Infectious and Epidemic Disease in History
Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker
Machupo virus, or "Black Typhus of Beni"
[Click on the shaded areas to see detailed maps of the regions described in the articles below.]
- July 7, 1963 -
U.S. AIDS BOLIVIA IN FEVER BATTLE
BALBOA, C.Z. [Canal Zone], July 6--The first samples of a newly isolated virus causing an epidemic of hemorrhagic fever in northeast Bolivia have reached the laboratory of the Middle America Research Unit. This is a field entity of the United States National Institute of Allergy and Infectious Diseases.
The fever -- known in Bolivia as the black typhus of Beni -- has depopulated several farm villages in the fertile pampas near the Brazil border.
Patients under observation in the State of Beni by Bolivian and international medical teams have suffered a mortality rate of 30 per cent. The disease is known to have killed about 130 persons in Beni in the last few years.
Last year, the Middle America Research Unit, under the guidance of Dr. Henry K. Beye, sent a field team to the epidemic area.
Last July, Bolivia appointed a hemorrhagic fever control commission that included Bolivians and Americans....
- July 9, 1963 -
Stricken U.S. Doctor Gains After Flight From Bolivia
BALBOA, C.Z., July 8 (UPI)--Dr. Ronald Mackenzie, the medical field research specialist who isolated a mysterious killer virus in Bolivia and then was struck down by the disease, was reported out of danger and improving today.
Dr. Mackenzie, 38 years old, of Sausalito, Calif., tracked down the virus of a mystery hemorrhagic fever raging in eastern Bolivia....
- October 6, 1963 -
Reports Conflict on Reasons for Move to Panama
Special to The New York Times
LA PAZ, Bolivia, Oct. 4--The five members of the American medical research unit who were working in Bolivia during the last four months in the investigation of a mysterious hemorrhagic fever left the country today with their work still incomplete.
There were conflicting reports as to why they had left and whether they would return.
Informed sources say that the team left Bolivia because the Bolivian Government did not give the monthly contribution it had promised to finance the program. But Bolivian authorities deny this. They insist that the team will return in a few months to continue the work.
The sources say that, since money and resources to continue the research in San Joaquin are not available, the group plans to continue the laboratory investigation in Panama....
Observers here doubt that the group will be able to continue the investigation in Panama though they are taking with them the specimens and the results of their investigations in San Joaquin. It is said that, though they have already isolated the virus, they have not found the vehicle of transmission of the disease. This vehicle has to be found in the affected area. Before the team left there was much hope here of success to their mission....
- October 22, 1963 -
U.S. Scientist to Lead Expedition To Trace Lethal Virus in Bolivia
By JOHN C. DEVLIN
A scientist from the American Museum of Natural History will lead an expedition into a little-charted section of the Bolivian wilderness in a new attack on a strange spreading fever.
The scientist, Dr. Richard G. Van Gelder, 34 years old, chairman and assistant curator of the museum's Department of Mammals, will take his party into a area on the Bolivian-Brazilian frontier where Indians armed with poisoned arrows and blowguns have on occasion resorted to cannibalism.
The members of the expedition will include at least two other American scientists, several from South America, and nonscientific personnel. He added that no physician would go unless one would be found who also could serve as a specialist in one of the museum forms of science.
Their mission will be to collect mammals and any parasites that live on the mammals' skin to try to trace virus that causes hemorrhagic fever was similar "to flu." Then, he said, the white blood count drops sharply and the blood pressure declines -- sometimes "down to zero." This usually lasts about 190 days; then the patient either dies or starts to recover....
Hemorrhagic fever originally was identified in 1953 in Junin, Argentina. It then made an inexplicable leap of hundreds of miles north to San Joaquin and Orobayaya, Bolivia. It has not yet been identified in the United States....
- April 10, 1964 -
DR. HENRY K. BEYE, 52, U.S. HEALTH OFFICIAL
WASHINGTON, April 9--Dr. Henry K. Beye, of the Public Health Service, died yesterday in Panama, where he had been directing the activities of the Middle America Research Unit (M.A.R.U.), it was learned here today. He was 52 years old.
An authority on tropical diseases, Dr. Beye had returned recently to Panama from Bolivia, where the unit's scientists are conducting intensive studies on Bolivian hemorrhagic fever. The agency is a government for research on arthropod-borne viruses....
