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Since the death of a young medical resident in Pakistan, Crimean Congo Hemorrhagic Fever (CCHF) has increasingly come into the limelight.
CCHF was first reported in Pakistan in 1976 but the number of cases has shown a dramatic increase since 2000. Pakistan's National Institute of Health (NIH) has confirmed that cases of CCHF have been recorded in the country. Twenty-two cases of CCHF have been confirmed this year (13 from Rawalpindi, three from Islamabad, one from Abbottabad and five from Balochistan). Health authorities in partnership with WHO are studying the potential impact of the flood in the frequency of these fevers, and it is likely that levels this year will be even higher.
Crimean-Congo Haemorrhagic Fever is an acute tick-borne viral disease. Patients usually present, after an incubation period of 2 to 7 days, with sudden onset of fever, malaise, marked loss of appetite, headache, muscle pain, vomiting, diarrhoea, rash and bleeding(e.g. from gum and nose). Case-fatality rate ranges from 2 per cent to 50 per cent.
• Direct or indirect contact with infected animal blood (farmers, slaughtering house, veterinarians, etc) • Tick bites • Person-to-person transmission due to direct or indirect contact with skin, mucous membranes, or body fluids of infected patients (blood, saliva, vomitus, urine, stool, semen)
There is a seasonal occurrence in temperate climates from June through September.
Pakistan's Ministry of Health is developing a prevention and control campaign to stop the spread of hemorrhagic fevers in the country. “For the CCHF, the great concern is the upcoming Eidul Azha period when over one million animals are expected to be slaughtered, increasing the possibility of people coming into contact with infected animal blood.” says Dr Professor Rashid Jooma, Director General of Health, Pakistan.
No vaccine is available against CCHF and treatment is primarily supportive although the antiviral ribavarin may be useful if available. Care should include careful attention to fluid balance and correction of electrolyte abnormalities, oxygenation and hemodynamic support, and appropriate treatment of secondary infections.
Those in endemic areas or other risk categories should adopt measures similar to anti-mosquito measures to avoid tick bite, and avoid contact with wild animals. Further information on minimising infection risk is available from the Health Protection Agency website. As the disease is highly infectious in the hospital setting, health care workers should adopt strict infection control practice in handling blood and secretions of infected Agricultural workers and others working with animals should use insect repellent on exposed skin and clothing. Insect repellents containing DEET are the most effective in warding off ticks. Wearing gloves and other protective clothing is recommended.
Of concern is the fact that the most vulnerable and at risk individuals in Pakistan most likely have insufficient knowledge of the infection and have little, or no access to prevention and control measures and even where they do, they probably cannot afford them.On October 11, 2010, a meeting of national and international experts was convened at the National Institute of Health in Islamabad to develop strategies to prevent increased CCHF transmission during Eid-ul-Azha. The measures identified will be conducted in coordination with the Food and Agriculture Organisation (FAO) and the Ministry of Agriculture and Livestock. These include:
• Ensuring necessary bio-safety measures and stockpiling of medications and other relevant supplies such as gloves, gowns and masks in tertiary care hospitals and provincial health departments. • Raising awareness among theanimal slaughters. • Establishing a Clinical Forum of Hemorrhagic Fevers for doctors to agree on triage and case management of patients with hemorrhagic fevers. • Rolling out an awareness campaign on prevention of both CCHF and Dengue for the general public; • Targeted vector control campaign.
It remains to be seen if these promises are kept. Will this supposed media campaign to inform people on how to protect themselves from CCHF infection transpire? If so, will it be appropriate and directed at the people that need it most?
*Please refer to your doctor if you have any symptoms.
