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Published Date: 2011-10-27 19:29:46
Subject: PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (02): (KK), human
Archive Number: 20111027.3199

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KHYBER PAKHTUNKHWA),
HUMAN
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International Society for Infectious Diseases
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Date: Tue 25 Oct 2011
Source: Dawn [edited]
http://www.dawn.com/2011/10/26/with-dengue-now-comes-congo-fever.html

If you thought dengue was the final blow that nature could inflict on
Pakistanis for this year [2011], you were wrong. In a cruel twist of
fate, the country is now expected to be plagued by a wave of the
high-fatality tick-bite disease, Crimean-Congo Haemorrhagic fever
(CCHF). The National Institute of Health's (NIH) warning on the latest
infectious disease comes a week after its 1st victim [this year?]
succumbed to it at the Pakistan Institute of Medical Sciences (PIMS).

"An adult patient from Haripur district of Khyber Pakhtunkhwa has died
due to CCHF. The patient came with massive bleeding and was admitted
at the isolation ward. We immediately sent his samples to NIH, but he
died during the course of his treatment due to massive bleeding," Prof
Mehmood Jamal, executive-director of Pims, stated.

Though the report from NIH came 8 days later, Prof Jamal clarifies
that the death of the patient from CCHF was no secret, and no attempts
were made to hide anything from the public. He does admit that doctors
feel the pressure of expectations of dealing with CCHF patients
alongside dengue cases.

Meanwhile, the NIH in a quick move has issued an advisory, saying:
"Provinces have been advised to take special measures in view of the
upcoming Eidul Azha, as there will be massive movement of sacrificial
animals from one province to another." [Eid-ul-Adha (Festival of
Sacrifice), also known as the Greater Eid, is the 2nd most important
festival in the Muslim calendar, falling this year on 6 Nov 2011, The
festival remembers the prophet Ibrahim's willingness to sacrifice his
son when God ordered him to do this. - Mod.CP]

A senior official of the NIH added that since a cattle market had
already been established in Saidpur village, their department had also
issued a similar warning to local health authorities [Saidpur is a
historic Pakistani village built on the slopes of the Margalla Hills
which overlook Islamabad and is a popular site for celebrations. -
Mod.CP].

The NIH has also asked the provincial health authorities to establish
isolation wards. "Even physicians and medical staff treating [CCHF]
patients have to avoid direct contact with a CCHF-positive patient,
because even the blood secretion from the patient is deadly," said one
official.

As a preventive measure, the NIH official suggested that butchers and
cattle handlers needed to be trained in the de-ticking of animals
before moving cattle from one place to other. "Preventive measures
such as body inspection of cattle are needed by the relevant
veterinary health officials working with the local district
administrations before transporting the cattle from farm to slaughter
house or cattle market," suggested the official.

But with most cattle herders paying little heed to inspectors or rules
and the movement of cattle between provinces uncontrolled, prevention
of an epidemic during Eid will require enhanced vigilance.

[Byline: Imran Ali Teepu]

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ProMED-mail <promed@promedmail.org>

[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever
caused by a Nairovirus. Although primarily a zoonosis, sporadic cases
and outbreaks of CCHF affecting humans do occur. The disease is
endemic in many countries in Africa, Europe and Asia.

The geographical distribution of the virus, like that of its tick
vector (_Hyalomma_ spp.), is widespread. Evidence of CCHF virus has
been found in Africa, Asia, the Middle East and Eastern Europe.
Healthcare workers in endemic areas should be aware of the illness and
the correct infection control procedures to protect themselves and
their patients from the risk of nosocomial (hospital-acquired)
infection.

Humans who become infected with CCHF acquire the virus from direct
contact with blood or other infected tissues from livestock, or they
may become infected from a tick bite. The majority of cases have
occurred in those involved with the livestock industry, such as
agricultural workers, slaughterhouse workers and veterinarians.
Nosocomial transmission of CCHF virus infection has been recorded in
Pakistan and elsewhere in the past and is a known hazard.

The length of the incubation period for the illness appears to depend
on the mode of acquisition of the virus. Following infection via tick
bite, the incubation period is usually one to 3 days, with a maximum
of 9 days. The incubation period following contact with infected blood
or tissues is usually 5-6 days, with a documented maximum of 13 days.

The mortality rate from CCHF is approximately 30 percent, with death
occurring in the 2nd week of illness. In those patients who recover,
improvement generally begins on the 9th or 10th day after the onset of
illness. A detailed account of the disease and its biology can be
found in the WHO web-site at:
http://www.who.int/mediacentre/factsheets/fs208/en/index.html.

A map showing the provinces of Pakistan can be accessed at:
http://www.asiawaves.net/pakistan-map.htm - Mod.CP]

See Also