HANTAVIRUSES IN AFRICA: AN UNRECOGNISED MENACE? Hantaviruses are hosted naturally by different species of rodents and shrews. They may be transmitted to human beings, mainly through exposure to excreta, in whom they may cause two types of disease: Haemorrhagic fever with renal syndrome (HFRS) in Asia and Europe, and Hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The first African hantavirus and its host were identified in Guinea in 2006 in the African Woodmouse Hylomyscus simus and named Sangassou virus. Since then, sequences of two more novel hantaviruses were identified in African shrews: Tanganya virus from Therese's shrew Crocidura theresae in Guinea and Azagny virus from Crocidura obscurior in Cote d'Ivoire. Our international collaborative study, together with partners from the Department of Conservation Ecology and Entomology at the University of Stellenbosch (http://www.cons-ent.com/sonja-matthee.php), the German National Reference Centre for Hantavirus Infections at Charité, Berlin (http://www.charite.de/virologie), Namibia and Guinea, aims to identify novel hantaviruses and possible hantavirus diseases in southern Africa. So far, the occurrence of these viruses and any possibly related illnesses is not known from our region. For this study, we are looking for patients with clinical symptoms that might be indicative of hantavirus disease. These symptoms are:
Fever of unknown origin, not responding to antibiotic treatment,
Any of the following, of unknown aetiology: acute renal failure, acute respiratory failure, acute liver failure, pneumonia and/or mucosal bleeding.
We need EDTA blood samples from patients fulfilling this case definition. Blood samples will be tested for the presence of hantavirus antibodies by an in-house ELISA assay. The study has been approved by the University of Stellenbosch ethics committee (N09/02/058). A general information flyer and patient information sheet and consent form as well as study sample form (asking for a minimum set of clinical information) are available. If you are caring for patients that might fulfil the above case definition, we look forward to hearing from you:
"One Health" seminar on Avian Influenza held on the 19th of August 2011 in the Virology Division, Stellenbosch University
After avian flu ravaged several farms in the Little Karoo region of South Africa, a flock of trained ostriches were destroyed after contracting the disease. The ostriches were a tourist attraction at the Highgate farm where visitors have been riding the birds for more than 80 years. The farm is near Oudtshoorn South Africa, the main town of the region. "I'm an ostrich farmer without ostriches," farm owner Arenhold Hooper told The Times in Johannesburg. He said the farm laid off 39 employees since the flock was culled in June 2011. Thousands of ostriches have been culled since the first reported case of avian flu in April, with further losses expected as the epidemic spreads.
The speakers and organizers of the "One Health" seminar on Avian Influenza held on the 19th of August 2011 in the Virology Division: Prof Graeme Cumming, Dr Pieter Koen, Dr Lesley van Helden, Dr Annelie Cloete, Prof Wolfgang Preiser and Dr Neil Cameron
Talks described the current outbreak of highly pathogenic avian influenza (HPAI - H5N2) epidemic in the Oudtshoorn area and the vigorous systematic response by the Animal Health Division of the Dept of Agriculture, the ongoing HPAI - H5N1 epidemic in Asia and Eastern Mediterranean region and H5N1 in humans and other flu viruses of this season.
"One Health" is joint effort of the Veterinary Services, Dept of Agriculture; Percy FitzPatrick Institute of African Ornithology, University of Cape Town; and the Divisions of Virology (NHLS) and Community Health of the University of Stellenbosch under the auspices of the Centre for Infectious Diseases (CID).
1. Current outbreak of Highly Pathogenic H5N2 in Western Cape Ostriches -John Grewar-August 2011. A description of the sequence of events with regards to the recent Avian Influenza H5N2 outbreak, which prompted the Western Cape Department of Agriculture to set up a Veterinary Control Centre in Oudsthoorn, was given. The case definition for the outbreak's AI infections included lab and clinical/epidemiological variables. The outbreak occurred in a ostrich dense area in the Western Cape Province and a description of the current Avian Influenza Control Area (AICA) was given. Following the confirmation of highly pathogenic avian influenza (HPAI) numerous rounds of surveillance have taken place within and outside of the AICA. These rounds have identified a total (as of 15 Aug 2011) of 34 positive farms, with all but 1 within the AICA. Also given was an indication of the planned surveillance to be done within the AICA. As of the date of the talk the infection was still active within the AICA but an application to the European Union for possible export from outside the AICA was being planned.
2. Control of Avian Influenza outbreaks in Ostriches - Pieter Koen (Veterinary Services, Dept of Agriculture) The control of this disease has resulted in a major campaign being launched in the Klein Karoo Valley. Animal Health Technicians and State Veterinarians had to be drafted into the area to assist with surveillance, informatics and epidemiology, movement control and killing and disposal. Planning of surveillance was greatly assisted by spatial data and maps of the relevant areas. During the initial round of surveillance there were severe bottle necks with respect to diagnostic laboratory capacity, especially PCR capacity. This was addressed by utilising a range of laboratories, both State and privately run to shorten turnaround times to expedite detection and control and minimise transmission. Adverse weather conditions such as heavy rains resulting in floods, road closures and extremely uncomfortable and dangerous outside working conditions taxed field staff to the utmost. Notwithstanding these challenges the campaign progressed well. Detection and control is still ongoing as new infections are constantly being detected, probably sparked by the cold and wet resulting in long virus survival. The presentation attached reflects the statistics of this eradication campaign thus far.
