The Coming Plague (115 page)
Authors: Laurie Garrett
4. Into the Woods
1
According to Brinkmann, at least one member of the group attempted suicide. Brinkmann chose to protect the individual's identity.
2
J. D. Frame et al., “Lassa Fever, a New Virus Disease of Man from West Africa,”
American Journal of Tropical Medicine and Hygiene
19 (1970): 670â76.
American Journal of Tropical Medicine and Hygiene
19 (1970): 670â76.
3
Several sources of excellent information on the events of 1969 in Nigeria were consulted in preparation of this chapter. The reader is particularly referred to the following: J. G. Fuller,
Fever: The Hunt for a New Killer Virus
(New York: Reader's Digest Press, 1974); and J. D. Frame, “The Story of Lassa Fever,”
New York State Journal of Medicine:
Fever: The Hunt for a New Killer Virus
(New York: Reader's Digest Press, 1974); and J. D. Frame, “The Story of Lassa Fever,”
New York State Journal of Medicine:
“Part I: Discovering the Disease,” Vol. 92 (1992): 199â202;
“Part II: Learning More About the Disease,” Vol. 92 (1992): 264â67;
“Part III: The Disease in the Community,” Vol. 92 (1992): 440â44;
“Part IV: The Politics of Research,” Vol. 93 (1993): 35â40;
“Part V: The Fruits of Research” (in press).
“Part II: Learning More About the Disease,” Vol. 92 (1992): 264â67;
“Part III: The Disease in the Community,” Vol. 92 (1992): 440â44;
“Part IV: The Politics of Research,” Vol. 93 (1993): 35â40;
“Part V: The Fruits of Research” (in press).
4
The bubonic plague that claimed hundreds of millions of lives worldwide in two major sweeps across Europe and Asia was spread originally by fleas. But there was a form of the disease that spread pneumonically, or in the air from one person to another.
5
Frame (1992), Part I, op. cit.
6
S. M. Buckley, J. Casals, and W. Downs, “Isolation and Antigenic Characterization of Lassa Virus,”
Nature
227 (1970): 174.
Nature
227 (1970): 174.
7
R. W. Speir et al., “Electron Microscopy of Vero Cell Cultures Infected with Lassa Virus,”
American Journal of Tropical Medicine and Hygiene
19 (1970): 692â94.
American Journal of Tropical Medicine and Hygiene
19 (1970): 692â94.
8
E. Leifer, D. J. Locke, and H. Bourne, “Report of a Laboratory-Acquired Infection Treated with Plasma from a Person Recently Recovered from the Disease,”
American Journal of Tropical Medicine and Hygiene
19 (1970): 677â79.
American Journal of Tropical Medicine and Hygiene
19 (1970): 677â79.
9
Frame (1992), Part I, op. cit.
10
F. P. Pinheiro et al., “Amapari, a New Virus of the Tacaribe Group from Rodents and Mites of Amapa Territory, Brazil,”
Proceedings of the Society of Experimental and Biological Medicine
122 (1966): 531â35.
Proceedings of the Society of Experimental and Biological Medicine
122 (1966): 531â35.
11
J. Casals et al., “A Current Appraisal of Hemorrhagic Fevers in the U.S.S.R.,”
American Journal of Tropical Medicine and Hygiene
15 (1966): 751â64.
American Journal of Tropical Medicine and Hygiene
15 (1966): 751â64.
12
Buckley et al. (1970), op. cit.
13
S. M. Buckley and J. Casals, “Isolation and Characterization of the Virus,”
American Journal of Tropical Medicine and Hygiene
19 (1970): 680â91; and Speir et al. (1970) op. cit.
American Journal of Tropical Medicine and Hygiene
19 (1970): 680â91; and Speir et al. (1970) op. cit.
14
The CDC has, over the years, upgraded its high-security laboratories repeatedly as the technology of biological containment improved. In the late 1960s the CDC's top security facility housed
labs-within-labs that formed a sort of concrete onion, layer upon layer of which had to be penetrated to reach the central core. At each level double air-lock doors sealed the air space tightly, and the chambers were kept under pressure that directed all airâand microbesâtoward special ventilators where they were destroyed by ultraviolet light and filtered through several layers of sheets that strained out anything bigger than a large molecule. All personnel showered before and after entry and wore protective head-to-toe suits.
labs-within-labs that formed a sort of concrete onion, layer upon layer of which had to be penetrated to reach the central core. At each level double air-lock doors sealed the air space tightly, and the chambers were kept under pressure that directed all airâand microbesâtoward special ventilators where they were destroyed by ultraviolet light and filtered through several layers of sheets that strained out anything bigger than a large molecule. All personnel showered before and after entry and wore protective head-to-toe suits.
