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)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
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.
[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]