- June 21, 1964 -
DRAMA OF DISEASE BEING RE-ENACTED
By JOHN A. OSMUNDSEN
The drama of "Yellow Jack," the Sidney Howard play of 1934 about the conquest of yellow fever, is being played in the same real setting of the tropics with similar heroes but with a new villain.
The villain in the Broadway depiction of disease-fighting was the Aedes aegypti mosquito, which Maj. Walter Reed and his co-workers proved 30 years earlier in Cuba and Panama to be the carrier of the yellow fever virus. They did this by deliberately allowing themselves to be stung by the insect and by contracting the disease in consequence.
Now, scientists from the National Institutes of Health working in the Panama Canal Zone report having identified a rodent as the carrier of another deadly virus. This virus causes a hemorrhagic fever. It is called "the black typhus of Beni," after the Bolivian department where it is epidemic. It has killed hundreds of persons in the last three years, and it now strikes about 30 a month, killing one in five.
Raging out of control since shortly after the first case was reported in 1959, the new disease has caused the depopulation of several farm villages. One, Orobayaya, has been abandoned, according to the report and the population of San Joaquin, hub of the field researches operations, has dropped from 2,000 to fewer than 900.
May Be Hard to Conquer
For these reasons, the disclosure by the American scientists that an animal carrier of the disease virus has been found was received as good news.
Just how good that news is remains to be seen, however. There are signs that this disease may be harder to conquer than yellow fever.
The parallel between the two stories of disease-fighting exists partly in the report from the workers in Bolivia and the Canal Zone, where their laboratory facilities are located that six persons associated with the work on the hemorrhagic fever have been stricken by it, and one came very close to death....
The risk of infection by person-to-person transmission of the virus is great in many viral diseases. It was not seriously considered in the new disease, however, because the scientists were so certain that the virus was transmitted to humans from an animal reservoir of some sort (which turned out to be a rodent) through an insect vector, as in the case of the yellow fever mosquito....
- November 8, 1964 -
BOLIVIAN EPIDEMIC IS BELIEVED OVER
Virus Vector Was Found in Time, Scientists Report
By JOHN A. OSMUNDSEN
How a team of American scientists snuffed out a viral disease epidemic in Bolivia recently when the odds seemed against them was recounted at a scientific meeting that ended here yesterday.
In an earlier report of the problem, it was revealed that four of the scientists had contracted the disease, Bolivian hemorrhagic fever, and that two of them had apparently transmitted it to their wives.
The possibility of person-to-person transmission of the disease suggested to the scientists that the epidemic might have entered a phase in which it would have been invulnerable to any immediate practical efforts to quench it. Hence, the fear was it might have been loosed generally in South America.
It was only because this viral disease was so unusual that the scientists managed to conquer it.
Experiences Are Recounted
The story was related by several of the scientists who were most involved in the work-- some of whom nearly died of the disease--at the 13th annual meeting of the American Society of Tropical Medicine and Hygiene at the Waldorf-Astoria Hotel.
The scientists were Dr. Ronald B. Mackenzie, Dr. Karl M. Johnson and his wife, Dr. Patricia A. Webb, and Dr. Merle L. Kuns, all of the Middle America Research Unit in the Panama Canal Zone.
Their story began in May, 1962, when Dr. Mackenzie was invited by the Minister of Health of Bolivia to visit an area in the Department of Beni where a highly lethal disease of known cause was epidemic. Ultimately, that disease would hit 1,100 persons and kill nearly a fourth of then.
Initially, the disease was confined to farm villages in the flat plain known as the Llanos de Mojos. Eventually it was to spread into the city of San Joaquin where what the scientists hope was the last battle with it was fought and apparently won.
The infectious agent -- the Machupo virus -- was isolated on May 18, 1963, from the spleen of a Bolivian who had died of the hemorrhagic fever. The virus was found to be related to both the Junin virus of an Argentine hemorrhagic fever and the Tacaribe virus isolated from the brains of bats in Trinidad.
From that time, the scientists tried to find the virus in animals that might have transmitted the disease to humans. They examined many birds, over 400 kinds of insects and several rodents and other mammals.
Eventually they found the virus in rodents of the species Calomys callosus, which was called a "laucha" by Bolivians whose houses it infests. No other animal--save the human--was infected.
Since there are no generally useful drugs against viral infections, and the possibility of developing a vaccine to prevent the disease was out of the immediate question, the scientists believed their best bet was to tr[y] to eradicate the lauches that carried the virus.
What they feared, however, was that even if the laucha extermination program was successful, humans who were infected with the virus might harbor it long after recovery and disseminate it to others.