15
Very detailed renditions of these events can be found in John Fuller's
Fever
and John Frame's “The Story of Lassa Fever. Part II: Learning More About the Disease.” Both are cited above.
Fever
and John Frame's “The Story of Lassa Fever. Part II: Learning More About the Disease.” Both are cited above.
16
G. M. Edington, and H. A. White, “The Pathology of Lassa Fever,”
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 381â401.
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 381â401.
17
J. M. Troup et al., “An Outbreak of Lassa Fever on the Jos Plateau, Nigeria, in January-February, 1970,”
American Journal of Tropical Medicine and Hygiene
19 (1970): 695â96.
American Journal of Tropical Medicine and Hygiene
19 (1970): 695â96.
18
D. E. Carey et al., “Lassa FeverâEpidemiological Aspects of the 1970 Epidemic, Jos, Nigeria,”
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 402â8.
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 402â8.
19
B. E. Henderson et al., “Lassa Fever: Virological and Serological Studies,”
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 409â16.
Transactions of the Royal Society of Tropical Medicine and Hygiene
66 (1972): 409â16.
20
D. Cummins et al., “Acute Sensorineural Deafness in Lassa Fever,”
Journal of the American Medical Association
264 (1990): 2093â96; L. P. Ryback, “Deafness Associated with Lassa Fever,”
Journal of the American Medical Association
264 (1990): 2119; J. D. Frame, “Clinical Features of Lassa Fever in Liberia,”
Review of Infectious Diseases
11, Suppl. 4 (1989): s783âs789; and J. B. McCormick et al., “A Case-Control Study of the Clinical Diagnosis and Course of Lassa Fever,”
Journal of Infectious Diseases
155 (1987): 445â55.
Journal of the American Medical Association
264 (1990): 2093â96; L. P. Ryback, “Deafness Associated with Lassa Fever,”
Journal of the American Medical Association
264 (1990): 2119; J. D. Frame, “Clinical Features of Lassa Fever in Liberia,”
Review of Infectious Diseases
11, Suppl. 4 (1989): s783âs789; and J. B. McCormick et al., “A Case-Control Study of the Clinical Diagnosis and Course of Lassa Fever,”
Journal of Infectious Diseases
155 (1987): 445â55.
21
J. B. Dibble,
Outlaw for God
(Hanover, MA: Christopher Publishing House, 1992).
Outlaw for God
(Hanover, MA: Christopher Publishing House, 1992).
22
Frame (1992), Part III, op. cit.
23
It is unfortunate that in historic outbreaks, such as this one, the names of non-Western disease victims and medical staff often go unrecorded in published literature. Whenever possible, the author has endeavored to include such names.
24
P. E. Mertens et al., “Clinical Presentation of Lassa Fever Cases During the Hospital Epidemic at Zorzor, Liberia, March-April 1972,”
American Journal of Tropical Medicine and Hygiene
22 (1973): 780â84.
American Journal of Tropical Medicine and Hygiene
22 (1973): 780â84.
25
Ibid.
26
The team's predictions proved quite accurate. Lassa is now known to be endemic to many regions of Liberia, and treatment of the disease had, prior to its most recent civil war, become a nearly routine feature of the country's medicine.
27
In 1867 English physician Lister revolutionized medicine by publishing and promoting details on sterile hospital practices. Prior to Lister, patients were extremely likely to die of bacterial infections following surgery.
28
T. P. Monath et al., “Lassa Virus Isolation from
Mastomys natalensis
Rodents During an Epidemic in Sierra Leone,”
Science
185 (1974): 263â65.
Mastomys natalensis
Rodents During an Epidemic in Sierra Leone,”
Science
185 (1974): 263â65.
29
D. W. Fraser et al., “Lassa Fever in the Eastern Province of Sierra Leone, 1970â1972. I: Epidemiological Studies,”
American Journal of Tropical Medicine and Hygiene
23 (1974): 1131â39; and T. P. Monath et al., “Lassa Fever in the Eastern Province of Sierra Leone, 1970â1972. II: Clinical Observations and Virological Studies on Selected Hospital Cases,”
American Journal of Tropical Medicine and Hygiene
23 (1974): 1140â49.
American Journal of Tropical Medicine and Hygiene
23 (1974): 1131â39; and T. P. Monath et al., “Lassa Fever in the Eastern Province of Sierra Leone, 1970â1972. II: Clinical Observations and Virological Studies on Selected Hospital Cases,”
American Journal of Tropical Medicine and Hygiene
23 (1974): 1140â49.
