Wednesday, October 17, 2012

Where Will The Next Pandemic Come From? And How Can We Stop It? | Popular Science

In June 2008, a Dutch woman named Astrid Joosten left the Netherlands with her husband for an adventure vacation in Uganda. It wasn't their first trip to Africa, but it would be more consequential than the others.
At home in Noord-Brabant, Joosten, 41, worked as a business analyst for an electrical company. Both she and her spouse, a financial manager, enjoyed escaping Europe on annual getaways. In 2002, they had flown to Johannesburg and, stepping off the airplane, felt love for Africa at first sight. On later trips they visited Mozambique, Zambia, and Mali. The journey to Uganda in 2008, booked through an adventure-travel outfitter, would allow them to see mountain gorillas in the southwestern highlands of the country as well as some other wildlife and cultures. They worked their way south toward Bwindi Impenetrable Forest, where the gorillas reside. On one day, the operators offered a side trip, an option, to a place called the Maramagambo Forest, where the chief attraction was a site known as Python Cave. African rock pythons lived there, languid and content, grown large on a diet of bats.
Joosten's husband, later her widower, is a fair-skinned man named Jaap Taal, a calm fellow with a shaved head and dark, roundish glasses. Most of the other travelers didn't fancy this Python Cave offering, he told me later. "But Astrid and I always said, 'Maybe you come here only once in your life, and you have to do everything you can.' " They rode to Maramagambo Forest and then walked a mile or so, gradually ascending, to a small pond. Nearby, half-concealed by moss and other greenery, like a crocodile's eye barely surfaced, was a low, dark opening. Joosten and Taal, with their guide and one other client, climbed down into the cave.
The footing was bad: rocky, uneven, and slick. The smell was bad too: fruity and sour. Think of a dreary barroom, closed and empty, with beer on the floor at three a.m. The cave seemed to have been carved by a creek, or at least to have channeled its waters, and part of the overhead rock had collapsed, leaving a floor of boulders and coarse rubble, a moonscape, coated with guano like a heavy layer of vanilla icing. It served as a major roosting site for the Egyptian fruit bat (Rousettus aegyptiacus), a crow-size chiropteran that's widespread and relatively abundant in Africa and the Middle East. The cave's ceiling was thick with them—many thousands, agitated and chittering at the presence of human intruders, shifting position, some dropping free to fly and then settling again. Joosten and Taal kept their heads low and watched their step, trying not to slip, ready to put a hand down if needed. "I think that's how Astrid got infected," Taal told me. "I think she put her hand on a piece of rock, which contained droppings of a bat, which are infected. And so she had it on her hand." Maybe she touched her face an hour later, or put a piece of candy in her mouth, "and that's how I think the infection got in her."
No one had warned Joosten and Taal about the potential hazards of an African bat cave. They knew nothing of a virus called Marburg (though they had heard of Ebola). They only stayed in the cave about 10 minutes. They saw a python, large and torpid. Then they left, continued their Uganda vacation, visited the mountain gorillas, took a boat trip, and flew back to Amsterdam. Thirteen days after the cave visit, home in Noord-Brabant, Joosten fell sick.
At first it seemed no worse than the flu. Then her temperature climbed higher and higher. After a few days, she began suffering organ failure. Her doctors, knowing of her recent time in Africa, suspected Lassa virus or maybe Marburg. "Marburg," said Taal, "what's that?" Joosten's brother looked it up on Wikipedia and told him: "Marburg virus: It kills, could be big trouble." In fact, it's a filovirus, the closest relative to the ebolaviruses (of which there are five species, including the most infamous, Ebola). Marburg was first discovered in 1967, when a group of African monkeys, imported to Marburg an der Lahn, in western Germany, for medical research uses, passed a nasty new virus to laboratory workers. Five people died. In the decades since, it has also struck hundreds of Africans, with a case fatality rate of up to 90 percent.
The doctors moved Joosten to a hospital in Leiden, where she could get better care and be isolated from other patients. There, she developed a rash and conjunctivitis; she hemorrhaged. She was put into an induced coma, a move dictated by the need to dose her more aggressively with antiviral medicine. Before she lost consciousness, though not long before, Taal went back into the isolation room, kissed his wife, and said to her, "Well, we'll see you in a few days." Blood samples, sent to a lab in Hamburg, confirmed the diagnosis: Marburg. She worsened. As her organs shut down, she lacked for oxygen to the brain, she suffered cerebral edema, and before long Joosten was declared brain-dead. "They kept her alive for a few more hours, until the family arrived," Taal told me. "Then they pulled the plug out, and she died within a few minutes."
More ...