3. Current situation of N5N1 globally in birds -Lesley van Helden (Veterinary Services, Diesease Control, Dept of Agriculture) H5N1 in 2011 has directly caused the deaths of approximately 200 000 poultry and indirectly, as a result of culling, 4.3 million poultry worldwide. Countries affected lie predominantly in South-East Asia, but Egypt is also an important location, where the disease has been declared endemic. Outbreaks tend to follow a pattern of peaking in the winter months of the northern hemisphere, which is consistent with current theories of spread, such as movement of migratory birds and increased trade in live poultry. Various methods of control are being used in each affected country, and each location has difficulties unique to their situation.
4. Wild Bird flight paths and risks for A1 transmission - Graeme Cumming (Percy FitzPatrick Institute of African Ornithology, UCT) I presented two sets of results from our ongoing research on wild birds and low pathogenic avian influenza. (1) The first set consisted of known prevalence's of AI in wild birds across our five different study sites: Strandfontein (W Cape), Barberspan (NW Province), Lakes Chivero and Mayame (Zimbabwe), Lake Ngami (Botswana) and Lake Chuali (Mozambique). The overall prevalence of LPAI viruses in wild birds in southern Africa is around 2.5%, with considerable spatial and temporal variation. Unexpectedly high prevalences (3-5%) were found in White-faced Duck, African Jacana, and some passerine groups. (2) The second set of results consisted of a brief summary of results from satellite telemetry of Red-billed Teal and Egyptian Geese, which we identified a priori as two of the higher-risk species for AI transmission. Our data suggest that Egyptian Geese in particular may move long distances during moult migrations (e.g., one individual went over a thousand kilometres in two days), making it extremely difficult to control AI in wild bird populations. Wild bird movements do however have some predictable elements relating to their life histories and moulting needs, and we hypothesize that ultimately the epidemiology of LPAI is driven by a combination of rainfall and the aggregated outcomes of seasonal bird movements
5. H5N in humans and other flu viruses of this season - Wolfgang Preiser (Virology, NHLS & SU) "Birds are probably the origin of all influenza viruses, some of which established themselves in other animal species including human beings. Direct transmission of avian influenza viruses to humans has been described but normally results in no or only mild disease; a notable exception is HPAI H5N1 which has killed more than half those infected. The HPAI H5N2 currently affecting ostriches in South Africa may cause human infections but so far the few cases described have been very mild. Nevertheless recommended precautions should be taken."
From left: Alan Sanderson (Ecosafe), Ivan Bromfield (City Health), Jantjie Taljaard (US & TBH), Neil Cameron (US), Frew Benson (National Health), Ian Gildenhuys (City Health), Rob Stewart (NHLS), Juno Thomas (NICD/ NHLS). Absent: Andy Cunningham (PGWC), Andrew Gartshore (Westin Grand), Adele Baleta (Media Consultant) and Murdock Ramathuba (National Health). Photo: Dr Bart Willems
National Legionnaires' Disease Symposium 2011
A Legionnaires Disease Symposium organized by the Centre for Infectious Diseases of the Faculty of Health Sciences, Stellenbosch University with the help of the Health Department of the City of Cape Town in the Civic Center on the 12th of May 2011. National experts in fields ranging from senior staff of the National Department of Health, environmental health practitioners, microbiologists, risk assessment consultants, infectious disease clinicians, hospital and hotel and a media consultant spoke at the symposium which was chaired by Dr Bromfield the Executive Director of the City Health Department and Dr Cameron of the Centre for infectious Diseases. Legionellae are common organisms found in many open water sources and tend to exploit man-made aquatic systems. The organisms are spread to humans through the inhalation of aerosols of contaminated water from hot water systems (showers), air conditioning towers, evaporative condensers, whirlpool spas, decorative fountains, respiratory therapy and wastewater treatment plants for wood, paper, petroleum and sewage. Legionellae grow best at temperatures between 25 - 40oC and survive adverse conditions in biofilms. Biofilms are aggregations of microorganisms and protozoa which adhere to each other along surfaces in aquatic environments especially in dead-leg pipes. Outbreaks are often linked to high-rise buildings hospitals, hotels, old age homes, schools and cruise ships, and so tend to be newsworthy and costly. Legionella pneumonia cause occasional outbreaks of flu like illness, progressing to toxicity with high fever with gastrointestinal symptoms and pneumonia. People over 50 and those immune compromised are more at risk. The mortality rate in hospital is high if not treated with the appropriate antibiotics. Incorrect laboratory sampling and testing complicates identification, diagnosis and management. Good environmental control is an essential part of managing the risk of Legionnaires' disease especially hospitals and hotels. A major international hotel group is currently being sued for millions of US dollars by the family of a man who died from legionnaires' disease after sleeping over in one of their hotels.
SU receives a $10 million grant from the USA for medical education and research training
Medical education and research training in South Africa received a $10 million boost when Stellenbosch University was included as recipient in a multimillion dollar United States project to build capacity in the field of medical education in sub-Saharan Africa. Read more...