30
Monath et al. (1974), “Lassa Fever in the Eastern Province.”
31
Nevertheless, Casals and Pinneo both donated blood countless times over subsequent years, and CDC antisera made from their plasma undoubtedly saved many lives, particularly in Nigeria. Nigerian physicians and nurses who survived Lassa fever also generously donated their blood over the years, providing a steady supply of antiserum specific to the Jos strain.
32
Upper Volta is now called Burkina Faso.
33
J. D. Frame, “Surveillance of Lassa Fever in Missionaries Stationed in West Africa,”
Bulletin of the World Health Organization
52 (1975): 593â98.
Bulletin of the World Health Organization
52 (1975): 593â98.
34
The April 9, 1974, edition of the
New Nigerian,
published out of Lagos, carried a headline: “How Alien Tried to Spread Killer DiseaseâLassa Epidemic Narrowly Avoided.”
New Nigerian,
published out of Lagos, carried a headline: “How Alien Tried to Spread Killer DiseaseâLassa Epidemic Narrowly Avoided.”
35
Diepahtzer Nachrichter
, March 18, 1974: 1.
, March 18, 1974: 1.
36
“This Doctor Risks His Life for a Deadly III Patient,”
Bild Zeitung
, March 18, 1974.
Bild Zeitung
, March 18, 1974.
37
This is the same Dr. Lehmann-Gruber described in Chapter 3 as playing a key role in the battle against the Marburg virus.
38
“Is the Fever Physician Dangerous for Us?”
Bild-Hamburg,
March 22, 1974.
Bild-Hamburg,
March 22, 1974.
39
“U.S. Foreign Minister Kissinger Will Save the Courageous Fever Doctor from Hamburg,”
Bild Zeitung,
March 19, 1974.
Bild Zeitung,
March 19, 1974.
40
Had Monath's final conclusions on the Sierra Leone outbreak been published before these events took place, the group's fears might have eased. Monath and Casals found that the terrifying fatality rates seen in the hospital outbreaks of Jos and Zorzor were atypical. About half of all infected people in those cases died. But surveys of the Sierra Leone villages showed that most people survived the disease: only 5 percent of those who were infected by inhaling the virus from another person or rat feces/urine developed fatal disease. Monath was convinced direct blood-to-blood exposure to the virus was more dangerous, and might account for the far higher death rates in hospital settings.
41
K. Muller, “Flug in einer Plastikfolie,”
Welt,
March 22, 1974.
Welt,
March 22, 1974.
42
“Ghostly Arrival,”
Hamburger Abendblatt,
March 22, 1974.
Hamburger Abendblatt,
March 22, 1974.
43
Hamburger Morgenpost,
March 19, 1974: 1.
March 19, 1974: 1.
44
H. Nannen, “One Can See How One May Err,”
Stern,
March 28, 1974: 3.
Stern,
March 28, 1974: 3.
45
New Nigerian
(1974), op. cit. Years later the Nigerian government and press positions concerning Lassa would change, as outbreaks of the disease continued. Though there would continue to be regret that the virus had been named after a Nigerian town, the press and government would no longer claim the disease was carried by foreigners. For good examples of later Nigerian press accounts, see A. Adenmosum, “The Lassa-Fever Scourge,”
Pharmacy World Journal
6 (1989): 95; and U. Fabian, “Combating Lassa Fever,”
Daily Sketch,
February 23, 1993: 5.
(1974), op. cit. Years later the Nigerian government and press positions concerning Lassa would change, as outbreaks of the disease continued. Though there would continue to be regret that the virus had been named after a Nigerian town, the press and government would no longer claim the disease was carried by foreigners. For good examples of later Nigerian press accounts, see A. Adenmosum, “The Lassa-Fever Scourge,”
Pharmacy World Journal
6 (1989): 95; and U. Fabian, “Combating Lassa Fever,”
Daily Sketch,
February 23, 1993: 5.
5. Yambuku
1
In addition to interviews, the author drew generally from the following written materials: P. Sureau,
Yambuku
(1992), unpublished; and S. R. Pattyn,
Ebola Virus Haemorrhagic Fever
(Amsterdam: Elsevier Press, 1978).
Yambuku
(1992), unpublished; and S. R. Pattyn,
Ebola Virus Haemorrhagic Fever
(Amsterdam: Elsevier Press, 1978).
2
International Commission, “Ebola Haemorrhagic Fever in Zaire, 1976,”
Bulletin of the World Health Organization
56 (1978): 271â93.
Bulletin of the World Health Organization
56 (1978): 271â93.
