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Intro to Public Health - Hot Zone Presentation

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Shakita Jenkins

on 4 October 2012

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Transcript of Intro to Public Health - Hot Zone Presentation

The Hot Zone Pt. 2 - Sister M.E.'s blood flown to Belgium, England and CDC in Atlanta for testing
* CDC- Patricia Webb, virologist, injected monkey cells with unknown agent - Eugene Johnson - USAMRIID
* Met unnamed man at Dulles International Airport near Washington
* Given box containing vials of blood serum
> 10 year old Danish boy •Explored the cave and made a map of it.
• Johnson got the army to sponsor a major expedition to the Kitkum cave and the government agreed to close the cave off to tourist
•Brought in Guinea pigs, monkeys, and baboons to the cave in hopes that some would break out with the Marburg virus.
•In the spring 1988 the expedition set up headquarters on Mount Elgon Lodge.
•The cave was thought to be a level 4 zone so spacesuits were worn before entering the cave.
•The animals were placed in specific spots in hopes that droppings would fall on the animals so that they would break out.
•Many rodents, birds, hyraxes and bats were trapped and tested negative for the disease.
•The expedition was considered a “dry hole”.
•Summer 1989
•Army assigned Jerry and Nancy Jaax to the Institute of Chemical Defense in Maryland
• Both received promotions to Lieutenant colonel
•Colonel Tony Johnson appointed head of pathology at Walter Reed Army Medical Center, he urged the army to appoint Nancy to his old position
*Granted in 1989
*Jerry was appointed to the veterinary division.
* Moved back to Thurmont in August 1989 •Eugene is six foot two about two hundred and fifty pounds.
•Eugene Johnson was told that the young boy had been in Kitkum Cave before getting sick.
* Flew to Nairobi to talk to the kid’s doctor Dr. David Silverstein and visit everyplace that the kid went.
*Met Peters parents
• Peter had taken some rocks from the cave in which they were broken by the driver washed by the cook.
*Negative for Marburg
•In 1986, General Johnson had done an experiment to see if Marburg and Ebola was airborne.
*Wore military gas masked and flowered pillowcases 1989 October 4, Wednesday
•Reston, Virginia was one of the first planned suburbs in America. Prosperous community 10 miles west of Washington, D.C.
•Autumn of 1989 a company called Hazelton Research Products which was located in a one story building was used as a monkey house.
*Division of Corning, Inc. Corning’s Hazleton unit which was involved in the importation and sale of laboratory animals.
*The monkey house was known as the Reston Primate Quarantine Unit.
*About 16,000 wild monkeys were imported each year.
*Monkeys must be quarantined for about a month before they are shipped anywhere else in the U.S. in order to prevent the spread of disease.
•Dan Dalgard
*Doctor of veterinary medicine and the consulting veterinarian at this location.
* Knowledgeable and skilled veterinarian in primate husbandry.
Wednesday, October 44, 1989
*Hazelton Research Products accepted a shipment of a hundred wild monkeys from the Philippians.
* Crab eating monkeys
*Led by a strict hierarchy. I Half of Reston Exposure
November 1, Wednesday
-Bill Volt: Colony Manager at Reston Monkey House

-Monkeys were dying in large numbers; third of the Philippine monkeys died.
*Deaths were taking place in Room F

-Dalgard inspected Room F and the monkeys by reading body language and their eyes

-Dalgard figured that the monkeys were dying doing to the extreme heat conditions
Inspected the dead carcasses (Spleen and intestines); believed them to have
Simian Hemorrhagic Fever Infected liver with SHF •Jahrling is testing the virus culture from the monkey house
o Used three sets of blood
• Musoke- test for Marburg from blood of survivor
• Boniface- test for Ebola Sudan
• Mayinga- test for Ebola Zaire
o Sample would glow if infected with the virus that it is being tested for
• Mayinga glowed brightly
• Jahrling was horrified - Geisbert comes into work and begins slicing into the chosen monkey – O53
* The animal is infected with active virus, inclusion bodies, “bricks”
* They had to wait to receive Jahrling’s test results - last confirmation needed for Marburg diagnosis
• Jahrling worked fervently and nonstop on identifying the virus
* Mid-day he decided to call Dan Dalgard
* Geisbert identified the virus as an unknown agent and asked him to cease all cutting of the monkeys until tests were completed and results were in
* Dalgard was left in anxiety
* Dalgard called and left message for absent Jahrling Questions or
Comments? Questions
for Discussion Would you have told CJ that you sniffed the flask that possibly contained traces of an unknown virus? Consider being in Eugene Johnson's position and having conducted tests on several viruses that resulted in false alarms. If you were handed yet another sample of blood serum would you have considered throwing it away? If you had been in Tom Geisbert's position and were worried about all of the things that he was when bringing the concern to Peter Jarhling, would you have brought the photo to your boss? Thank you for your time! By:
Shakita Jenkins, Destiny Kelly, Erin Legrand and Rashaunnah Sledge -Tom Geisbert goes in to work unsuspecting yet anxious
* Worked with a diamond knife
* Cutting machine held diamond knife
* Wooden stick with human eyelash glued to it
* Tweezers and small metal grid
*Tiny box Image of virus under electron microscope 3 Phillipine Macaque monkeys Friday, November 10
-Dalgard returned back to the colony house
*Found 3 more dead monkeys
*Took dead carcasses to examination room
-Dalgard thought it would be wise to keep a diary; “Chronology of Events”
-Found the spleens to be abnormal

