KARACHI: The Sindh health ministry has alerted all its officials in divisions and districts, medical superintendents of major hospitals across the province and managers of vertical programmes to devise contingency plans to rein in dangers of lethal Crimean Congo haemorrhagic fever (CCHF) as Eidul Azha is approaching, officials said on Tuesday.

“The extensive movement of sacrificial animals ahead of Eidul Azha significantly enhances the risk of CCHF disease transmission due to increased human-animal interaction,” said an advisory flashed across the province by director general health, Sindh.

The advisory has been issued after officials said recently that five people, including three last month, had died due to CCHF infection thus far this year across the province.

The advisory added that it aimed at alerting various stakeholders including the human and animal healthcare authorities to ensure timely steps were taken for the prevention and control of CCHF during coming weeks.

The CCHF is caused by a tick-borne virus (Nairovirus) with the case fatality rate ranging from 10-40 per cent. Ticks, especially of the Hyalomma genus serve as both the reservoir and vector for the virus.

Numerous wild and domestic animals, such as cattle, buffaloes, goats and sheep are silent carriers of the virus and adult ticks get infected by feeding on those animals.

High-risk groups

The advisory identified high-risk groups, which included healthcare workers along with animal herders, veterinarians, para-veterinary staff, livestock and agriculture workers, animal merchants, butchers and slaughterhouse workers.

“These groups are at higher risk of CCHF. Besides, [those] caring [for] the patients and persons involved in burial practices are also at risk of getting infection,” it added.

Officials said currently there was no vaccine available for humans and the only way to reduce infection was by raising awareness.

Precautions

The advisory recommended wearing protective light-coloured clothing (long sleeves, long trousers) during visits to animal markets to allow easy detection of ticks; and if found, remove them safely.

It asked for monitoring of sacrificial animals at entry points or markets by the authorities and making sure that every animal was treated with approved acaricide body sprays at least a week ahead of scheduled slaughtering.

Besides, it recommended wearing gloves and other protective clothing while handling animals or their tissues, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home.

It advised to avoid close contact with suspected patients, wearing gloves and protective equipment when taking care of patients, washing hands frequently after caring or visiting ill people.

It said safe burial practices included spraying the body with 1:10 liquid bleach solution before wrapping it in winding sheet. The winding sheet should be sprayed with bleach solution before the body is placed in a plastic bag, which should be sealed with adhesive tape. Besides, disinfecting the transport vehicle and burning all clothing of the deceased has also been recommended.

At healthcare settings, workers caring for suspected patients or handling their specimens have been asked to take greater precautions. The suspected samples must be processed by trained staff working in suitably equipped labs.

“Always examine the animals for ticks especially on ears, armpits, axilla, abdominal region, teats or udder and region below the tail,” said the official advisory; adding, tick control with approved acaricides (chemicals intended to kill ticks) was an important option.

“Ticks should never be crushed with fingers. Always use gloves and forceps for the removal and collection of ticks.”

The advisory asked the general public to apply insect repellents and use full sleeves and light-coloured clothes, gloves and masks during their visit to cattle markets.

It said visitors to markets should use recommended tick sprays or showers for their purchased animals. Besides, butchers should use gloves and long plastic shoes (gum boots) during slaughtering. Animals should be kept in clean and ventilated places in homes or neighbourhoods.

It said water for animals should be stored properly and kept covered after use; the blood, skin, intestines and other remnants of animals should be disposed of properly.

It also asked physicians to exercise high degree of suspicion while examining patients with likely symptoms for CCHF.

Published in Dawn, July 24th, 2019