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Published Date: 2012-06-25 17:38:30
Subject: PRO/EDR> Crimean-Congo hem. fever - Pakistan (03): (BA & QA) WHO
Archive Number: 20120625.1180202

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (BALOCHISTAN AND QUETTA), WHO
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Date: Sun 24 Jun 2012
Source: The Express Tribune [edited]
http://tribune.com.pk/story/398275/who-concerned-over-rising-number-of-congo-fever-cases/

The World Health Organisation (WHO) has expressed concern over the recent outbreak of measles and Crimean-Congo haemorrhagic fever (CCHF) in some parts of the country. According to the WHO Weekly Epidemiological Bulletin, 22 suspected cases of CCHF were reported throughout the country, of which 15 cases were confirmed, leading to 5 deaths this year [2012]. Out of 15 cases reported from Balochistan, 13 cases were in Quetta.

Disease Early Warning System (DEWS) Senior Surveillance Officer at WHO, Dr Musa Rahim, said: "Currently, the situation is not alarming, but it is worrisome, and immediate measures need to be taken to control these outbreaks, which spread rapidly. Cases of CCHF are being reported from Balochistan, and the victims are workers who work in farmhouses or are associated with the leather business," he added.

The WHO DEWS team is working in close coordination with the health department to control the outbreak of CCHF. The district health department has planned a door-to-door distribution of flyers in Quetta to raise awareness on the hazards of exposure to ticks and fresh blood when animals are butchered.

[Byline: Sehrish Wasif]

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Communicated by: ProMED-mail correspondent Susan Baekeland
ProMED-mail <promed@promedmail.org>

[CCHF outbreaks are often associated with a change in situation such as war, population and animal movements, or climatic and vegetation changes which produce more ground cover for small mammals which act as hosts for ticks. These conditions can lead to explosions in tick populations and allow increased tick/human contact.

The incubation period of CCHF appears to vary according to the mode of acquisition of the virus. If a patient has been infected by a tick bite, the incubation period is usually 1-3 days and up to 9 days. Infection via contact with infected blood or tissues leads to an incubation period of 5-6 days, and the maximum recorded incubation period is 13 days. The illness begins abruptly, with fever, muscle aches, dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). Nausea, vomiting and sore throat may also occur, with diarrhoea and abdominal pain. Over the next few days, the patient may experience mood swings, confusion and aggression, followed by sleepiness, depression and liver enlargement. More severe symptoms may follow, including petechial rash (a rash caused by bleeding into the skin), bruising and generalised bleeding of the gums and orifices. In severe cases, patients develop failure of the liver, kidneys and lungs and become drowsy and comatose after 5 days. Approximately 30 percent of cases are fatal.

Diagnosis of CCHF requires highly specialised, high biosafety level laboratory facilities. Antibodies may be detected in serum by about day 6 of illness. The virus may be isolated from blood or tissue specimens in the 1st 5 days of illness, and grown in cell culture, and nucleic acid detection methods may also be used to detect the viral genome. Patients with fatal disease do not usually develop a detectable antibody response, and in these individuals, and those in the early stages of infection, diagnosis is by virus detection.

General supportive therapy is given, including replacement of blood components, balancing fluids and electrolytes, and maintaining oxygen status and blood pressure. There is evidence that CCHF responds to treatment with the antiviral drug ribavirin, in both oral and intravenous formulations.

Persons living in or visiting endemic areas should use personal protective measures to avoid contact with ticks. This includes avoiding areas where ticks are abundant at times when they are active, using tick repellents, and carefully checking clothing and skin for ticks.

Those who work with livestock or other animals in endemic areas should protect themselves by using tick repellents on their skin and clothing and wearing gloves or other protective clothing to prevent skin coming into contact with infected tissue or blood. (For more detailed information, see: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/CCHF/GeneralInformation/cchfBackgroundinformation/.)

The interactive HealthMap of Pakistan can be accessed at: http://healthmap.org/r/1iGJ. A map of the provinces of Pakistan can be found at: http://www.mapsofworld.com/pakistan/pakistan-political-map.html. - Mod.CP]

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