The Korean War's silent killer strikes again.
Almost half a century has passed since the start of the Korean War on June 25, 1950. More than three years of fighting between United Nations and communist forces culminated indecisively with the July 27, 1953, signing of what has become an uneasy truce.Although the belligerents finally stopped killing each other, a different type of assailant -- oblivious to the armistice -- continued its relentless assault. It waged war not only on the ravaged Korean peninsula, but throughout the world. Today, the battle against this adversary isn't being fought by armies, but by soldiers of science whose basic weapon is research. They have yet to achieve victory, as their elusive target adopts divergent forms.
Not differentiating friend from foe, this enemy of both enemies first attracted international attention after it struck U.S. troops during the Korean War. No stranger in a part of the world where it had been active for centuries, it blindly attacked opposing sides and civilians with equal intensity and was irrefutably responsible for the demise of untold numbers on and off the battlefields. Unarmed and unnoticed as it moved among its prey-striking indiscriminately -- this insidious killer was a disease: Korean hemorrhagic fever (KHF). Allied and communist troops alike, as well as civilians, endured its wrath.
KHF is a widespread and often fatal illness caused by a rodent-borne species of Hantavirus known clinically as Hantaan virus. The same or closely related Hantavirus maladies (called epidemic hemorrhagic fever in China and by several different names in at least 20 countries) are pervasively rampant throughout the Far East.
Hantaan virus is the pathogenic namesake of the Hant'an River and Valley. It was there, in the area near the confluence of the Hant'an and lmjin rivers, that the earliest significant concentration of hemorrhagic fever cases among UN troops was reported during the Korea War.
Thirty-three years after the fighting had ended, the basically identical ailment, precipitated by the same viral pathogen, launched another brutal assault. Of a contingent of U.S. Marines engaging in peacetime maneuvers with their South Korean counterparts in 1986, 14 became ill and two died. The culprit was identified as Hantaan Hantavirus. The Marines in the mid 1980s and the combatants in the early 1950s were in rodent-infested areas where there was vulnerability to KHF, the primary vector of which is rats. The Marines, during preparedness exercises, were in the field. Allied forces (mostly American) moving up and down the battle-torn peninsula so many years earlier not only lived and fought in desolated fields, they occupied cities and villages destroyed by war. Sometimes, they took refuge in abandoned, filth-permeated houses and buildings where rats and other vermin proliferated.
Flamethrowers, often used to clear brush and debris, were unsuccessful in substantially eliminating the breeding and nesting places of disease carriers. Thus, there was no shortage of hosts favored by Hantaan Hantavirus.
There never has been conclusive evidence of person-to-person transmission of the agent causing KHF. Four known species of rats, several of mice, and common voles have been identified as Hantavirus hosts. The virus is airborne, arising from dusty ground saturated by feces, urine, and saliva deposited by its rodent vectors. Victims are infected through inhalation. Ingestion of contaminated foodstuffs has not been blamed for infection, though viral penetration of skin abrasions has been mentioned as a possibility. The incubation period is approximately a month, sometimes even more, as viral invasion of blood cells accelerates and replication of the pathogen occurs.
How many stricken Americans actually succumbed to the ravages of KHF? Mortality figures from official sources fail to show the full extent of illness and death caused by the disease. Moreover, imprecise or even missing medical records have made it impossible to compile an accurate death count. Conflicting estimates emanate from different sources and range from five to 15%. Consequently, it isn't unreasonable to speculate that the percentage of KHF victims who perished during the war substantially exceeded even the highest approximations.
There is, furthermore, an unanswerable question: Did any of those who perished in unsanitary, disease-ridden, communist-run prisoner-of-war camps actually have Korean hemorrhagic fever? It isn't unreasonable to postulate that the disease contributed to the inordinately high morbidity rate among the thousands in Red-controlled internment centers where malnutrition, filth, exposure, and brutality claimed thousands. Subsisting on putrescent swill, many prisoners failed to survive. Among the afflictions were tuberculosis, pneumonia, typhus, hepatitis, dysentery, beriberi, pellagra, and gangrene.
