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CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN (06): ABATTOIR WORKERS
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Tue 3 Nov 2009
From: Shamsudeen Fagbo <oloungbo@yahoo.com>
I have followed the interesting current Crimean-Congo hemorrhagic fever
(CCHF) thread and have some comments to make. Dr Chinikar's study (though I
could not access the full text online) and ProMED-mail's postings are
indeed interesting and, more importantly, relevant to risk assessment and
animal health surveillance efforts for the impending Haj pilgrimage in
Saudi Arabia, where CCHF is endemic [El-Azazy OME, Scrimgeour EM.
Crimean-Congo haemorrhagic fever virus infection in the Western Province of
Saudi Arabia. Trans R Soc Trop Med Hyg 1997; 91(3): 275-8, abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/9231193>; also see
ProMED-mail Crimean-Congo hem. fever - Iran (03): update 20090908.3172] and
the massive slaughter of livestock will take place within a very short
period. Such slaughter will be replicated elsewhere as well.
Dr Chinikar asserts that butchers slaughtering animals outside government
approved commercial slaughterhouses seem to be more at risk of CCHF
infection. The value of this information would be better enhanced if more
details were provided. Are we to assume that it is the enhanced
pre-slaughter inspection, normally routine in the commercial establishments
but lacking with the butchers, that is responsible for the disparity? This
will be difficult to prove as CCHF infected animals are normally
asymptomatic. Or are the animals pre-tested for CCHF? -- this would be
laborious and costly. Was the observation of the slaughterhouse workers and
the butchers well controlled for confounders such that the observation is
really true?
It is possible, as Dr Chinikar did mention in passing, that the butchers
ate raw livers and the slaughterhouse workers did not. But is this really
the case? We also cannot determine if there is a statistical significance
in the difference observed with the limited data given. As an example,
there are cases and some are documented in the El-Azazy & Scrimgeour study
from Jeddah, Saudi Arabia. Knowing the exact risk factors would be
beneficial and add value to this ProMED-mail post.
Merritt Clifton [Crimean-Congo hem. fever - Iran (02): (KV) abattoir
workers 20090908.3166] somewhat implies that the halal method may contribute
to CCHF infection risk while also conceding his personal preference or
bias. Such bias goes against the sound epidemiological principles that
characterize modern evidence-based public health: his comments are not
accompanied by any ascertained data.
If one were to look at just the study by Dr Sadegh Chinikar (referred to
earlier in the previous posting in this thread), 16 cases out of 223
slaughterhouse workers gives you a low incidence of 7 per cent. This is far
from what would be expected if the fears of blood flying around were truly
having an effect on CCHF incidence.
In addition, it is pertinent to note that over 1 billion people, a large
number of whom live in CCHF endemic countries in Africa, Asia, and Europe,
adhere to this halal method. The expected high incidence of CCHF relative
to Merritt's argument is simply non existent.
In contrast, modern health promotion and epidemiology takes into cognisance
working around and not belittling local practices that may interplay in
infectious disease processes.
--
Shamsudeen Fagbo, DVM
Jeddah
Saudi Arabia
<oloungbo@yahoo.com>
[Among other matters Shamsudeen Fagbo has drawn attention to the fact that
CCHF virus-infected domestic livestock are normally asymptomatic, a
circumstance which will complicate risk assessment and animal health
surveillance efforts during the impending Haj pilgrimage in Saudi Arabia.
With this contribution the thread is now cut. - Mod.CP]
[see also:
Crimean-Congo hem. fever - Iran (05): abattoir workers 20091101.3774
Crimean-Congo hem. fever - Iran (04): abattoir workers 20091018.3582
Crimean-Congo hem. fever - Iran (03): update 20090908.3172
Crimean-Congo hem. fever - Iran (02): (KV) abattoir workers 20090908.3166
Crimean-Congo hem. fever - Iran: (KV) abattoir workers 20090907.3149
2002
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Crimean-Congo hem. fever - Iran ex Afghanistan 20020607.4430
2000
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Crimean-Congo hem. fever - Iran (Southeast): RFI 20000918.1599]
.................cp/mj/sh
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