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Published Date: 2012-05-12 10:34:07
Subject: PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan: (BA)
Archive Number: 20120512.1130671

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN: (BALOCHISTAN)
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Date: 11 May 2012
From: WHO Pakistan

NIH, Pakistan, a WHO collaborating center for virology, has sent the following alert to all provincial disease surveillance focal points regarding the peak season for Crimean-Congo hemorrhagic fever (CCHF):

There has been an outbreak of 8 cases of CCHF in Pakistan including 3 deaths which have date of onset between 5 Apr to 28 Apr 2012.

While the 8 cases have been identified in all 4 provinces and Afghanistan, they are all linked to Balochistan, a known endemic focus of CCHF:
- 2 cases from DI Khan, Khyber-Pakhtoonkhwa, trade in animals from District Zhob, Balochistan, and wife of one also became ill with confirmed CCHF.
- Coal miner from District Harnai, Balochistan
- Tannary worker from District Quetta, Balochistan, presented at hospital in Karachi
- Butcher from District Pishin, Balochistan
- Cattle farmer from Multan, Punjab, also trades in animals from Balochistan.
- Afghan working in Kandahar, Afghanistan, but living in Quetta, Balochistan
All above cases have been confirmed by PCR.

All hospital staff need to be reminded to use precautions - at least gloves - when patients present with epistaxis or other hemorrhage. CCHF is up to 50 percent fatal. Oral ribavirin is available to treat with physician supervision. Joint health and veterinary teams are advocating preventive measures in the field.

--
WHO Pakistan

[Borrowing from Mod. CP's comments from an earlier post on Crimean-Congo hemorrhagic fever in Pakistan (see Crimean-Congo hem. fever - Pakistan: (BA) 20081027.3392):

"CCHF is endemic in this region and Pakistan is one of the countries most affected by the disease. The causative agent is a bunyavirus belonging to the genus _Nairovirus_. CCHF virus is transmitted from cattle and sheep to humans via a tick vector and can also spread from person to person via infected blood. Cases usually occur singly among shepherds or among small groups of individuals in contact with livestock or animal products. Occasionally, clusters of cases occur as a result of nosocomial transmission in hospitals. Mortality can be as high as 40 percent in extreme situations but is normally in the region of 15 percent. The distribution of CCHF follows that of the principal tick vector (_Hyalomma _ spp.), and CCHF is maintained both by alternation between mammalian hosts and ticks and by vertical transmission in ticks.

An image of a _Hyalomma_ tick, a map of the limits of its distribution, and other information relating to CCHF can be found at http://www.who.int/csr/disease/crimean_congoHF/en/.

The HealthMap/ProMED-mail interactive map of Pakistan is available at http://healthmap.org/promed?g=1183606&v=30,66,5. A map of Balochistan can be accessed at http://pakistanmaps.fortunecity.com/BALUCHISTAN%20_MAP.jpg."

As can be seen from the prior ProMED-mail posts, outbreaks of CCHF have been reported from Pakistan annually over the past decade or so, with cases occurring in all provinces of the country. - Mod.MPP]

2011
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Crimean-Congo hem. fever - Pakistan (03): (SD) human 20111120.3416
Crimean-Congo hem. fever - Pakistan (02): (KK), human 20111027.3199
Crimean-Congo hem. fever - Pakistan ex Afghanistan, nosocomial 20110917.2833
2010
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Crimean-Congo hem. fever - Pakistan (09): (NW) 20101016.3759
Crimean-Congo hem. fever - Pakistan (02): (KI) 20100917.3372
2010
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Crimean-Congo hem. fever - Pakistan ex Afghanistan: RFI 20100629.2161
Crimean-Congo hem. fever - Pakistan (03): differential 20091012.3527
Crimean-Congo hem. fever - Pakistan (02): ex Saudi Arabia, susp. 20091011.3516
2009
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Crimean-Congo hem. fever - Pakistan (Abottabad): RFI 20090927.3377
2008
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Crimean-Congo hem. fever - Pakistan (03): (PB), susp. 20081121.3678
Crimean-Congo hem. fever - Pakistan: (BA) 20081027.3392
2006
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Crimean-Congo hem. fever - Pakistan: susp 20060521.1440
2005
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Crimean-Congo hem. fever - Pakistan: susp 20051212.3581
Crimean-Congo hem. fever - Pakistan (Sindh)(02) 20051127.3440
Crimean-Congo hem. fever - Pakistan (Sindh) 20051126.3432
Crimean-Congo hem. fever - Pakistan (Islamabad) 20050425.1150
2004
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Crimean-Congo hem. fever - Pakistan (Rawalpindi) 20040927.2663
Crimean-Congo hemorrhagic fever- Pakistan (Bal)(05): susp. 20040621.1657
Crimean-Congo hem. fever - Pakistan (Baluchistan): suspected 20040512.1279
2003
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Crimean-Congo hem. fever - Pakistan: suspected 20030228.0498
2002
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Crimean-Congo hemorrhagic fever - Pakistan 20020228.3643
2001
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Crimean-Congo HF - Afghanistan, Pakistan 20011004.2409
Crimean-Congo hem. fever - Pakistan (Baluchistan) 20010531.1071
Crimean-Congo HF, confirmed - Pakistan (NW Frontier) 20010424.0800
2000
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Crimean-Congo hem. fever - Pakistan (Baluchistan) (07) 20001122.2027
Crimean-Congo hem. fever - Pakistan (Baluchistan) 20000925.1651
1998
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Crimean-Congo hemorrhagic fever - Pakistan 19980509.0908
.................................................mpp

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