Nevertheless, lauchas exterminators started setting traps and laying poisoned baits in San Joaquin during the first week of May, this year.
They were lucky. Within four weeks, the incidence of infection dropped precipitously. There has not been a new case since June 28, the scientists reported last week.
It was thus evident, the scientists believed, that the person-to-person route of transmission was not an important factor in the spread of the disease.
Several questions remain, however.
One is why the disease appeared so suddenly in 1959, when the Bolivians in Llanos de Mojos had been living with lauchas for many years.
The answer, the scientists believe, is that another rodent, which has been found to carry the virus but which normally lives in the tropical forests, began a few years ago to move out of the forests and into regions where it could infect the lauchas. The lauchas were then able to transmit the virus to man by infecting his dwellings....
[In 1977, the name of Dahomey was officially changed to Benin.]
- February 10, 1970 -
New Fever Virus So Deadly That Research Halts
By LAWRENCE K. ALTMAN
American doctors have discovered a virus so virulent that they have stopped their research into its mysteries.
The virus, called Lassa Fever, killed three of the five Americans it infected during the last year. Those infected were three American missionary nurses, who contracted the disease in Nigeria, and two laboratory workers at Yale University. Two of the nurses and one of the laboratory workers died.
Scientists at Yale, collaborating with doctors at Columbia University and in West Africa, identified the virus last year from blood samples of the three nurses.
Blood tests show that none of the other laboratory or hospital personnel or family members got sick from Lassa Fever, although the virus possibly infected another American missionary in Guinea a few years ago, doctors at Yale and Columbia said in recent interviews.
The episode vividly illustrates the hazards of virology research, which has led to at least 2,700 cases and 107 deaths from laboratory acquired infections over the years. Most of these cases have occurred since 1950 as more researchers have tried to better understand viruses and have discovered new ones, almost as virulent as Lassa Fever, among the hundreds of viruses previously known.
Just as important, Lassa Fever demonstrates that disease is not restricted by geographic or political boundaries.
Lassa Fever infection can involve almost all the body's organs; symptoms may vary in the individual patient. The virus produces a fever as high as 107 degrees; mouth ulcers; a skin rash with tiny hemorrhages; pneumonia; infection of the heart leading to cardiac failure; kidney damage, and severe muscle aches.
The Yale researchers knew of the hazards when they received blood samples from the three missionaries.
"We were aware of the dangers of our research, but we had commitments to the doctors and patients," said Dr. Jordi Casals, the virologist who later got Lassa Fever.
Accordingly, Dr. Casals and his co-worker, Dr. Sonja Buckley, proceeded cautiously. Only by inoculating the victims' blood into Vero cells (from a green monkey) were researchers able to show quickly evidence of a virus, and only after months of tests were they able to say it was new.
By custom, they named it for the place from which it came, which was Lassa, a village of about 1,000 Nigerians, situated about 150 miles below the Sahara.
2 Deaths in Africa
There, while working near the Church of the Brethren's mission station, the first nurse, Laura Wine, became ill. Flown by private plane to the Sudan Interior Mission's hospital in Jos, she died 24 hours later.
A week later, Charlotte Shaw, one of Miss Wine's nurses, got what she thought was migraine headache. However, she developed a fever unresponsive to antibiotics, became sicker, and died 10 days later.
Assisting at Miss Shaw's autopsy was Lily Pinneo, a missionary nurse, who had cared for both earlier victims.
"A week later, I got a 103-degree fever and severe ulcers in my mouth," Miss Pinneo recalled at her home in Rochester. Considering that she might have the same illness, Miss Pinneo's doctors flew her to Lagos. She spent four days in a hospital, cared for by Dr. Stanley O. Foster, a United States Public Health Service physician.
Lying on a stretcher in a curtained-off area of [the] cabin and accompanied by a nurse and another Health Service physician, Dr. J. Lyle Conrad, she spent 12 hours on a direct flight here.
From John F. Kennedy International Airport, where officials had no reason to suspect a new viral disease, an ambulance took Miss Pinneo to Columbia-Presbyterian Hospital. Also at the airport was Dr. John D. Frame, who drew a blood sample from Miss Pinneo and sent it along with those previously obtained from the two dead missionaries to the Yale Arborvirus Research Unit.
At Columbia-Presbyterian, Miss Pinneo was isolated. Her doctors ruled out the known tropical diseases.