Sunday, November 12
-Dan returned to monkey house
*Found 3 more dead monkeys
*Examined these dead monkeys and called them “O53” 1989 November 13, Monday

-Dalgard brought this matter to the attention of USAMRIID
-Dan spoke with virologist, Peter Jaharling
*Agreed to look at “O53” sample
-Meanwhile things were fine at the Monkey House and there were no results
-A day later, 8 monkeys died in Room F

Thursday, November 16

-Monkeys continued to die in Room F
-Jaharling called with a diagnosis of simian hemorrhagic fever
-Dan killed and examined 8 healthy monkeys for SHF November 17
-Thomas Geisbert
*27yr old intern at USAMRIID Institute
*Analyzed test tubes from Room F monkeys
>Noticed that the cells from these monkeys looked very abnormal
-Tom told Jarling about findings and they both took a closer look.
Both of them sniffed the flask for a smell but there was none.
EXPOSED THEMSELVES TO AN UNKNOWN November 20-25
- Jaxxes visited family in Kansas for the Thanksgiving holiday.
- Over Thanksgiving Dan Dalgard called USAMRIID to receive that test result.
-Day after Thanksgiving 5 monkeys died in Room H; 2 doors down from
Room F.
- Sister M.E. is dying
* Terminal shock
* Convulsions
* Agonal biopsy – rapid sampling of tissue close to death instead of full autopsy
* Blood samples from arm -Dr. Murphy analyzed virus particles under microscope
* Thought what he saw was Marburg resurfacing
* Webb ran more tests concluded particles did not react to any tests for Marburg - Karl Johnson named new hot agent Ebola
* Left for Sudan and Zaire with a group of doctors
* Organized efforts to stop virus from spreading - Joel Breman – met with governor in Bumba Zone
* Drove through Africa looking for proof of virus spreading
* Realization, after traveling through African towns, Ebola virus had already peaked
* Unsanitary hospitals
* Breman headed back to Bumba Zone

- Back in Ngaliema Hospital in Kinshasa:
* Nurse Mayinga is being watched over by Dr. Isaacson
Symptoms began:
> Hemorrhagic nose bleeding
> Blood from mouth
> 3 whole blood transfusions
> Galloping heartbeat indicating Ebola had entered heart
> Heart attack resulted in death

- Medical teams found 37 people who had come in contact with Mayinga during her illness
* Set up bio containment pavilions
> Proper disposal of bodies
> Reduce panic of town
> Result 0 out of 37 caught virus
- Ebola is subsiding
- Visited parents in Africa – traveled through Kenya on vacation
* Developed red eyes in town called Mombasa
> Flown to Nairobi hospital under care of Dr. Silverstein - Cardinal’s Initial Symptoms:
* “Fluffy” lungs
- Secondary Symptoms:
* Blue in color
* Red spots
* Deranged liver functions
* Dilated pupils – blood in the brain
- Final Symptoms:
* Bled out under skin – “third space” -E. Johnson dropped Cardinal’s blood serum into flask with monkey cells
* Result: cells were bursting
-Tested blood serum in guinea pigs
* Result: “killed them like flies”
-Conclusion: Cardinal was infected by Marburg -Johnson wondered how Cardinal became infected with Marburg...?
* Contacted Dr. Tukei in Nairobi
-Tukei discovered cardinal had been in Kitum Cave on Mount Elgon
***Recall Charles Monet - Geisbert combed the “forest” of the cell looking for viruses
* “blown apart” - crawling with worms
- Bittersweet moment
* His preliminary conclusion: Marburg virus
- Nervous and hesitant about his conclusion November 27th @ 0700 HRS - Geisbert brings the problem to his boss: Peter Jahrling
* First reaction: this is a joke and its not funny
* Second reaction: remembering all of the things he had done
* Third reaction: checking and double checking
* Final reaction: take the findings to his boss – Colonel CJ Peters, MD - Peters is involved in the findings of Geisbert
* Pictures were placed in a folder
* Jahrling flashes only a glimpse of the photo to Peters
* Peters asks when will confirmation test be done so that work may begin on addressing the issue if it is Marburg
* Peters demands more proof •Geisbert and Jahrling begin to rationalize why they didn’t and shouldn’t tell that they sniffed the flask •They test their own blood – blood is drawn by outside civilian technician who swears to keep quiet
o This point is when Jahrling reflects on sniffing the flask and how he should have exercised more caution in that situation November 27th @ 1000 HRS November 28th November 28th @ 1500 HRS Going Deep
•Monkeys were placed in their own cages, under artificial lights and were fed biscuits and fruit.
*12 monkey rooms labeled A thru L.
•Upon their arrival October 4 two monkeys were dead in their crates and within the next three weeks an unusual number of monkeys began to die
•On October 4 the same day as the shipment arrived, Jerry Jaax’s younger brother John had been found murdered at work.
*Found by his wife at work in his office.
*Reed Buente was the police officer who took the case.
•Wednesday, November 1
•Bill Volt was the colony manager and Reston
* watched his first monkey die
*He became very alarmed.•
•November 1
* Bill called Dan Dalard.Informed him that nearly 29
out of 100 monkeys had died.
* Facility heating and air handling system issues.
*Deaths occurring in Room F. II Half of Reston Into Level 3 Thanksgiving Ngaliema Hospital - Africa Testing Analyzation Ebola Searching for Evidence Nurse Mayinga Post Mayinga’s Death Box of the Unknown “Peter Cardinal” Symptoms It's Marburg Charles Monet Rings a Bell
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