TWO DEATHS BY UNKNOWN DISEASE IN ZAMBIA; EAC

C O N F I D E N T I A L LUSAKA 000982 STATE FOR S/S-CMS, MED, AF/S, AND CA/OCS PRETORIA FOR RMO/MED SIPDIS E.O. 12958: DECL: 10/03/2009 TAGS: ESTH ASEC AMED ZA SUBJECT: TWO DEATHS BY UNKNOWN DISEASE IN ZAMBIA; EAC MEETING HELD Classified By: Charge d'affaires a.i., Michael Koplovsky, reasons 1.4, b/d. ¶1. (C) Summary: Embassy Lusaka CDC office has learned that two cases of "suspected" hemorrhagic fever are being investigated in Zambia after two people died subsequent to being med-evaced to South Africa. We understand a South African nurse at Morningside Hospital who treated the second Zambian case has come down with the same symptoms. Four tourists with the same safari company from which the first case originated were brought to Lusaka for testing, but two were confirmed NOT to have the same illness and the other two do not appear to be following up. EAC is attempting to gather further information before deciding whether to issue a warden message. End Summary. ¶2. (C) The first case of suspected hemorrhagic fever from Zambia was South African woman employed by Wilderness Safaris company in Lusaka. She fell ill on Sept. 10 with fever, headache, diarrhea, sore throat, and later, rash. She was med-evaced to South Africa by the local air ambulance service Specialty Emergency Services (SES),and she died there on Sept. 14. The Zambian paramedic who accompanied her during the med-evac fell ill on Sept. 25 (same symptoms) and died in RSA on Oct. 1. Death was due to organ failure/internal bleeding. We understand that there is a third confirmed case in an ICU nurse in South Africa who treated the paramedic. The first case had been treated at three Lusaka clinics without success before resorting to med-evac, including Care for Business (used by Embassy),Corp Med, and a Korean clinic adjacent to an AmEmbassy housing complex. ¶3. (C) A hemorrhagic fever is suspected in the two initial cases, but serum samples tested by a respected South African lab with a history of good cooperation with CDC and WHO rule out Ebola, Marburg, and Crimean-Congo. The first victim apparently lived in a rural area around Lusaka, with horses and other animals on her property. Physicians brought in by Wilderness Safaris suspect a possible tick-borne disease. Only those who had intimate contact with the patients have come down with similar symptoms, so person-to-person transmission may be via bodily fluids -- vomit, saliva, blood, etc. The first two cases indicate an incubation period from exposure to death of about three weeks, and from presentation of symptoms to death of about one week. Corp Med reports that four other Wildlife Safari customers from their bushcamp on the Lower Zambezi fell ill and have come to Lusaka for assessment. Corp Med tells us they have tested the first two, and they do NOT have the same illness. The other two have not yet appeared for care. ¶4. (C) Embassy EAC met Oct. 3 to assess the situation. The group assessed the risk to AmCits, Embassy personnel and EFMs as "low" given the need for intimate contact for transmission, but remained concerned. MGT/Health has been in touch with RMO Pretoria; CDC is in touch its HQ in Atlanta, RSA officials, a local doctor, the Wilderness Safari doctors, and the Zambian Ministry of Health. Despite a rumor that Care for Business was closed to new patients, we have confirmed that it is open. We understand South African law prohibits med-evacs of suspected hemorrhagic fever, and we are attempting to confirm whether medevacs of other emergencies would be allowed from Zambia. EAC will review tripwires for authorized departure in public health situations like this one. ¶5. (C) Given the lack of available information at this time (e.g. whether this is really hemorrhagic fever, from where in Zambia the other yet-to-be-tested patients are coming, and whether Lusaka has viable medevac options for other possible emergencies) EAC has decided not to issue a warden message at this time (as of 1100 local) as that could fuel unnecessary panic. EAC will review the situation and new information at 1200 local (0600 EDT) and report via cable. KOPLOVSKY