"After a few days, we realized that hers was not a usual disease," recalled one of her physicians, Dr. David J. Gocke, who said that they looked to the Yale laboratory for Miss Pinneo's diagnosis. Except for excellent nursing care, her doctors had no specific therapy to offer....
At Yale, researchers studied the effects of the virus on animals such as mice but they said only Dr. Casals, Dr. Buckley and Dr. Wilbur G. Downs, the group's director, worked with the virus.
In June, Dr. Casals felt ill but did not suspect he had Lassa Fever because his severe thigh-muscle aching was a sympto[m] that the others had escaped. A friend urged Dr. Casals, who lives here, to enter Columbia-Presbyterian Hospital. There, physicians suspected Lassa Fever as a laboratory-acquired infection.
Against the Infection
Since antibiotics are ineffective against viruses, his doctors used a therapy common in prevaccine and preantibiotic days, but seldom used now, to save Dr. Casals's life. They asked Miss Pinneo to fly to New York from Rochester. They withdrew two units of blood and separated her plasma, which contained the antibodies she had made to fight her infection, and injected it into Dr. Casals's veins.
Miss Pinneo's plasma also worked against Dr. Casals's infection. The virus stopped circulating in Dr. Casals's blood immediately after this specific therapy was given, laboratory tests later showed, whereas it was found in Miss Pinneo's untreated blood for six weeks.
Dr. Casals returned to Yale to learn how many other Africans or missionaries, if any, have the disease and how it is transmitted. But this research was stopped when a laboratory worker, Juan Roman, who had no known contact with the virus, died in December. He left for a Thanksgiving vacation in York, Pa., where he became ill and was hospitalized.
Yale researchers say they learned of his illness just before he died there. And from blood samples Dr. Casals obtained in York, Dr. Buckley identified the Lassa Fever virus.
"We simply do not know how the virus was transmitted to the technician," Dr. Downs, the group's director, said. Any future research, he said, would have to be conducted in a maximum security laboratory.
Dr. Downs, meanwhile, has written laboratories in Africa warning them of the dangers of the virus and communicating what is known about the fat covered, spherical particle, which contains RNA (ribonucleic acid) and can be seen only under an electron microscope.
The researchers say they believe there is no threat now to anyone associated with these cases. In such an event, Dr. Downs said, his laboratory would do all necessary tests for diagnostic purposes.
- February 18, 1970 -
Spread of Deadly Viral Fever Is Suspected in Nigeria
By LAWRENCE K. ALTMAN
The American scientists who discovered the virus that causes Lassa fever suspect that there is now an outbreak of the lethal disease in Jos, a tin mining town in northern Nigeria.
Ten of 20 Nigerian and American patients died at Evangel Hospital in Jos of what is suspected to be Lassa fever in recent weeks, these American doctors said in interviews yesterday. Their information was based on reports by sources in Nigeria....
The Lassa fever virus was identified by Yale virologists last summer after it had appeared in an ailing missionary who had been brought back to the United States from Nigeria for treatment....
The greatest mystery is where the disease came from. Doctors suspect it was transmitted originally from an animal -- which one they do not know -- but that the patients with known Lassa fever acquired the infection from each other.
Of more than curiosity now is the fact that last year's cases and this year's outbreak have occurred during the same months -- January and February.
Furthermore, doctors hope that the studies now being done at the Rockefeller Foundation-supported laboratory at Ibadan will provide clues to several other lethal viruses that scientists wish to better understand.
This is why the center in Atlanta began construction of the maximum security laboratory at a cost of $240,000 a year ago. It was to study all these lethal viruses, not just that of Lassa fever, which was unknown then.
Such lethal viruses include the Marburg virus -- first identified in West Germany -- that killed 7 of 31 victims in that country and in Yugoslavia about three years ago. That virus apparently was transmitted through monkeys exported from Uganda to Europe.
Other lethal viruses include the Machupo virus, which was responsible for hundreds of Bolivian hemorrhagic fever, including illness and death among the Middle America Research Unit's laboratory workers in Panama about 7 years ago. Also included are the Congo virus and the Crimean hemorrhagic fever virus....
- February 25, 1970 -
Letters to the Editor of The Times
Lassa Fever Case
To the Editor:
In your editorial of Feb. 11 on Lassa Fever you said that we were "not aware that [our] patient harbored a hitherto unknown, but highly virulent disease," and that, "as a result, two persons in this country contracted the ailment and one of them died."