Influenza ranged far and wide. The more execrable and horrid the living conditions of the POWs, the more vulnerable they became to the ravages of life-threatening ailments -- some of which were suffered concomitantly. Regardless of their agonies, they received little or no medical treatment or essential drugs in prisoner compounds that were no more than death factories.
As concern mounted for the deteriorating welfare of prisoners, based on intelligence reports from agents in North Korea, the hierarchy at UN Command Headquarters in Tokyo was gravely disturbed by other intelligence communications. From behind the lines in North Korea came word that many of the Chinese invaders had become incapacitated and were dying of a rapidly spreading sickness resembling the type of plague common in China (Yersinia pasteurella pestis).
Gen. Douglas MacArthur and the UN Command feared that the plague, if it actually existed in enemy ranks, could spread to allied forces, inactivating thousands and critically impeding the campaign against the communists. It soon was learned, however, that plague was not responsible for the escalating illness among the Chinese Communist Forces (CCF). While that fear was dispelled, health officers at MacArthur Headquarters continued to search for exact information about the deadly pestilence said to be incapacitating and killing large numbers of enemy troops.
Allied medical investigators, relieved that the reported scourge was not plague, still were apprehensive that the malady striking the enemy might spread to American and other UN units at the front. An epidemic among those facing the CCF could have hampered critically or even shattered efforts to contain the recently arrived Chinese adversaries who possessed virtually unlimited replacements, thousands of whom were hapless peasants dragooned into service to fight in a war they knew little about. United Nations reserves, by comparison, were limited. UN soldiers, with the exception of South Koreans, would necessarily travel great distances to reach Korea; CCF legions, with vastly greater manpower in neighboring Manchuria, simply could cross the Yalu River and arrive at the battle zones in little time. Disease, therefore, could result in a potentially irreversible U.S.-UN setback on the battlefield while benefiting the foe.
With plague ruled out, some agents in North Korea secretly messaged Tokyo that many sick Chinese soldiers appeared to have smallpox. These surreptitious transmissions turned out to be erroneous. (The Chinese Revolutionary Government had utilized the old, but efficacious, smallpox vaccine, administering it to many CCF troops. Allied forces also had received vaccinations protecting them from what was then one of the world's most feared contagions.)
Suspicion subsequently focused on a particularly virulent type of influenza -- the same strain that infected much of the world's population in the early 1950s, had its genesis in the Far East, and eventually was dubbed Asian flu. Many American and UN troops came down with what was assumed to be the flu or some relatively nonthreatening ailment. The exact incapacitating sickness affecting both sides never was defined precisely. Many troops did suffer from influenza and it hit combatants very hard. Did some personnel, thought to have critical cases of that common disease, actually suffer from Korean hemorrhagic fever?
Elements of the CCF'S enormous First Field Army began pouring onto the Korean peninsula beginning Oct. 14, 1950. There is little doubt that rodents, some of them Hantavirus carriers, burrowed into CCF supplies -- transported from Manchuria across the Yalu River, where hemorrhagic fever was no stranger. It is considered within the realm of possibility that many Chinese soldiers were laid low by Hantavirus-induced infections.
For the communists, sickness among their own forces presented an ideal opportunity to promulgate anti-American propaganda. Allegations that the U.S. had perpetrated germ warfare soon circulated globally. The communist misinformation campaign never was supported by conclusive evidence of germ warfare by the Americans.
A litany of malaise
Korean hemorrhagic fever presents a tortuous multitude of acute symptoms. Its abrupt onset mimics an inordinately harsh, incapacitating influenza. It is produced by a pathogen capable of delivering agonizing blows. Following the first blow, the "pseudo flu," is profound weakness leading to prostration, fever, nausea, retching and uncontrollable vomiting, food revulsion, and difficulty in retaining liquids. Headaches, ocular malfunction, and swollen eyelids are common complications, as are dizziness, impaired cognition, and blunted perception. Throat irritation sometimes occurs, as do stomach pangs and gnawing abdominal discomfort. Profuse and bloody urine, usually in the advanced stages of the disease, add to the misery and discomfort of those afflicted.
