The Hot Zone - Страница 6

К оглавлению

6

Доступ к книге ограничен фрагменом по требованию правообладателя.

International health authorities were urgently concerned to find the exact source of the monkeys, in order to pin down where in nature the Marburg virus lived. It seemed pretty clear that the Marburg virus did not naturally circulate in monkeys, because it killed them so fast it could not successfully establish itself in them as a useful host. Therefore, Marburg lived in some other kind of host—an insect? a rat? a spider? a reptile? Where, exactly, had the monkeys been trapped? That place would be the hiding place of the virus. Soon after the outbreak in Germany, a team of investigators under the auspices of the World Health Organization flew to Uganda. The team couldn’t discover the exact source of the virus.

There the mystery lingered for many years. Then, in 1982, an English veterinarian came forward with new eyewitness information about the Marburg monkeys. I will call this man Mr. Jones (today, he prefers to remain anonymous). During the summer of 1967, when the virus erupted in Germany, Mr. Jones was working at a temporary job inspecting monkeys at the export facility in Entebbe from which the sick Marburg monkeys had been shipped, while regular veterinary inspector was on leave. This monkey house, which was run by a rich monkey trader (“a sort of lovable rogue,” according to Mr. Jones) was exporting about thirteen thousand monkeys a year to Europe. This was a very large number of monkeys, and it generated big money. The infected shipment was loaded onto an overnight flight to London, and from there it was flown to Germany—where the virus broke out of the monkeys and “attempted” to establish itself in the human population.

After making a number of telephone calls, I finally located Mr. Jones in a town in England, where today he is working as a veterinary consultant. He said to me: “All that animals got, before they were shipped off, was a visual inspection.”

“By whom?” I asked.

“By me,” he said. “I inspected them to see that they appeared normal. On occasion, with some of these shipments, one or two animals were injured or had skin leisons.” His method was to pick out the sick-looking ones, which were removed from the shipment and presumably killed before the remaining healthy-looking animals were loaded onto the plane. When, a few weeks later, the monkeys started the outbreak in Germany, Mr. Jones felt terrible. “I was appalled, because I had signed the export certificate,” he said to me. “I feel now that I have the deaths of these people on my hands. But that feeling suggests I could have done something about it. There was no way I could have known.” He is right about that: the virus was then unknown to science, and as few as two or three not-visibly-sick animals could have started the outbreak. One concludes that the man should not be blamed for anything.

The story becomes more disturbing. He went on: “The sick ones were being killed, or so I thought.” But later he learned that they weren’t being killed. The boss of the company was having the sick monkeys put in boxes and shipped out to a small island in Lake Victoria, where they were released. With so many sick monkeys running around it, the island could have become a focus for monkey viruses. It could have been a hot island, an isle of plagues. “Then, if this guy was a bit short of monkeys, he went out to the island and caught a few, unknown to me.” Mr. Jones thinks it is possible that the Marburg agent had established itself on the hot island, and was circulating among the monkeys there, an that some of the monkeys which ended up in Germany had actually come from that island. But when the WHO team came later to investigate, “I was told by my boss to say nothing unless asked.” As it turned out, no one asked Mr. Jones any questions—he says he never met the WHO team. The fact that the team apparently never spoke with him, the monkey inspector, “was bad epidemiology but good politics,” he remarked to me. If it had been revealed that the monkey trader was shipped off suspect monkeys collected on a suspect island, he could have been put out of business, and Uganda would have lost a source of valuable foreign cash.

Shortly after the Marburg outbreak, Mr. Jones recalled a fact that began to seem important to him. Between 1962 and 1965 he had been stationed in eastern Uganda, on the slopes of Mount Elgon, inspecting cattle for disease. At some time during that period, local chiefs told him that the people who lived on the north side of the volcano, along the Greek River, were suffering from a disease that caused bleeding, death, and “a particular skin rash”—and that monkeys in the area were dying of a similar disease. Mr. Jones did not pursue the rumors, and was never able to confirm the nature of the disease. But it seems possible that in the years preceding the outbreak of Marburg virus in Germany, a hidden outbreak of the virus occurred on the slopes of Mount Elgon.