This is a false and misleading statement. When the patient was brought to the Columbia Presbyterian Medical Center we were fully conscious of the possibility that she was suffering from a novel and dangerous viral infection.
She was put on strict isolation precautions in our infectious disease unit, which is designed for this purpose, and attempts immediately were made to discover the cause of her illness, using the help of Dr. Wilbur G. Downs, Professor of Epidemiology at Yale Medical School, who is an expert in the field of tropical virus infections.
Dr. Downs and his associates were successful in recovering the causative agent, which, as expected, proved to be a new strain of virus.
The two persons who subsequently were infected in the United States with Lassa Fever virus, one of whom unfortunately died, were associated with a laboratory in which research work on the virus is being done. Their infections indicate the hazard that is known to accompany work of this kind. They do not represent either ignorance or lack of understanding on the part of the physicians who cared for the patient.
HARRY M. ROSE, M.D.
New York, Feb. 11, 1970
The writer is Professor and Chairman of the Department of Microbiology, College of Physicians and Surgeons.
- February 26, 1970 -
Nurse Goes to Nigeria With Plasma to Fight Lassa Fever Virus
By LAWRENCE K. ALTMAN
The American missionary nurse in whose blood Lassa fever virus was first detected was on her way last night to Jos, Nigeria, where there is an outbreak of the disease.
Miss Lily Pinneo is carrying with her a small supply of plasma from her blood. The plasma contains antibodies that doctors in Nigeria may use to counteract this otherwise untreatable infection in a few victims at Jos.
These antibodies developed in Miss Pinneo's body during a lengthy recovery from Lassa fever disease last year.
The virus that causes Lassa fever was detected at Yale last summer. While its impact appears to have been confined mainly to an area of Nigeria, the virus has commanded considerable attention among public health officials because of its deadliness and the mystery surrounding its transmission....
The latest known death from the lethal viral disease, Dr. Frame said, is that of Dr. Jeanette Troup of the Sudan Interior Mission. According to a letter just received from Nigeria, she died Feb. 18 in Jos....
Just a year ago, Dr. Troup cared for Miss Penneo and her two nursing colleagues who died in Jos....
- March 15, 1970 -
Threat to Nigeria From Lassa Fever Found to Be Over
LAGOS, Nigeria, March 14 (AP)--Doctors studying Lassa fever, a mystifying virus that has proved very dangerous to work on, say the disease no longer threatens the northern Nigeria area where it was discovered.
Dr. Jordi Casals, who flew over from Yale University, and Dr. Donald E. Carey, who runs the University of Ibadan virus research laboratory, traveled early this month to the town of Jos, where the virus had spread from nurse to nurse in a fatal chain at a missionary hospital.
Dr. Casals and Dr. Carey reported that they had found only 12 cases that they considered to be Lassa fever.
"The outbreak was restricted to Jos and there were no new cases in almost a month," Dr. Carey said in an interview. He said that nine of the 12 cases had been fatal and that only the three nonfatal cases had been proved in a laboratory as Lassa fever. The others were strongly suspected.
Dr. Carey and his staff are now working on about 100 blood samples brought from Jos to identify the other nine cases positively and to find out if the virus also causes a minor illness besides the serious illness.
- July 3, 1972 -
DOCTORS TO STUDY A DEADLY FEVER
They Will Collect Specimens of Lassa Virus Victims
By LAWRENCE K. ALTMAN
Doctors at Columbia and Yale, reacting to an unpublicized recent outbreak of Lassa fever in Liberia that claimed the life of an American nurse among others, are planning a new study into the mysterious viral disease.
The study, which was announced yesterday, is aimed at learning more about the natural range and distribution pattern of Lassa fever virus. Columbia doctors will collect and Yale virologists will test blood specimens for Lassa fever from people who have had recent illnesses while living in West Africa. The program will be supported by funds from private organizations and from the World Health Organization in Geneva.
Lassa fever can cause a fever as high as 107 degrees, sore throat, muscle aches, inflammation of the brain, heart, kidneys and liver. It is named for the northern Nigerian town where the first known case occurred.
Yale scientists discovered Lassa fever virus in 1969 from specimens taken from a missionary nurse who became ill in Nigeria and who was treated by doctors at Columbia-Presbyterian Medical Center.
But the Yale scientists stopped direct investigation with the virus because of its virulence. A technician died and a virologist became seriously ill from Lassa fever infection accidentally acquired during the research studies.
