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Published Date: 2012-06-16 13:30:01
Subject: PRO/AH/EDR> Crimean-Congo hem. fever - Pakistan (02): (BA)
Archive Number: 20120616.1170377

CRIMEAN-CONGO HAEMORRHAGIC FEVER - PAKISTAN (02): (BALUCHISTAN)
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Date: Sat 16 Jun 2012
Source: Dawn.com (Newspaper Urdu edition) [edited]
http://dawn.com/2012/06/15/congo-fever-claims-life-of-farm-worker/

Farm worker in Balochistan dies of Crimea-Congo Haemorrhagic Fever
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A 57-year-old farm worker from the Dalbandin area in Balochistan (Baluchistan} who was admitted to the Liaquat National Hospital [LNH] in the city with a history of high-grade fever, muscle pain and gum bleed died on Wed 13 Jun 2012 it emerged on Thursday.

Sources at the LNH said that the Pashto-speaking patient was admitted to the hospital on 10 Jun 2012. He tested positive for Crimean-Congo haemorrhagic fever (CCHF) virus infection at a private university hospital laboratory. He became tachypnic [rapid respiration], his oxygen level dropped after midnight and he was declared clinically dead on Wednesday morning [13 Jun 2012].

A trader from Quetta accompanying the patient told Dawn that the dead was a relative of a customer of his and he was a member of a group that came to Karachi. "As I was told, the man kept a cattle herd at his home in a village some 600 kilometres from Quetta and received treatment at a private hospital in Quetta before coming to Karachi," he said.

The deceased was a resident of Gardi Jungle district, near Dalbandin, and was doing different jobs, including feeding goats and cleaning cattle pens, to earn a living. Having symptoms such as low-grade fever, myalgia [muscle pain] and generalised weakness, he continued working before he began bleeding from the nose which became profuse in the next half an hour. The patient was admitted to the LNH in the evening of 10 Jun 2012 and was shifted to the medical ICU.

A total of 3 deaths caused by the CCHF virus infection were reported in 2010, 2 in 2011, including that of a doctor who was believed to have contracted the deadly viral infection during a surgical operation in Quetta, and a young man of Gazdarabad, Ranchhore Line. A source at the Dengue Surveillance [Group] of the Sindh Health Department, which also records CCHF cases reported in the province, said 4 persons had been reported as confirmed CCHF patients by 3 different private health concerns in the city this year. 3 of them, including the latest victim, came from Balochistan, said the source, adding that the death of the patient was the 1st caused by the CCHF in the city this year.

Dr Shobha Luxmi, an infectious disease consultant at the LNH, said the patient had the history of handling livestock as well. CCHF is a tick-transmitted viral haemorrhagic fever and sporadic cases and outbreaks affecting humans did occur in Pakistan, she said, adding that the disease was endemic in many other countries.

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[Balochistan (Baluchistan) is the largest of the 4 provinces of Pakistan, constituting approximately 44 percent of its total land area. It is bordered by Afghanistan to the north and northwest, Iran to the southwest, Punjab and Sindh to the east, and Khyber Pakhtunkhwa and the Federally Administered Tribal Areas to the northeast. The Arabian Sea borders it to the south. The largest city, Quetta, serves as its capital. The main ethnic groups in the province are Balochs, Pashtun and Brahuis, with smaller communities of Hazaras and Sindhis. The name Balochistan means "land of the Baloch." The interactive HealthMap of Balochistan can be accessed at: http://healthmap.org/r/03Bd.

CCHF is endemic in this region. CCHF virus is transmitted from cattle and sheep to humans via a tick vector and can spread also 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. Livestock in general are unaffected by CCNF virus infection. In humans mortality can be as high as 40 percent in extreme situations in the absence of treatment, but is normally in the region of 15 percent. The distribution of CCHF follows that of the principal tick vector (_Hyalomma _), and CCHF is maintained both by alternation between mammalian hosts and ticks and by vertical transmission in ticks. A detailed account of the biology of _Hyalomma_ spp. ticks can be found at: http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/72111.htm. - Mod.CP]

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