3
R. D. Estes,
The Behavior Guide to African Mammals
(Berkeley: University of California Press, 1991).
The Behavior Guide to African Mammals
(Berkeley: University of California Press, 1991).
4
The Belgian Catholic missionaries who worked in the Yambuku Mission Hospital were:
| Sister Béata | (Jeanne Vertommen, age 42) |
| Sister Myriam | (Louise Ecran, age 42) |
| Sister Edmonda | (Jeanne DeRoover, age 56) |
| Sister Romana | (Angeline Geerts, age 54) |
| Father Germain Lootens | (age 67) |
In addition to the Belgians employed in hospital work, there were in Yambuku:
| Sister Genoveva | (Annie Ghysebrechts) |
| Sister Mariette | (Mariette Witrouwen) |
| Mother Superior Aloydis | (Bumba Zone) |
| Sister Marcella | (Julienne Ronsmans) |
| Father Carlos Rommel | (district head for Bumba Zone) |
| Father Germain Moke | (Bumba Zone) |
| Brother Adolphe Litepu | |
| Father Augustin Siegers | (superior for Yambuku) |
| Father Léon Claes | (aka “Père Dubois”) |
The Zairian staff included seven male nurse assistants:
| Amane Ehumba | (age 26) |
| Anangi Mabelesama | (age 25) |
| Mgwanga Magbuka | (age 30) |
| Ambaya Mandu | (age 30) |
| Sukato Manzomba | (age 24) |
| Magbo Mazebele | (age 35) |
| Masangaya Alola | (age 40) |
5
It was common for people to bury their dead inside the village, even under the clay floor of their houses. Ngoi feared such practices could spread the disease.
6
Untreated rabies ranks as number one: it is 100 percent fatal. Many experts believe HIV/AIDS has a lethality that approaches 100 percent, but, because of the extremely protracted course of HIV disease and the difficulty in knowing how many people are asymptomatic HIV carriers, it is impossible to say with certainty what percentage of HIV cases are fatal.
7
Dr. Close's daughter, the movie actress Glenn Close, reportedly hopes to make a Hollywood
film based on the Zairian disease story. William Close has written a novelized version of these events, entitled
Yambuku: A Novel
. It is, as yet, published only in Dutch. The author also drew comments from W. T. Close, “A Medical Perspective from Africa and the Rocky Mountains,” presentation to the University of California Medical School at Davis, 1993.
film based on the Zairian disease story. William Close has written a novelized version of these events, entitled
Yambuku: A Novel
. It is, as yet, published only in Dutch. The author also drew comments from W. T. Close, “A Medical Perspective from Africa and the Rocky Mountains,” presentation to the University of California Medical School at Davis, 1993.
8
World Health Organization, “Viral Haemorrhagic Fever,”
Weekly Epidemiological Report
52 (1977): 177â84; and WHO Expert Committee, “Viral Haemorrhagic Fevers,”
Technological Report Series
(1985), No. 721.
Weekly Epidemiological Report
52 (1977): 177â84; and WHO Expert Committee, “Viral Haemorrhagic Fevers,”
Technological Report Series
(1985), No. 721.
9
Isolated by Guido van der Gröen and Peter Piot.
10
Translated from the French by the author.
11
CDC memo, October 14, 1976, signed by Karl Johnson and issued on that date internally; several days later sent to WHO in Geneva and the U.S. Embassy in Kinshasa.
12
G. A. Martini and R. Siegert,
Marburg Virus Disease
(Frankfurt: Springer Verlag, 1971).
Marburg Virus Disease
(Frankfurt: Springer Verlag, 1971).
13
Despite deliberate attempts to render press accounts banal, some reports swung hyperbolically in the opposite direction. The October 28 issue of
L'Express
claimed: “Huit cents morts en un mois au Soudan. Responsable: le virus de Marburg. Un des trois cents âarbovirus' de l'Afrique Centrale contre lesquelle la médecine n'a pas d'armes.” And the highly exaggerated account concluded by asking:
L'Express
claimed: “Huit cents morts en un mois au Soudan. Responsable: le virus de Marburg. Un des trois cents âarbovirus' de l'Afrique Centrale contre lesquelle la médecine n'a pas d'armes.” And the highly exaggerated account concluded by asking:
“Que se passera-t-il le jour ou des voyageurs commenceront à exporter la virus? D'ores et déjà , l'Afrique du Sud a annonce que des mesures sanitaires impitoyables ont été prises aux frontières. Mais l'extension des transports aériens permet-elle de contrôler efficacement lâétat de santé de tous les voyageurs circulant dans les regions infestées par ces maladies méconnues, venues du fond des temps? La civilisation industrielle a commence d'unifier la planète. Les philosophes s'en rejouissent autant que les hommes d'affaires. Les medecins, eux, ne cachent pas quâils y a aussi des raisons de s'inquieter.”