Ten Public Health Service officers at the Center for Disease Control in Atlanta took up the studies in a maximum security laboratory. Despite such studies, virologists are in doubt about the precise way that Lassa fever spreads to infect humans and how i[t] has caused outbreaks in Nigeria and Guinea in recent years.
After a period during which no outbreak was detected, Lassa fever appeared on Zorzor, Liberia, near the Guinean border last March. Four of 10 infected victims died from the disease. Seven of the patients were staff members of the hospital in Zorzor.
The dead included Miss Esther Bacon, an American nurse who served in Liberia for 35 years and who had taught tropical medicine to the many young Columbia doctors who had studied the subject in the west African country.
Intimate Contact Cited
From a study of the Liberian outbreak of Lassa fever, Public Health Service epidemiologists learned that infection apparently required sustained intimate contact of the intensity that occurs in caring for patients in a hospital.
One of the proposed theories is that the virus occurs naturally in rodents, which spread it to man through urine or fecal droppings that contaminate food. However, proof for this and other theories is lacking.
To ascertain more facts and to gain a better perspective of the mysterious disease, Dr. John D. Frame of Columbia plans to collect blood samples from patients who have had attacks of fever during the last year in West Africa.
Dr. Frame said in an interview that with the aid of assistants he planned to collect samples from patients at 80 hospitals in West Africa.
Dr. Frame said he would send the specimens to Dr. Jordi Casals at Yale, who will do tests to detect Lassa fever virus indirectly. Ultimately, researchers hope to develop a vaccine against the fever.
- October 3, 1972 -
U.S. Team Joininng Fight to Stem Rare Fatal Fever in Africa
By LAWRENCE K. ALTMAN
The United States Public Health Service, responding to a request from the Government of Sierra Leone, is sending a team of six experts to fight a new outbreak of Lassa fever, a mysterious, lethal viral disease.
Full details are not available about the outbreak of Lassa fever infections, against which there are no known effective drug therapies.
Federal health officials said yesterday that on the basis of current information at least 46 cases of Lassa fever had been diagnosed in recent months in Panguma, which is in eastern Sierra Leone.
About half the victims died from the virus....
The scientists intend to collect blood, urine and other samples from humans and to trap insects, rodents and other animals to test them for evidence of Lassa fever.
"Handling [human] specimens might be a bit risky for those who are not immune," Dr. [Jordi] Casals [the Yale virologist who survived Lassa fever] said. None of the five other scientists are known to have immunity against the fever....
- March 22, 1974 -
2 DIE IN OUTBREAK OF LASSA FEVER
An Ill Missionary Is Flown From Nigeria to Germany
By LAWRENCE K. ALTMAN
A renewed outbreak of Lassa fever has occurred in Nigeria, claiming two lives and generating intensive efforts to cope with the deadly and baffling viral infection.
In addition to the two deaths, a German missionary physician has become seriously ill with what is suspected to be Lassa fever. He was flown yesterday from Nigeria to Hamburg on a chartered Lufthansa jet transport.
The plane was chartered after West German officials had asked the United States for emergency loan of the mobile quarantine unit in which Apollo astronauts were isolated on their return from the moon, to transport the ailing physician. Officials at the Federal Center for Disease Control in Atlanta said yesterday that they had recommended against loan of the quarantine unit because they felt it was "unnecessary."
Epidemiologists from the Atlanta center and from Yale University are investigating the outbreak in the south-central area around Onitshi in Nigeria.
Since discovery of the mysterious disease in Lassa, Nigeria, in 1969, a series of outbreaks have struck hospital personnel, killing dozens of Africans and missionary doctors and nurses. A few patients have recovered.
Missionary Has Died
One of the two fatalities in the new outbreak was that of a West German missionary physician, Dr. Egon Sauerwald, who died in a hospital in Enugu. The other was an African patient. The third patient, West German missionary physician, Dr. B. Mandrella, performed an emergency operation on Dr. Sauerwald.
When Dr. Mandrella became ill a week after Dr. Sauerwald's death, Lassa fever was first suspected as the cause of the outbreak. Dr. Mandrella was then transferred to a hospital in Ibadan, where he was treated with serum derived from blood of a patient who survived an attack of Lassa fever in an earlier outbreak.
Immediately thereafter, Dr. Mandrella's condition reportedly improved....
[S]tudies of the outbreak in Sierra Leone disclosed evidence that Lassa fever had left its "fingerprints" in the blood of as many as 6 per cent of the people living in some areas there.