Redness of the skin affects the face, neck, and upper torso, giving distinct evidence of a discase process. Rubescent blotches are an external indication of internal chaos caused by capillary leaks. High blood pressure can fall to an abnormal low if recovery doesn't begin prior to terminal manifestations. Danger of a secondary (not opportunistic) bacterial infection exists, usually during any but the earliest phases of KHF. (Bacterial invasion of a body already weakened by a viral malady can produce an abundance of complications, while markedly slowing the recovery process and creating further danger of greatly prolonged illness or eventual death.)
The anguish of many patients is intensified by an aggregate combination of disastrous occurrences adversely affecting body chemistry and organic function. There is an imbalance of calcium (critical for blood coagulation and other vital functions) and potassium (important in the conduction of nerve impulses affecting the heart and other organs). Cardiac insufficiency becomes obvious, with the heartbeat slow or irregular. In the most devastating cases -- invariably terminal -- breathing becomes labored as fluid accumulates in the lungs. Kidney shutdown is a possibility, as is liver enlargement. Progression to shock and convulsion bring the end of life to many. Some, however, survive even these extremes and eventually recover. During the Korean War, there were others who contracted a less virulent form of KHF brought on by exposure to what since has been identified and dubbed "Seoul virus." This infectious agent is related to Hantaan virus, but is not likely to kill. It is considered to be a random mutation.
Hemorrhagic fever cases, frequently unrecognized as such, were among those cared for at medical installations in the field, known officially as rear hospitals. Recuperating patients at these facilities included persons who had undergone treatment at Mobile Army Surgical Hospitals. The medical and functional relationship of MASH facilities to rear hospitals was vital. Identified cases of hemorraghic fever eventually were treated at the 48th MASH. This installation was created when cases of the disease were proliferating and the number of severely ill patients was growing.
Omnipresent, Hantavirus is a versatile and deadly infectious agent. Proceeding in stealth, it is progenitor of a large and flourishing family of pathogens -- ravenously virulent in some countries, relatively mild in others. In its classic structure, the virus probably is ancient, having modified and mutated through the ages. Its origin is lost in the mists of pre-history, but ancient writings and medical treatments provide evidence of afflictions and symptoms resembling those precipitated by the Hantavirus. It is likely that this pathogen and its variant strains have bedeviled people for thousands of years.
Two years before America entered World War I, British soldiers in France suffered at least 2,000 cases of "field nephritis" or "war nephritis" -- physical manifestations not recognizably different than KHF. The disease diminished by the time U.S. forces arrived in France. An undetermined number of Germans were devastated as well, but, oddly, there were no reported cases of widespread infection among the French.
A disease that mirrored KHF was experienced by German invaders in the Soviet Union during World War II. The same thing struck thousands of Japanese when they occupied Manchuria from 1931 to 1945.
Is the U.S. at risk?
The U.S. has not escaped the wrath of Hantavirus. It was responsible for the deaths of at least 40 persons in 17 states in little more than a year. The mortality rate among those infected was said to be approximately 60%, an average exceeding known cases of Korean hemorrhagic fever among U.S. troops in the early 1950s.
The first medically certifiable cases of the infection in this country were reported in and around the huge Navajo reservation that lies in the Four Corners region of New Mexico, Arizona, Colorado, and Utah in March, 1993. Authorities were baffled at first by the spreading ailment, which eventually claimed about 20 lives. They referred to a "mystery disease." It wasn't long until what was thought to be a new species of Hantavirus was indicted -- adult respiratory distress syndrome (ARDS), also known as Hantavirus pulmonary syndrome. It is theorized that ARDS could have been caused by a re-emerging form of Hantavirus, quiescent for a very long time, or a mutant strain with no recognized pathological antecedent. More important is that the many types of Hantavirus do not present the same symptoms. An example is the distinct difference between the terminal stages of KHF and those of ARDS, though both present symptoms that include capillary leaks.
The initial sickness, brought on by KHF and ARDS, resembles a sudden influenza attack. While the pathogen causing KHF becomes capable of striking the kidneys, its devastating relative, ARDS, takes lethal aim at the lungs, resulting in deadly respiratory involvement, progressing to oxygen deprivation.
