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Published Date: 2011-09-17 16:14:20
Subject: PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan ex Afghanistan, nosocomial
Archive Number: 20110917.2833

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN ex AFGHANISTAN, NOSOCOMIAL
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Date: Sat 17 Sep 2011
Source: Pakistan today [abbreviated, edited]
http://www.pakistantoday.com.pk/2011/09/surgeon-among-four-down-with-congo-virus-in-quetta/

Surgeon among 4 down with CCHF virus in Quetta
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A total of 4 people, including a surgeon and a medical technician,
have fallen victim to haemorrhagic fever in Quetta. Reports said a
patient suffering from Congo virus [Crimean-Congo haemorrhagic fever
virus (CCHF) infection] was brought to Quetta from Afghanistan for
surgery. He was being operated on by senior surgeon Dr Mohammad Ayaz
at a private hospital when he [Dr Ayaz] got infected with the virus as
well. A medical technician who was assisting the surgeon also got
infected.

Dr Ayaz was immediately moved to Karachi for treatment, despite the
fact that isolation wards have been established for such patients at
Fatima Jinnah Hospital in Quetta. The technician, however, was being
treated in an isolation ward at the hospital. Reports further said
that another 2 patients [with CCHF virus infection had been] admitted
to Fatima Jinnah Hospital.

Dr Aadam, the [physician] in charge of the isolation ward, said that
another 2 patients, including an Afghan refugee and a youth from
Kuchlak, were also suffering from [CCHF virus infection]. He said
there was a possibility that more attendants and medical staff [would
become infected] with CCHF virus while treating these patients. The
doctor said [CCHF] was a dangerous disease and doctors in the hospital
lacked proper equipment to protect themselves from it.

He said over the past 4 years, members of the staff had not been
vaccinated. [No vaccine is currently approved for human use. -
Mod.CP]

[Byline: Shahzada Zulfiqar]

--
Communicated by:
Shamsudeen Fagbo, DVM
National Coordinator
Zoonotic Diseases Unit
Directorate of Communicable Diseases
Ministry of Health
Riyadh 11176
Saudi Arabia
<oloungbo@yahoo.com>

[At least 2 of the patients admitted to the hospital in Quetta had
come to Pakistan from Afghanistan, and the surgeon, a technician and
possibly others contracted infection during treatment of the index
case. No information is provided regarding the condition of those
affected, other than that the surgeon operating on the index case was
evacuated to a hospital in Karachi. Serious nosocomial infection in a
Pakistan hospital was reported previously in 2010 (see ProMED-mail
reference below).

CCHF is found throughout the Mediterranean region, in northwestern
China, central Asia, Africa, the Middle East, and the Indian
subcontinent. Ixodid ticks, especially those of the genus, _Hyalomma_,
are both a reservoir and a vector for CCHF virus. Numerous wild and
domestic animals, such as cattle, goats, sheep and hares, serve as
amplifying hosts for the virus. Transmission to humans occurs through
contact with infected animal blood or ticks. CCHF can be transmitted
from one infected human to another by contact with infectious blood or
body fluids. CCHF has also occurred in hospitals due to improper
sterilization of medical equipment, reuse of injection needles, and
contamination of medical supplies.

The onset of CCHF is sudden, with initial signs and symptoms including
headache, high fever, back pain, joint pain, stomach pain, and
vomiting. Red eyes, a flushed face, a red throat, and petechiae (red
spots) on the palate are common. Symptoms may also include jaundice,
and in severe cases, changes in mood and sensory perception. As the
illness progresses, large areas of severe bruising, severe nosebleeds,
and uncontrolled bleeding at injection sites can be seen, beginning on
about the 4th day of illness and lasting for about 2 weeks. In
documented outbreaks of CCHF, fatality rates in hospitalized patients
have ranged from 9 percent to 50 percent. Animal herders, livestock
workers, and slaughter houses in endemic areas are at risk of CCHF.
Health care workers in endemic areas are at risk of infection through
unprotected contact with infectious blood and body fluids.

Treatment for CCHF is primarily supportive. The virus is sensitive in
vitro to the antiviral drug ribavirin and it has been used in the
treatment of CCHF patients reportedly with some benefit. An
inactivated, mouse-brain derived vaccine against CCHF has been
developed and is used on a small scale in Eastern Europe. However,
there is no safe and effective vaccine widely available for human use.
For more information, see:
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/cchf.htm.

The city of Quetta is located near the Durand Line border with
Afghanistan and is an important trade and communications centre
between the 2 countries. The city lies on the Bolan Pass route which
was once the only land route to and from South Asia. The
HealthMap/ProMED-mail interactive map of Pakistan can be accessed at:
http://healthmap.org/r/00tj. - Mod.CP]

See Also