Why most of these people escaped Lassa fever while a much smaller fraction came down with symptoms of the disease is just one of the many unanswered questions about Lassa fever. The disease is one of the most mysterious in the annals of medicine.
From the Sierra Leone outbreak, Government epidemiologists and scientists from the Smithsonian Institution in Washington, found suggestive evidence that one species of an African house rat might play a role in the spread of the disease.
Despite the clue, scientists are still uncertain about the precise natural history of Lassa fever, and what causes it to break out from time to time, as it seemingly has just done in Nigeria.
- June 29, 1974 -
Lassa Victim Recovers
LAGOS, Nigeria, June 28 (Agence France-Presse)--A West German doctor who was sent home to Hamburg in March with a little-known and often fatal African disease has recovered and returned to work in Nigeria, it was announced today. Dr. Bernhard Mandrella, who works at a hospital in Onitsha Province ha[d] contracted Lassa fever.
[In July 1997, the name of Republic of Zaire was officially changed to Democratic Republic of the Congo.]
- October 6, 1976 -
Doctors Sent to Africa for Study Of a Disease That Has Killed 150
By LAWRENCE K. ALTMAN
The World Health Organization has sent a team of doctors to northern Zaire [now the Democratic Republic of the Congo] and the Sudan in Africa to begin an investigation of an as yet unidentified disease that has killed mo[r]e than 150 people, including four Belgian missionaries, in recent weeks, according to an American health official.
The official, Dr. John A. Bryan, an epidemiologist and head of the viral diseases section at the Federal Center for Disease Control, said in a telephone interview from Atlanta last night that the World Health Organization had sent the medical team to determin[e] more precisely the nature of the illness, the number of people affected and the extent of the areas involved.
First reports from European missionary officials, businessmen and journalists indicate that there have been several hundred cases of the disease, with a very high death rate. United Press International reported that one area involved was Yambuku, north of Bumba in northern Zaire....
Symptoms of the disease are said to include high fever and bleeding from the nose, according to doctors at Antwerp's Institute of Tropical Medicine....
On the basis of preliminary information, Dr. Bryan said, the diagnoses being considered are yellow fever, Marburg disease and Lassa fever. Doctors have known about yellow fever since the last century. But the viruses that cause Marburg disease and Lassa fever were discovered only in the last decade....
Kenyan officials have closed that country's frontier with the Sudan and have canceled airline flights between Nairobi and Juba, the town nearest the stricken region, according to UPI.
- October 10, 1976 -
MYSTERIOUS DISEASE TAKING AFRICAN TOLL
Health Groups Are Trying to Combat Deadly Ailment in The Sudan -- Kenya Closes Its Border
By MICHAEL T. KAUFMAN
NAIROBI, Kenya, Oct. 9--Four weeks ago a villager who had walked from the southern Sudanese hamlet of Nzara to the regional center of Maridi was gripped by a sudden high fever. Taken to the local 30-bed hospital, he developed a rash and died within two days.
When his family came to claim the body, two brothers developed the same symptoms and died.
These men, according to the regional director of the World Health Organization here, Dr. Boodhun Teelock, were the first reported victims of a mysterious fever that appears to be spreading in still small but lethal waves through Central Africa. According to doctors at the Maridi clinic, which is reachable only by radio, 45 people, including a Sudanese Government physician, eight nurses and two hospital janitors, have died there of the still-undiagnosed disease, which is marked by nosebleeds and ultimate vascular collapse.
In northern Zaire, at a Roman Catholic mission 100 miles south of Maridi, which lies just over the Sudanese border, more than 100 people have died of the disease.
The area involved is remote, and news travels slowly, largely on foot. Kenyan and international health officials say it is still not possible to compile accurate accounts, but reports from health authorities here and in Kinshasa, the capital of Zaire, indicate that as of Friday, 230 deaths had been confirmed.
Trying to Avoid Panic
In an effort to prevent panic the health officials are refraining from calling the outbreak an epidemic. While some suggest that the disease is similar to the fearful Lassa fever, named for a town in Nigeria, they all caution against premature diagnosis. "Based on what little information we have," Dr. Teelock said, "we feel it may be hemorrhagic viral fever, and our second choice is Lassa fever."
Kenya has closed its border with the Sudan and has canceled flights to the Maridi area. Nine West German engineers supervising a road project in Maridi have been flown to Khartoum, as have five German and French missionaries.
Kennyd Jones, a World Health Organization physician, left here yesterday for Maridi to begin medical detective work on the causes of the disease, whose victims include a high proportion of medical and hospital people.