14
To this day members of the CDC team refuse to name the American individual. As McCormick puts it, “You can't blame a guy for being scared as hell. And I respect that he had the guts to be honest about it. It would have been a lot worse if he tried to be macho about it and came to Zaire, and then was an impediment to our work because he was so frightened that we couldn't count on him.”
15
The species gathered for analysis in the Yambuku area were:
| Bedbugs, | Cimex hemipterus | 818 | samples |
| Mosquitoes, | Culex cinereus | 8 | |
| Culex pipiens | 2 | ||
| Mansonia africana | 5 | ||
| Pigs, domestic | 10 | ||
| Cows, domestic | 1 | ||
| Bats, species unidentified | 7 | ||
| Rodents, | Mastomys | 69 | |
| Rattus rattus | 30 | ||
| Squirrels | 8 | ||
| Monkeys, | Cercopithecus | 6 | |
| Duikers, | Cephalophus monticola | 2 |
None of the samples was infected with the Ebola virus.
16
That day Sureau summarized his feelings after a month in the eye of the epidemic storm. “There it is, the virus responsible for the Yambuku hemorrhagic fever is baptized: âEbola'! I would have preferred âYambuku' but Karl prefers to give the names of rivers where the virus is discovered: he called âMachupo' after the name of a nearby river, the virus that caused hemorrhagic fever in Bolivia ⦠. But no matter; we don't ask genius to be right; we ask it to be provocative,” Sureau wrote in his diary.
17
A clinical account of Platt's case appears in: R. T. D. Emond, et al., “A Case of Ebola Virus Infection,”
British Medical Journal
2 (1977): 541â44.
British Medical Journal
2 (1977): 541â44.
18
“The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of northeastern Zaire between the Bumba Zone and the Sudan frontier near Nâzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless, it was established that people can and do make the trip between N'zara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an infection at the outpatient clinic,” stated the official report of an International Commission. See World Health Organization, “Ebola Haemorrhagic Fever in Zaire, 1976” (1978), op. cit.
19
N. J. Cox, J. B. McCormick, K. M. Johnson, and M. P. Kiley,”Evidence for Two Subtypes
of Ebola Virus Based on Oligonucleotide Mapping of RNA,”
Journal
of Infectious
Diseases 147 (1983): 272â75.
of Ebola Virus Based on Oligonucleotide Mapping of RNA,”
Journal
of Infectious
Diseases 147 (1983): 272â75.
20
J. G. Breman et al.,”Human Monkeypox Update 1970â79,” Bulletin of the World Health Organization 58 (1980): 849â68.
21
I. Arita et al.,”Human Monkeypox: A Newly Emerged Orthopoxvirus Zoonosis in the Tropical Rain Forests of Africa,” American Journal of Tropical Medicine 34 (1985): 781â89.
22
Z. Jezek et al.,”Human Monkeypox: A Study of 2,510 Contacts of 214 Patients,” Journal of Infectious Diseases 154 (1986): 551â55.
23
L. Khodakevich, Z. Jezek, and D. Messinger,”Monkeypox Virus: Ecology and Public Health Significance,” Bulletin of the World Health Organization 66 (1988): 747â52.
24
P. E. M. Fine et al.,”The Transmission Potential of Monkeypox Virus in Human Populations,”
International Journal of Epidemiology
17 (1988): 643â50.
International Journal of Epidemiology
17 (1988): 643â50.
25
World Health Organization,
Weekly Epidemiologic Record
(1977), op. cit.
Weekly Epidemiologic Record
(1977), op. cit.
26
WHO Expert Committee, “Viral Haemorrhagic Fevers,”
WHO Technical Report Series
721 (1985).
WHO Technical Report Series
721 (1985).
27
International Commission (1978), op. cit.
28
The brief official CDC summaries of Yambuku and Maridi events appeared in the agency's
Morbidity and Mortality Weekly Report:
October 15, 1976 (p. 324); October 26, 1976 (p. 339); November 5, 1976 (p. 342); December 3, 1976 (pp. 378â79); and July 1, 1977 (pp. 209â10).
Morbidity and Mortality Weekly Report:
October 15, 1976 (p. 324); October 26, 1976 (p. 339); November 5, 1976 (p. 342); December 3, 1976 (pp. 378â79); and July 1, 1977 (pp. 209â10).
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