Mr. Jones’s personal vision of the Marburg outbreak reminds me of a flashlight pointed down a dark hole. It gives a narrow but startling view of the larger phenomenon of the origin and spread of tropical viruses. He told me that some of the Marburg monkeys were trapped in a group of islands in Lake Victoria known as the Sese Islands. The Senses are a lowlying forested archipelago in the northwestern part of Lake Victoria, an easy boat ride from Entebbe. The isle of plagues may have been situated among the Senses or near them. Mr. Jones does not recall the name of the hot island. He says it is close to Entebbe. At any rate, Mr. Jones’s then-boss, the Entebbe monkey trader, had arranged a deal with villagers in the Sese Islands to buy monkeys from them. They regarded the monkeys as pests and were happy to get rid of them, especially for money. So the trader was obtaining wild monkeys from Sese Islands, and if the animals proved to be sick, he was releasing them on another island somewhere near Entebbe. And some monkeys from the isle of plagues seemed to be ending up in Europe.

In papyrus reeds and desolate flatlands on the western shore of Lake Victoria facing the Sese Islands, there is a fishing village called Kasensero. You can see the Sese Islands from the village. Kasensero was one of the first places in the world where AIDS appeared. Epidemiologists have since discovered that the northwestern shore of Lake Victoria was one of the initial epicenters of AIDS. It is generally believed that AIDS came originally from African primates, from monkeys and apes, and that it somehow jumped out of these animals into the human race. It is thought that the virus went through a series of very rapid mutations at the time of its jump from primates to humans, which enabled it to establish itself successfully in people. In the years since AIDS virus emerged, the village of Kasensero has been devastated. The virus has killed a large portion of the inhabitants. It is said that other villages along the shores of Lake Victoria have been essentially wiped off the map.

The villagers of Kasensero are fishmen who were, and are, famous as smugglers. In their wooden boats and motorized canoes they ferried illegal goods back and forth across the lake, using the Sese Islands as hiding places. One can guess that if a monkey trader were moving monkeys around Lake Victoria, he might call on the Kasensero smugglers or on their neighbors.

One general theory for the origin of AIDS goes that, during the late nineteen-sixties, a new and lucrative business grew up in Africa, the export of primates to industrialized countries for use in medical research. Uganda was one of the biggest sources of these animals. As the monkey trade was established throughout central Africa, the native workers in the system, the monkey trappers and handlers, were exposed to large numbers of wide monkeys, some of which were carrying unusual viruses. These animals, in turn, were being jammed together in cages, exposed to one another, passing viruses back and forth. furthermore, different species of monkeys were mixed together. It was a perfect setup for an outbreak of a virus that could jump species. It was also a natural laboratory for rapid virus evolution, and possibly it led to the creation of HIV. Did HIV crash into the human race as a result of the monkey trade? Did AIDS come from an island in Lake Victoria? A hot island? Who knows. When you begin probing into the origins of AIDS and Marburg, the light fails and things go dark, but you sense hidden connections. Both viruses seem part of a pattern.


When he learned what Marburg virus does to human being, Dr. David Silverstein persuaded the Kenyan health authorities to shut down Nairobi Hospital. For a week, patients who arrived at the doors were turned away, while sixty seven people were quarantined inside the hospital, most medical staff. They included the doctor who had done autopsy on Monet, nurses who had attended Monet or Dr. Musoke, the surgeons who had operated on Musoke, and aides and technicians who had handled any secretions from either Monet or Musoke. It turned out that a large part of the hospital’s staff had direct contact with either Monet or Musoke or with blood samples and fluids that came from the two patients. The surgeons who had operated on Musoke, remembering only too well that they had been “up to the elbows in blood”, sweated in quarantine for two weeks while they wondered if they were going to break with Marburg. A single human virus bomb had walked into the Casualty waiting room and exploded there, and the event had put the hospital out of business. Charles Monet had been an Exocet missile that stuck the hospital below the water line.

Dr. Shem Musoke survived his encounter with a hot agent. Ten days after he fell sick, the doctors noticed a change for the better. Instead of merely lying in bed in a passive state, he became disoriented and angry and refused to take medicine. One day, a nurse was trying to turn him over in bed, and he waved his fist at her and cried, “I have a stick, and I will beat you.” It was around that time that he began to get better, and after many days his fever subsided and his eyes cleared; his mind and personality came back, and he recovered slowly but completely. Today he is one of the leading physicians at Nairobi Hospital, where he practices as a member of David Silverstein’s group. One day I interviewed him, and he said to me that he has almost no memory of the weeks he was infected in Marburg. “I only remember bits and pieces,” he said. “I remember having major confusion. I remember, before my surgery, that I walked out of my room with my IV drip hanging out of me. I don’t remember much of the pain. The only pain I can talk about is the muscle ache and the lower-back ache. And I remember him throwing up on me.” Nobody else at the hospital developed a proven case of Marburg-virus disease.

Доступ к книге ограничен фрагменом по требованию правообладателя.

6