Mission Watch Additional Report - HEALTH CONCERN : "THE SOUR"
Of Concern: HEALTH CONCERN, EMERGENT DISEASE, INFECTIOUS DISEASE, POSSIBLY ABNORMAL, Africa, human contagion, REGIONAL, EPIDEMIC, treatable, LETHAL.
Concern Summary: Conclusions of an article about the Rupertine disease. Written by Dr. Sarah Desjeux, Health and Prevention Field Executive member.
The Sour is an emergent epidemic first identified in IDP camps in Niger, where UN-OCHA work clusters first encountered it. MCF personnel from the Ruperts-1 Work Group established a local Research-Health Programme with the approval of local authorities and African Union4, GOC5 and UN-OCHA6 support. It has been repeatedly called since 'the Rupertine' or 'Rupert's disease" by the local media and scientific bulletins emitted from both GOC and MCF internal editorials, but in truth it should be called by the names the affected communities have given it, as they are much more descriptive.
The Sour, also called the Milking Maggots disease, is caused by a virus which can be caught from infected humans. It is transmitted mostly through skin contact. It has been theorized that its etiologic agent, a virus possibly pertaining to the Herpesviridae family, is capable of surviving in contaminated water by infecting Giardia lamblia, a very common free-life protozoan. This makes clean water supply a priority for any Mission dispatched to areas affected by it, and immensely complicates Concern management.
The Sour doesn't have early onset symptoms. However, after an incubation period of ten to twelve days after infection, all patients will suddenly suffer from acute psychotic disorders which mainly involve psychotic clinical and radically altered behavior. They will be followed by a secondary phase in which self-inflicted injuries and/or severe trauma due to reckless demeanor are frequent.
A key symptom present in Sour patients is that most injuries occurred during this period will not heal nor bleed, releasing instead a pus-like white substance of a slightly floral smell and, reportedly, very sour taste. This usually dehydrates the subject, who quickly enters a state of passivity and delirium that may be accompanied by fever. Blood analysis has confirmed the presence of the likely etiologic agent in the bloodstream, but no satisfactory explanation for the apparent transmutation it undergoes when exiting the blood vessels due to traumatic injury larger than a pinprick.
It is infrequent, but not exceptional, to find small worm-like tumors in the edges of injuries suffered by the subjects; these characteristic growths give the Sour its other name, the Milking Maggot disease.
Normally, these symptoms should subside in ten to thirteen weeks of natural development, provided the patient survives the behavioral alteration phase. After this, normal healing processes resumes; however, chronic pain and/or general loss of health are frequent after the illness has run its course, due to major scarification and internal injuries — it is frequent to find injuries so complicated and/or extensive that normal healing processes cannot handle them.
Currently, early diagnosis of this disease is considered difficult even with access to laboratory conditions. Focus on contagion prevention measures and isolation of known patients should be absolute priorities to all Work Groups.
However, the agent has proven to be sensitive to a combined treatment of generic Aciclovir and Prometerine — see attached field manuals for dosage and viable administration routes, necessary material for the inoculation and possible alter-scientific uses —, and may be used as primary prevention, entirely stopping the development of the disease with an estimated 98% efficacy. Finally, if properly addressed and treated, the infection can be stopped in its early stages; actually, when combined with isolation and support measures to counteract the loss of fluids, even patients in deteriorated phases may survive!
To sum it up, the Sour has proven to be a highly infectious process, a dangerous threat to human life and an extremely distressing phenomenon to behold, both for relatives of its victims, first responders and NGO workers. The Manna Charitable Foundation possesses the means, the experience and the on-site assets to respond to this health concern in a comprehensive, complete capacity.
With a new possible outbreak in Sool, we stand on the brink of a potentially catastrophic deterioration in the state of humanitarian concerns of the area and the permanent destabilization of its already suffering societies. I, with the full support of my team, motion that we intervene immediately.
Dr. Sarah "Opal" Desjeux is a forty-nine years old Health and Prevention Field Executive member and has worked as such for thirty-one years, making her one of the most veteran field workers in the Manna Charitable Foundation. She worked as a volunteer for three years and has been a Mission Work Group Operation Leader for ten.
Programme Priority: Medium-High. All deployed personnel must be on the lookout for new outbreaks. Mission Watch will elevate Programme Priority accordingly to increases in rate of infection and mortality rates or new clinical presentations.
Safety Concerns: Strictly restricted to trained volunteers, specialists and Executive members. Engage only in optimal gear and deployment conditions. If detected, warn a) Mission Watch, b) Mission Branch Health and Prevention Directorate, c) the pertinent Continental Branch Secretariat and d) the UN-OCHA.