread of infection. Epidemiological data of the 1989 Reston outbreak suggest that droplet or vomit transmission was a major factor in virus spread within quarantine facilities. Virus is usually recovered from acute-phase sera and has also been found in throat washes, urine, soft tissue effusates, semen and anterior eye fluid, even when the specimens were obtained late in convalescence. It has also been regularly isolated from autoptic material, such as spleen, lymph nodes, liver and kidney but rarely from brain or other nervous tissues."

[bitt]

the whole net is having problems - notice how long it takes to download pictures on this site?

it is probably the new bad guys doing DNS poisoning...

http://informationweek.com/story/showArticle.jhtml?articleID=160502330

[Mother Abigail]

Bill,

This bug has a bad feel about it, the WHO update released yesterday gave the number of cases as 181 and the number of deaths as 156.

The update released today reports 19 additional cases and another 17 deaths.

MA

[cabbieguy]

Symptoms: Fever, Chills, Malaise.

I think we had an outbreak here in the USA during the Carter misadministration.

[Diogenesis]

These viruses have decoy proteins and mimic human proteins.

I bet they are part of the green monkey genome in Africa and the Phillipines.

"The initial symptoms are a severe frontal & temporal headache, generalised aches & pains, malaise, by the second day the victim will have a fever. Later symptoms include watery diarrhoea, abdominal pain, nausea, vomiting, a dry sore throat, & anorexia. By day seven of the symptoms, the patient will have a maculopapular (small slightly raised spots) rash. At the same time the person will develop thrombocytopenia & haemorrhagic manifestations, particularly in the gastrointestinal tract, & the lungs, but it can occur from any orifice, mucous membrane or skin site. By day twelve the skin starts to peel away from the rash. Ebola causes lesions in almost every organ, although the liver & spleen are the most noticeably affected. Both are darkened & enlarged with signs of necrosis. The cause of death is normally shock, associated with fluid & blood loss into the tissues.

The haemorrhagic & connective tissue complications of the disease are not really understood, but may be related to the fact that the VP40 protein is antigenically related to human cell matrix proteins (abdominal aortic aneurism protein & MFAP-4), leading to autoimmune attack.

Why does the immune system not clear the infection? This may be associated with the two forms of the virus glycoprotein. The glycoprotein gene has a translation stop codon in the middle of it, preventing the synthesis of the full length protein. Approximately twenty percent of the mRNA isolated from infected cells had been edited to contain an extra adenosine in a stretch of seven adenosine residues at positions 1019-1026. This causes a frame shift, allowing the synthesis of the full length protein . The larger protein (130Kd - GP) is membrane associated protein, & the truncated version (approximately 60 Kd - SGP) is secreted.

A possible role for SGP is to protect the virus from the immune system as a decoy antigen. However, SGP binds to neutrophils & interferes with their function. Moreover, GP also appears to be immunosuppressive, further interfering with the response to infection."

[Tuscaloosa Goldfinch]

That's what I was thinking -- all those people traveling there from all over the world.

[Mother Abigail]

I might caution you that this bug cannot be compared to prior outbreaks.

It is hot and killing all it touches.

Old data seems terribly inaccurate when facing this scourge.

Something has changed, either this is a variant of the Marburg family that we have only now encountered, or it's evolved.

I do not the answer. But the body count is disturbing.

MA

[tdewey10]

Very worisome. What flights go in/out of Angloa/SA?

[tdewey10]

Could be time to re-read the Book of Revelations.

[Travis McGee]

Wow.

[Squantos]

BTTT

[Oorang]

I guess I don't know what secondary transmission means?

I'm not sure either. From the article I would guess it means that as the initial marburg victim passes it on to persons #2, then #3 it is not as severe. Although using the phrase "not as severe" and Marburg together sounds like a bit of an oxymoron.

[Oorang]

Carburg?

[Oorang]

Yeah, didn't leave me feeling all warm and fuzzy either.

[Gabz]

2 words from me................

GOOD GRIEF.

I'm calling it a night - will check back in the morning.

[11th_VA]

Could be time to re-read the Book of Revelations.

Start with Jeremiah ...

[starfish923]

When the Great Rift Valley opened up and created an orological desert down wind with swords of flame keeping our ancestors from from their Eden...

Whaaaat?

[null and void]

One possible origin of the racial memory of being cut off from Eden...

[Greenpees]

And there it could go.

94 people on an airplane from Luanda to Heathrow.

One was infected and coughing, with dropulettes racing around the inside of the plane's air circulation system.

52 Stayed in London and surrounding suburbs. during thier stay and before showing any symptoms, they make contact with 27 others who ultimately boarded flights to 7 different countries, including the US.

In 10 to 15 days, London is already reeling, with most of the population locking themselves in their homes. 1,400 people will die before this virus is contained.

44 of the original 96 made connections without ever leaving Heathrow. They went to 16 different destinations They will no show symptoms for days.

By day 10, the infected 44 have passed this ghastly death on to, at least, 900 people and it will be days before many of them ever show up to a hospital.

Somewhere at about day 14, the CDC has the airports shut down and the aircraft sterilyzed.

By day 14, over 20,000 people are dying a certain death. With each passing day, the situation gets exponentially worse.

Commerce screaches to a halt. People are told to remain in doors for at least 30 days to insure that the problem is totally isolated.

Even medical treatment is denied families who repeatedly call 911 for help. They simply have to wait, and watch one another die.

The numbers could be larger, but this would be a worse case scenario.

Makes you wonder if it isn't time to stock up on water and food?