Published Date: 2001-04-24 23:50:00
Subject: PRO/AH/EDR> Crimean-Congo HF, confirmed - Pakistan (NW Frontier)
Archive Number: 20010424.0800

CRIMEAN-CONGO HEMORRHAGIC FEVER, CONFIRMED - PAKISTAN (NW FRONTIER)
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See Also

Crimean-Congo HF, suspected - Pakistan (NW Frontie... 20010404.0674
Crimean-Congo HF, suspected - Pakistan (NW Frontier) 20010331.0652
2000
----
Crimean-Congo hem. fever - Pakistan (Baluchistan) 20000925.1651
Crimean-Congo hem. fever - Pakistan (Baluchistan) (07) 20001122.2027

Date: Tue 24 Apr 2001 15:14:40 -0400
From: Rashid A. Chotani <Rashid.Chotani@jhuapl.edu>
Source: Dawn Online, Fri 20 Apr 2001 [edited
<http://www.dawn.com/2001/04/20/local15.htm>


Deaths in Islamabad and Peshawar Confirmed as Cases of CCHF
-----------------------------------------------------------
ISLAMABAD, 19 Apr 2001: The National Institute of Virology (NIV),
Johannesburg, South Africa, has confirmed that 2 people who died
recently in Islamabad and Peshawar (and whose blood samples had been
sent to the NIV) were victims of Crimean-Congo hemorrhagic fever
(CCHF).

In March a 65-year-old man died at the Lady Reading Hospital,
Peshawar, while his 30-year-old son expired at the Shifa International
Hospital, Islamabad. However, the life of a nephew of the 65-year-old
man was saved by doctors at the Khyber Teaching Hospital, Peshawar,
when doctors from the Pakistan National Institute of Health (NIH)
reached Peshawar in time with a medicine costing US $10 000 a vial. [I
think a few extra zeroes must have got added here. - Mod.JW

The NIH had sent the blood samples of the 3 patients to the NIV, which
confirmed that the [samples from the 2 deceased patients were CCHF
virus-positive. It, however, cleared [the surviving patient by
saying that his life had been saved by the timely administration of
the injection. [This could be interpreted to mean that the blood
sample was negative for CCHF virus because of the action of the
drug. - Mod.CP

NIH Executive Director, Dr Athar Saeed Dil, told Dawn that the blood
samples [had to be sent to the NIV [in South Africa, since
diagnostic facilities for the confirmation of CCHF were not available
in Pakistan. However, he said, efforts were being made to establish a
[diagnostic laboratory at the NIH in collaboration with the World
Health Organization. Dr Dil said that the spread of CCHF virus in
Peshawar had been controlled due to the timely response of the NIH
experts. [He must have been referring to person-to-person spread,
because there is no way to effectively control human contact with
ticks in the local context. - Mod.JW

CCHF is an endemic tick-borne viral disease, the geographical
distribution of which includes the cold, arid regions of Pakistan. The
virus replicates in its natural hosts, which include goats, sheep,
cattle, and camels. Humans are infected by the body fluids of the
infected animals or other humans. About 42 people died of this virus
since 1976, the most notable being the death of the surgeon Mateen
Siddiqui, who died at the Central Government Hospital, Rawalpindi, in
1976 while treating a shepherd. Last year, 21 people died at various
places, including 12 at Loralai, 5 in Karachi, and 3 in Quetta. [i.e.
half of all deaths from CCHF in the last 25 years occurred in 2000? -
Mod.JW

Dr Dil asked all the hospitals and health-care facilities throughout
the country to report to the NIH immediately any suspected case of
CCHF so that immediate action could be taken by the epidemic
investigation team.

--
R. A. Chotani, MD, MPH
Johns Hopkins University
<Rashid.Chotani@jhuapl.edu>

[The nature of the drug administered to control the infection in the
surviving patient is unclear -- ribavirin or immune globulin, perhaps?
Further information from the NIH physicians involved would be
appreciated. - Mod.CP
...............................cp/pg/jw

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