Timeline for ID of New African Arenavirus

A newly identified arenavirus has killed one Zambian woman and two South Africans and has sickened at least one other South African healthcare worker. Provided here is the month-long timeline of events leading to the virus's identification.

September 12: An employee at a Zambian safari-tour company, Cecilia "Silky" van Deventer, 36, is airlifted from a Lusaka hospital to South Africa for management of an acute, unknown illness characterized by high fever and a deteriorating mental state. Prodromal symptoms included fever, headache, diarrhea, and myalgias for approximately 7 days. Van Deventer is presumed to be suffering from "tick-bite fever," given her contact with horses.

September 14: Van Deventer dies at the Morningside Medi-Clinic, a 230-bed private hospital in Sandton, near Johannesburg.

September 27: Paramedic Hannes Els, 33, who assisted in the evacuation of van Deventer from Zambia to South Africa is admitted to a Johannesburg hospital. Prodromal symptoms are similar to those of van Deventer, according to WHO.

October 1: An ICU nurse, Gladys Mthembu, 34, who cared for van Deventer in South Africa, is admitted to Sir Albert Robinson Hospital in the West Rand for similar symptoms.

October 2: Paramedic Els dies.

October 5: Nurse Mthembu dies.

October 13: Test results from the National Health Laboratory Service in Johannesburg and the CDC in Atlanta indicate that the causative agent is a newly identified arenavirus.* WHO reports that another South African nurse, who cared for either Els or Mthembu, has become ill with the disease (virus is confirmed by PCR). Latest reports indicate that the nurse is in stable condition in hospital isolation.

October 15: Sowetan reports that a radiographer, who worked at Morningside Medi-Clinic and came into contact with van Deventer, is admitted to St. Augustine's Hospital in Durban with arenavirus symptoms. There are doubts, however, about whether the radiographer is infected with the newly recognized virus.

WHO indicates that contacts of the fatal cases, 121 in South Africa and 23 in Zambia, are being traced. Person-to-person transmission of the virus (usually in the healthcare setting) is believed to occur primarily through contact with body fluids, as in the case of Lassa virus. Therefore an epidemic of the new virus is not expected.

Online posts and other news reports suggest that there is contention between Zambians and South Africans about the origin of the virus and the nationality of the index case, van Deventer.

* In the same family as viruses that cause Lassa fever and lymphocytic choriomeningitis. The most common vector for members of this virus family is rodents.

Photo of house mouse (Mus musculus), which is the rodent vector for the arenavirus lymphocytic choriomeningitis virus, from Wikipedia.