"The virus was isolated, and found to exhibit a unique morphology, leading to the designation of a new group: the Filoviridae. In the Marburg outbreak the disease presented with a 32% mortality rate (7 deaths out of 31 infections). Between 1987 and 1998, reported cases of Marburg were due solely to laboratory accidents both in the former Soviet Union. While there have been several naturally occurring outbreaks what happens when it is laboratory acquired? " Marburg hemorrhagic fever (MHF) in human and non-human primates, characterized by person to person transmission and high case fatality rates (2). To date, 34 filovirus hemorrhagic fever (FHF) outbreaks and laboratory -acquired infections are known to have occurred in humans. (23 EHF and 11 MHF), all in or originating from sub-Saharan Africa and yielding approximately 2800 laboratory confirmed, suspected, or putative cases (3-7). Epidemiological studies were done in parallel with the microbiological studies. It became apparent very early that all the patients in Marburg were employees of Behringwerke, a producer of sera and vaccines, and that the patients in Frankfurt were employees of the Paul Ehrlich Institute, a control institute for sera and vaccines. The primary case patient in Belgrade, a veterinarian, was employed at Institute Torlak. A major activity of these institutions was the production and safety testing of live poliomyelitis vaccine. All patients with primary infections at the 3 locations had direct contact with blood, organs, and cell cultures from Cercopithecus aethiops monkeys. These animals were imported from Uganda and were used mainly for the production of kidney cell cultures, which were needed for the propagation of vaccine strains. .For complete repport on German Marburg outbreak" see: http://jid.oxfordjournals.org/content/196/Supplement_2/S131.full
While this outbreak is certainly ranked among the worst laboratory acquired, highly pathogenic infectious diseases, it is more concerning still that it happened in a German laboratory, given, at that time, what would have been relatively high standards. Unfortunately, Germany has since witnessed other laboratory acquired diseases or LAD's. Recalling a sharps and sticks accident that happened as recently as 2009 in a Hamburg laboratory, the Journal of Infectious Diseases published a study entitled: "Management of Accidental Exposure to Ebola Virus in the Bio-Safety Level 4 Laboratory Hamburg, Germany", the report details this accident stating that "A needlestick injury occurred during an animal experiment in the biosafety level 4 laboratory in Hamburg, Germany in March 2009 The syringe contained Zaire ebolavirus (ZEBOV) mixed with Freund's adjuvant. Following a risk-benefit assessment, it was recommended the exposed person take an experimental vaccine. The syringe contained Zaire ebolavirus (ZEBOV) mixed with Freund's adjuvant. Despite high standards of protection in these laboratories, laboratory workers are still at risk of contracting Ebola hemorrhagic fever, in particular during animal experimentation. Three laboratory accidents iwth Ebola virus are documented in the literature: 1 case was fatal (4), 1 case was symptomatic and survived(5), and 1 case, there was no evidence that the accident resulted in infection (6). Here, we report on the management of laboratory accidents with Ebola virus that occurred in the BSL-4 facility at the Bernhard Nocht Insitute for Tropical Medicine in Hamburg, Germany." See full report: http://jid.oxfordjournals.org/content/204/suppl_3/S785.long
|Scientist separates cells in order to test for the Ebola virus at the European Mobile Laboratory Gueckedou, Guinea. Photo: Reuters|
The Case Study, detailed in the Journal of Infectious Diseases Report (http://jid.oxfordjournals.org/content/204/suppl_3/S785.long) included the following very detailed account. It gives us insights into what actually happens when a viral hemorrhagic fever such as Ebola or Marburg escape or in this terrible case, when there is exposure through sharps and sticks. The following is quite comprehensive account, but worth reading.
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