Although the most ominous, death-dealing symptoms of these two diseases are critically different, they are contracted in a common way. The guilty microbe is airborne -- issuing from the waste products of rats in Korea and field mice in the southwest U.S. Rats, legions of them stowaways on ships, are the usual hosts for Hantaan and Seoul Hantaviruses in urban areas of this country. As viruses emerge from rodent excreta, they permeate the surrounding atmosphere and are apt to be inhaled by persons nearby.
The Hantaan virus (or an agent with similar properties) may have infected persons in at least one major U.S. city. Antibodies of Hantaan or related viruses have been found in Norway rats in Baltimore, possibly emerging from ships in its harbor. Medical investigators have detected antibodies of hemorrhagic fever precursors in serum samples provided by a significant number of residents living in Baltimore's high-poverty port area, where rats are in abundance. Apparently, any illnesses they had were not severe, but, nevertheless, may have produced residual ailments such as kidney disease and high blood pressure. These are two of the hypothetical KHF aftermath conditions; the other is an increased risk of stroke.
The Army's Medical Research Institute of Infectious Diseases was selected to compile information possibly leading to a pilot study about the suspected proclivity of late-developing conditions among those who survived KHF during duty in Korea. (Sustained pathological chronic conditions would tend to refute generally accepted medical dogma that KHF is an acute illness, the opposite of one resulting in a chronic condition not infrequently manifested by a slow degenerative onset.) A completed study, analysis, and evaluation of the present health of former KHF victims who have experienced chronic high blood pressure, stroke, and/or kidney disorder remains in limbo, awaiting sufficient Federal funding.
In this article, we have referred to the American Hantavirus in the singular -- as a unitary ailment. Actually, researchers at the Centers for Disease Control in Atlanta have reported at least four sub-types presumably producing comparable manifestations. Multiple versions of the viral archetype apparently rule out a vaccine of maximum effectiveness against all four. This has been the experience in the Far East, where a universally applicable Hantavirus vaccine has defied development.
One experimental drug has shown in vitro effectiveness in preventing replication of at least one strain of Hantavirus. In the absence of a broadly efficacious vaccine, however, the battle against the Hantavirus family centers on elimination, or at least significant reduction, of vector rodents. Current treatment merely is symptomatic. There has been no specific remedial medication.
The diverse species of the marauding Hanta pathogen are winning the war for now. Hantavirus in its various forms continues to bring severe illness and death to millions throughout the world. Fortunately for Americans, there have been relatively few victims in the U.S. -- so far! Today, this menace to health joins other rapacious ailments claiming untold numbers of lives. It is among so-called emerging viral diseases, including (but not limited to) Ebola, Lassa, Marburg, and Dengue fevers, as well as AIDS. (Use of the term "emerging" incorrectly can indicate that a disease is new, novel, or developing. More precisely, it is one that has existed, but attacks with renewed vigor-possibly expanding its domain into previously unpenetrated regions -- its original form unchanged or mutated.) Other viral and bacterial entities may be lurking in the shadows.
Prevention of these burgeoning viral scourges is greatly dependent on early detection and appropriate care and treatment that are often lacking. Public and professional awareness to prevent their spread is essential. Frequently, changes in lifestyle and environment are the most expeditious keys to prevention, as are stringent sanitary measures.
Victory over Hantavirus and all other pestilent agents appears to be doubtful. The rapidly increasing world population and human movement from country to country, contributing to the spread of disease, combine with ignorance and apathy to present a bleak view of the future. There is fervent hope, however, that new vaccines and therapies will be developed so that science eventually will triumph over the most devastating infections.
Mr. Hoffman, a Columbus, Ohio, free-lance journalist, served with the U.S. Army's Third Infantry Division's Information and Education Section in Korea during 1951-52. He has an intimate knowledge of Korean hemorrhagic fever, having been infected with the disease during his wartime service.
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Title Annotation: | hemorrhagic fever |
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Author: | Hoffman, George J. |
Publication: | USA Today (Magazine) |
Date: | Sep 1, 1997 |
Words: | 2981 |
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