Another physician, from the Pasteur Institute in Dakar, Senegal, is on his way to the afflicted area. The center for Disease Control in Atlanta, Ga., which isolated the virus of Lassa fever, has been alerted and is assembling quantities of serum that is the only known remedy for that disease.
Here in Nairobi, a Scottish surgeon who flies weekly to remote mission hospitals to treat the injured and sick expressed his fears of a growing epidemic. "I have been alerted that I may be needed," he said. "But if it turns out to be Lassa fever, then that poses a wicked conflict. We already know that hospital staff are extremely vulnerable. Do you go in the hope of doing some good, knowing that the chances are better than fair that you might become sick yourself and die?"
Two Who Died Quickly
Derek Williams, a teacher now in Nairobi, was in Maridi when the disease surfaced. He said that the deterioration caused by the fever was quick. Two of his teaching colleagues, Arabs from the northern Sudan, were stricken on the same day. Mr. Williams was with them when they were taken to the clinic. Twelve hours later, he said, they could not walk, and they were soon dead.
Hemorrhagic viral fever, which Dr. Teelock says seems to best fit the symptoms, has never been recorded in East or Central Africa; its most recent outbreak was last year in Pakistan.
Lassa fever, which a British expert on tropical medicine has termed the most dangerous of currently known virus diseases, appeared six years ago at a mission in northeastern Nigeria. There have been several outbreaks in Nigeria, Sierra Leone, Liberia and South Africa. The disease has killed many doctors and nurses, including a member of a Yale research team whose investigations were suspended because of the danger.
Though serum developed from patients who survived has proved effective, there is no preventive inoculation and serum supplies are limited.
Ecological researchers have determined that one cause of the Lassa eruption may be the efficient extermination of the brown rat, a carrier of other diseases and a destroyer of crops. The Lassa virus is carried by a smaller species of rat, whose numbers had been curbed by the brown rat. The smaller rat, a shy animal, avoided human habitations until its natural enemy was eliminated.
- October 16, 1976 -
W.H.O. Team to Study Fatal African Disease
GENEVA, Oct. 15 (UPI)--The World Health Organization said today that a team of specialists would fly to Africa to try to find the cause of a mysterious disease carried by green monkeys that has killed more than 300 people.
An agency spokesman said the team of four to six specialists, would leave for the Sudan and Zaire as soon as official approval was received from the two counties.
The disease, called a viral hemorrhagic fever, is a variant of the so-called "Green Monkey" or "Marburg" disease, the spokesman said. It was first identified in 1967 in Marburg, West Germany, when 30 laboratory technicians became sick after handling green monkeys from Uganda and Kenya. Seven of the technicians died.
- October 23, 1976 -
African Viral Disease Reported on Wane
GENEVA, Oct. 22--The viral hemorrhagic fever epidemics that erupted this summer in the southern Sudan and the bordering area of northern Zaire are waning, a World Health Organization spokesman said today.
Laboratories in Britain, the United States and Belgium have identified the virus that caused the disease as a variant of the Marburg virus, first discovered in 1967....
The Sudan, where 59 deaths resulted from 137 reported incidents of the fever, has reported that no new cases have developed there since Oct. 9, the W.H.O. spokesman said. Zaire has not reported the number of cases recorded there, but deaths were said to total 260 up to Oct. 14.
- October 29, 1976 -
African Virus to be Studied in U.S.
Federal scientists at the Center for Disease Control in Atlanta expect to receive specimens today from victims of a new disease in Africa to help determine how serious a threat the infection might represent to the world.
In recent weeks, it has killed at least 335 people, including doctors and nurses who treated victims, in Zaire and the Sudan. The mode of spread is not known and no effective treatment exists.
Since the World Health Organization sent a team of doctors to investigate the outbreak in Zaire on Oct. 6, scientists at the Atlanta center and in Europe have identified the virus as one not previously known.
"It is a new virus in the Marburg family," said Dr. William H. Foege, assistant to the director of the Center for Disease Control, in a telephone interview last night....
Symptoms of the ailment are said to include high fever and bleeding. The virus is believed to affect the capillary blood vessels, which connect arteries and veins, and to interfere with the clotting mechanism, leading to lethal internal bleeding.
[T]wo Belgian doctors said that Belgian and other researchers had set a high priority on trying to develop something to help combat the infection....
[S]erum from victims who had recovered from Marburg disease had proved ineffective in treating the new infection.